BNF for Children 2011-2012

BNFC 2011–2012 14.5.2 Disease-specific immunoglobulins 625NHS laboratories (except for Transplant Centres, seep. 622), also available from BPLDoseProphylaxis against hepatitis B infection. By intramuscular injection(as soon as possible after exposure; ideally within 48hours, but no later than 7 days after exposure)Child 1 month–5 years 200 unitsChild 5–10 years 300 unitsChild 10–18 years 500 unitsPrevention of transmitted infection at birth. By intramuscular injectionNeonate 200 units as soon as possible after birth; for fulldetails consult Immunisation against Infectious Disease(www.dh.gov.uk)Hepatect c CP (Biotest UK) AIntravenous infusion, hepatitis B-specific immunoglobulin50 units/mL, net price 500 units (10 mL) =£300.00, 2000 units (40 mL) = £1100.00DoseFollowing exposure to hepatitis B virus-contaminatedmaterial (as soon as possible after exposure, but nolater than 72 hours); prevention of transmittedinfection at birth; prophylaxis against re-infection oftransplanted liverConsult product literatureRabiesFollowing exposure of an unimmunised child to ananimal in or from a country where the risk of rabies ishigh, the site of the bite should be washed with soapywater and specific rabies immunoglobulin of humanorigin should be administered. All of the dose should beinjected around the site of the wound; if this is difficult orthe wound has completely healed it can be given in theanterolateral thigh (remote from the site used for vaccination).Rabies vaccine should also be given intramuscularlyat a different site (for details see Rabies Vaccine,p. 617).Rabies Immunoglobulin A(Antirabies Immunoglobulin Injection)See notes aboveAvailable from Specialist and Reference Microbiology Division,Health Protection Agency (see section 14.5 under Availability)(also from BPL)TetanusTetanus immunoglobulin, together with metronidazole(section 5.1.11) and wound cleansing, should also beused for the treatment of established cases of tetanus.For the management of tetanus-prone wounds, tetanusimmunoglobulin of human origin should be used inaddition to wound cleansing and, where appropriate,antibacterial prophylaxis and a tetanus-containingvaccine (see Diphtheria-containing Vaccines, section14.4).TETANUS IMMUNOGLOBULINCautions IgA deficiency; interference with live virusvaccines—see, p. 622Side-effects injection site swelling and pain; rarelyanaphylaxis; buccal ulceration; glossitis, chest tightness,dyspnoea, tremor, dizziness, arthralgia, andfacial oedema also reportedIndication and dosePost-exposure prophylaxis. By intramuscular injection250 units, increased to 500 units if more than 24hours have elapsed or there is risk of heavy contaminationor following burnsTreatment of tetanus infection. By intramuscular injection150 units/kg (multiple sites)Tetanus Immunoglobulin A(Antitetanus Immunoglobulin Injection)Available from BPLNote May be difficult to obtainRABIES IMMUNOGLOBULINCautions IgA deficiency; interference with live virusvaccines—see p. 622 under Normal ImmunoglobulinSide-effects injection site swelling and pain; rarelyanaphylaxis; buccal ulceration, glossitis, chest tightness,dyspnoea, tremor, dizziness, arthralgia, andfacial oedema also reportedIndication and dosePost-exposure prophylaxis against rabiesinfection. By intramuscular injection20 units/kg, by infiltration in and around thecleansed wound; if the wound not visible or healedor if infiltration of whole volume not possible, giveremainder by intramuscular injection into anterolateralthigh (remote from vaccination site)Note The potency of individual batches of rabies immunoglobulinfrom the manufacturer may vary; potency may alsobe described differently by different manufacturers. It istherefore critical to know the potency of the batch to be usedand the weight of the patient in order to calculate the specificvolume required to provide the necessary doseVaricella–zosterVaricella–zoster immunoglobulin (VZIG) is recommendedfor individuals who are at increased risk ofsevere varicella and who have no antibodies to varicella–zostervirus and who have significant exposure tochickenpox or herpes zoster. Those at increased riskinclude:. neonates whose mothers develop chickenpox in theperiod 7 days before to 7 days after delivery;. susceptible neonates exposed in the first 7 days oflife;. susceptible neonates or infants exposed whilstrequiring intensive or prolonged special care nursing;. susceptible women exposed at any stage ofpregnancy (but when supplies of VZIG are short,may only be issued to those exposed in the first 20weeks’ gestation or to those near term) providingVZIG is given within 10 days of contact;14 Immunological products and vaccines