BNF for Children 2011-2012

626 14.5.3 Anti-D (Rh 0 ) immunoglobulin BNFC 2011–201214 Immunological products and vaccines. immunocompromised individuals including thosewho have received corticosteroids in the previous3 months at the following dose equivalents of prednisolone:children 2 mg/kg daily (or more than40 mg) for at least 1 week or 1 mg/kg daily for 1month.Important: for full details consult Immunisationagainst Infectious Disease. Varicella–zoster vaccineis available—see section 14.4.For treatment of varicella–zoster infections and attenuationof infection if varicella–zoster immunoglobulin notindicated, see section 5.3.2.1VARICELLA–ZOSTERIMMUNOGLOBULINCautions IgA deficiency; interference with live virusvaccines—see p. 622 under Normal ImmunoglobulinsSide-effects injection site swelling and pain; rarelyanaphylaxisIndication and doseProphylaxis against varicella infection (as soonas possible—not later than 10 days afterexposure). By deep intramuscular injectionNeonate 250 mgChild 1 month–6 years 250 mgChild 6–11 years 500 mgChild 11–15 years 750 mgChild 15–18 years 1gGive second dose if further exposure occurs morethan 3 weeks after first doseNote No evidence that effective in treatment of severedisease.Normal immunoglobulin for intravenous use (section 14.5.1)may be used in those unable to receive intramuscularinjection.Varicella–Zoster Immunoglobulin A(Antivaricella–zoster Immunoglobulin)Available from selected Health Protection Agency and NHSlaboratories (see section 14.5 under Availability) (also fromBPL)14.5.3 Anti-D (Rh 0 )immunoglobulinThis section is not included in BNF for Children. SeeBNF for use of Anti-D (Rh 0 ) immunoglobulin14.6 International travelNote For advice on malaria chemoprophylaxis, see section5.4.1.No special immunisation is required for travellers to theUnited States, Europe, Australia, or New Zealandalthough all travellers should have immunity to tetanusand poliomyelitis (and childhood immunisations shouldbe up to date); see also Tick-borne Encephalitis, p. 619.Certain precautions are required in Non-European areassurrounding the Mediterranean, in Africa, the MiddleEast, Asia, and South America.Travellers to areas that have a high incidence of poliomyelitisor tuberculosis should be immunised with theappropriate vaccine; in the case of poliomyelitis previouslyimmunised adults may be given a booster doseof a preparation containing inactivated poliomyelitisvaccine. BCG immunisation is recommended for travellersaged under 16 years proposing to stay for longerthan 3 months (or in close contact with the localpopulation) in countries with an incidence 1 of tuberculosisgreater than 40 per 100 000; it should preferablybe given three months or more before departure.Monovalent influenza A(H1N1)v vaccine (see p. 612)can be offered to travellers visiting countries in thesouthern hemisphere during their influenza season.Yellow fever immunisation is recommended for travelto the endemic zones of Africa and South America.Many countries require an International Certificate ofVaccination from individuals arriving from, or who havebeen travelling through, endemic areas, whilst othercountries require a certificate from all entering travellers(consult the Department of Health handbook, HealthInformation for Overseas Travel, www.dh.gov.uk).Immunisation against meningococcal meningitis isrecommended for a number of areas of the world (fordetails, see p. 614).Protection against hepatitis A is recommended fortravellers to high-risk areas outside Northern and WesternEurope, North America, Japan, Australia and NewZealand. Hepatitis A vaccine (see p. 607) is preferredand it is likely to be effective even if given shortly beforedeparture; normal immunoglobulin is no longer givenroutinely but may be indicated in the immunocompromised(see p. 622). Special care must also be taken withfood hygiene (see below).Hepatitis B vaccine (see p. 608) is recommended forthose travelling to areas of high prevalence who plan toremain there for lengthy periods and who may thereforebe at increased risk of acquiring infection as the result ofmedical or dental procedures carried out in those countries.Short-term tourists are not generally at increasedrisk of infection but may place themselves at risk bytheir sexual behaviour when abroad.Prophylactic immunisation against rabies (see p. 617) isrecommended for travellers to enzootic areas on longjourneys or to areas out of reach of immediate medicalattention.Travellers who have not had a tetanus booster in thelast 10 years and are visiting areas where medicalattention may not be accessible should receive a boosterdose of adsorbed diphtheria [low dose], tetanus andinactivated poliomyelitis vaccine (see p. 604), even ifthey have received 5 doses of a tetanus-containingvaccine previously.Typhoid vaccine is indicated for travellers to countrieswhere typhoid is endemic, but the vaccine is no substitutefor personal precautions (see below).There is no requirement for cholera vaccination as acondition for entry into any country, but oral choleravaccine (see p. 604) should be considered for backpackersand those travelling to situations where the1. List of countries where the incidence of tuberculosis isgreater than 40 cases per 100 000 is available atwww.hpa.org.uk