protection is sought (see under Immunoglobulins). The
duration of this passive immunity varies according to the
dose and the type of immunoglobulin. Passive immunity
may last only a few weeks; when necessary, passive
immunisation can be repeated.
Antibodies of human origin are usually termed
immunoglobulins. The termantiserumis applied to material
prepared in animals. Because of serum sickness and other
allergic-type reactions that may follow injections of antisera,
this therapy has been replaced whenever possible by the use
of immunoglobulins. Reactions are theoretically possible
after injection of human immunoglobulins, but reports of
such reactions are very rare.
Vaccines and antisera availability
Anthrax vaccine and yellow fever vaccine, live p. 802 ,
botulism antitoxin p. 776 , diphtheria antitoxin p. 776 , and
snake and spider venom antitoxins are available from local
designated holding centres.
For antivenom, see Emergency Treatment of Poisoning.
Enquiries for vaccines not available commercially can also
be made to:
Vaccines and Countermeasures Response Department
Public Health England
Wellington House
133 – 155 Waterloo Road
London
SE 18 UG
[email protected]
In Scotland information about availability of vaccines can be
obtained from a Specialist in Pharmaceutical Public Health.
In Wales enquiries for vaccines not available commercially
should be directed to:
Welsh Medicines Information Centre
University Hospital of Wales
Cardiff
CF14 4XW
( 029 )2074 2979
In Northern Ireland:
Pharmacy and Medicines Management Centre
Northern Health and Social Care Trust
Beech House
Antrim Hospital Site
Bush Road
Antrim
BT41 2RL
[email protected]
For further details of availability, see under individual
vaccines.
Anthrax vaccine
Anthrax vaccine is rarely required for children.
BCG vaccine
BCG (Bacillus Calmette-Guérin vaccine p. 790 ) is a live
attenuated strain derived fromMycobacterium boviswhich
stimulates the development of hypersensitivity toM.
tuberculosis. Bacillus Calmette-Guérin vaccine should be
given intradermally by operators skilled in the technique.
The expected reaction to successful Bacillus Calmette-
Guérin vaccine is induration at the site of injection followed
by a local lesion which starts as a papule 2 or more weeks
after vaccination; the lesion may ulcerate then subside over
several weeks or months, leaving a smallflat scar. A dry
dressing may be used if the ulcer discharges, but air should
notbe excluded.
All children of 6 years and over being considered for
Bacillus Calmette-Guérin vaccine mustfirst be given a skin
test for hypersensitivity to tuberculoprotein (see under
Diagnostic agents). A skin test is not necessary for a child
under 6 years, provided that the child has not stayed for
longer than 3 months in a country with an incidence of
tuberculosis greater than 40 per100 000(a list of countries
or primary care trusts where the incidence of tuberculosis is
greater than^40 cases per100 000is available atwww.gov.uk/
phe), the child has not had contact with a person with
tuberculosis, and there is no family history of tuberculosis
within the last 5 years.
Bacillus Calmette-Guérin vaccine is recommended for the
following groups of children if BCG immunisation has not
previously been carried out and they are negative for
tuberculoprotein hypersensitivity:
.neonates with a family history of tuberculosis in the last
5 years;
.all neonates and infants ( 0 – 12 months) born in areas
where the incidence of tuberculosis is greater than 40 per
100 000;
.neonates, infants, and children under 16 years with a
parent or grandparent born in a country with an incidence
of tuberculosis greater than 40 per100 000;
.new immigrants aged under 16 years who were born in, or
lived for more than 3 months in a country with an
incidence of tuberculosis greater than 40 per100 000;
.new immigrants aged 16 – 18 years from Sub-Saharan
Africa or a country with an incidence of tuberculosis
greater than 500 per100 000;
.contacts of those with active respiratory tuberculosis;
.children under 16 years intending to live with local people
for more than 3 months in a country with an incidence of
tuberculosis greater than 40 per100 000.
Bacillus Calmette-Guérin vaccine can be given
simultaneously with another live vaccine, but if they are not
given at the same time, an interval of 4 weeks should
normally be allowed between them. When Bacillus Calmette-
Guérin vaccine is given to infants, there is no need to delay
routine primary immunisations. No further vaccination
should be given in the arm used for BCG vaccination for at
least 3 months because of the risk of regional lymphadenitis.
For advice on chemoprophylaxis against tuberculosis; for
treatment of infection following vaccination, seek expert
advice.Tuberculosis Diagnostic Agents
TheMantoux testis recommended for tuberculin skin testing,
but no licensed preparation is currently available. Guidance
for healthcare professionals is available atwww.dh.gov.uk/
immunisation.
In the Mantoux test, the diagnostic dose is administered
by intradermal injection of Tuberculin Purified Protein
Derivative (PPD).
TheHeaf test(involving the use of multiple-puncture
apparatus) is no longer available.
Two interferon gamma release assay (IGRA) tests are also
available as an aid in the diagnosis of tuberculosis infection:
QuantiFERON®TB GoldandT-SPOT®.TB. Both tests
measure T-cell mediated immune response to synthetic
antigens. For further information on the use of interferon
gamma release assay tests for tuberculosis, seewww.gov.uk/
phe.Botulism antitoxin
A polyvalent botulism antitoxin p. 776 is available for the
post-exposure prophylaxis of botulism and for the treatment
of persons thought to be suffering from botulism. It
specifically neutralises the toxins produced byClostridium
botulinumtypes A, B, and E. It is not effective against
infantile botulism as the toxin (type A) is seldom, if ever,
found in the blood in this type of infection.
Hypersensitivity reactions are a problem. It is essential to
read the contra-indications, warnings, and details of
sensitivity tests on the package insert. Prior to treatment
checks should be made regarding previous administration of
any antitoxin and history of any allergic condition, e.g.BNFC 2018 – 2019 Vaccination 779
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