BNF for Children 2011-2012

BNFC 2011–2012 14.4 Vaccines and antisera 621Typhoid vaccine, live (oral)Vivotif c (Crucell) ACapsules, e/c, live attenuated Salmonella typhi(Ty21a), net price 3-cap pack = £14.77. Label: 23, 25,counselling, administrationDose. By mouthChild 6–18 years 1 capsule on days 1, 3, and 5Counselling Swallow as soon as possible after placing inmouth with a cold or lukewarm drink; it is important tostore capsules in a refrigeratorin human diploid cells, net price 0.5-mL vial (withdiluent) = £30.28Excipients include gelatin and neomycinDose. By intramuscular or subcutaneous injection intodeltoid region (or higher anterolateral thigh in youngchildren)Child 1–13 years (see notes above) 2 doses of 0.5 mLseparated by an interval of at least 4 weeks (2 dosesseparated by 12 weeks in children with asymptomaticHIV infection)Child 13–18 years 2 doses of 0.5 mL separated by 4–8weeksVaricella–zoster vaccineVaricella–zoster vaccine (live) is licensed for immunisationagainst varicella in seronegative individuals. It isnot recommended for routine use in children but can begiven to seronegative healthy children over 1 year whocome into close contact with individuals at high risk ofsevere varicella infections.Rarely, the varicella–zoster vaccine virus has beentransmitted from the vaccinated individual to closecontacts. Therefore, contact with the following shouldbe avoided if a vaccine-related cutaneous rash developswithin 4–6 weeks of the first or second dose:. varicella-susceptible pregnant females;. individuals at high risk of severe varicella, includingthose with immunodeficiency or those receivingimmunosuppressive therapy.Varicella–zoster immunoglobulin is used to protectsusceptible children at increased risk of varicella infection,see p. 625.VARICELLA–ZOSTER VACCINESCautions see section 14.1; also post-vaccination closecontactwith susceptible individuals (see notes above):interactions: Appendix 1 (vaccines)Contra-indications see section 14.1Pregnancy avoid pregnancy for 3 months aftervaccination; see also p. 600Breast-feeding see p. 600Side-effects see section 14.1; also varicella-like rash;rarely thrombocytopeniaIndication and doseImmunisation against varicella infection (seenotes above)For dose, see under preparationsVarilrix c (GSK) AInjection, powder for reconstitution, live attenuatedvaricella–zoster virus (Oka strain) propagated inhuman diploid cells, net price 0.5-mL vial (with diluent)= £27.31Excipients include neomycinDose. By subcutaneous injection preferably into deltoidregionChild 1–18 years (see notes above), 2 doses of 0.5 mLseparated by an interval of at least 6 weeks (minimum 4weeks)Varivax c (Sanofi Pasteur) TAInjection powder for reconstitution, live attenuatedvaricella-zoster virus (Oka/Merck strain) propagatedYellow fever vaccineLive yellow fever vaccine is indicated for those travellingto or living in areas where infection is endemic (seep. 626). Infants under 6 months of age should not bevaccinated because there is a small risk of encephalitis;infants aged 6–9 months should be vaccinated only ifthe risk of yellow fever is high and unavoidable (seekexpert advice). The immunity which probably lasts forlife is officially accepted for 10 years starting from 10days after primary immunisation and for a further 10years immediately after revaccination.Very rarely vaccine-associated adverse effects havebeen reported, such as viscerotropic disease (yellowfever vaccine-associated viscerotropic disease, YEL-AVD), a syndrome which may include metabolic acidosis,muscle and liver cytolysis, and multi-organ failure.Neurological disorders (yellow fever vaccine-associatedneurotropic disease, YEL-AND) such as encephalitishave also been reported. These very rare adverse effectshave usually occured after the first dose of yellow fevervaccine in those with no previous immunity.Pregnancy Live yellow fever vaccine should not begiven during pregnancy, but if a significant risk ofexposure cannot be avoided then vaccination shouldbe delayed to the third trimester if possible (but the needfor immunisation usually outweighs risk to the fetus).Breast-feeding Vaccination should be considered inbreast-feeding women when there is a real risk to themother from yellow fever disease.YELLOW FEVER VACCINECautions see section 14.1; also see interactions:Appendix 1 (vaccines)Contra-indications see section 14.1 and notes above;also children under 6 months; history of thymusdysfunctionPregnancy see notes aboveBreast-feeding see notes aboveSide-effects see section 14.1; also reported neurotropicdisease, and viscerotropic disease (see notesabove)Indication and doseImmunisation against yellow fever. By deep subcutaneous injectionChild 9 months–18 years 0.5 mL (see also notesabove)14 Immunological products and vaccines