asthma, hay fever, etc. All patients should be tested for
sensitivity (diluting the antitoxin if history of allergy).Cholera vaccine
Cholera vaccine (oral) p. 791 contains inactivated Inaba
(including El-Tor biotype) and Ogawa strains ofVibrio
cholerae, serotype O 1 together with recombinant B-subunit
of the cholera toxin produced in Inaba strains ofV.cholerae,
serotype O 1.
Oral cholera vaccine is licensed for travellers to endemic or
epidemic areas on the basis of current recommendations.
Immunisation should be completed at least 1 week before
potential exposure. However, there is no requirement for
cholera vaccination for international travel.
Immunisation with cholera vaccine does not provide
complete protection and all travellers to a country where
cholera exists should be warned that scrupulous attention to
food, water, and personal hygiene isessential.
Injectable cholera vaccineprovides unreliable protection
and is no longer available in the UK.Diphtheria vaccine
Diphtheria vaccines are prepared from the toxin of
Corynebacterium diphtheriaeand adsorption on aluminium
hydroxide or aluminium phosphate improves antigenicity.
The vaccine stimulates the production of the protective
antitoxin. The quantity of diphtheria toxoid in a preparation
determines whether the vaccine is defined as‘high dose’or
‘low dose’. Vaccines containing the higher dose of diphtheria
toxoid are used for primary immunisation of children under
10 years of age. Vaccines containing the lower dose of
diphtheria toxoid are used for primary immunisation in
adults and children over 10 years. Single-antigen diphtheria
vaccine is not available and adsorbed diphtheria vaccine is
given as a combination product containing other vaccines.
For primary immunisationof children aged between
2 months and 10 yearsvaccination is recommended usually in
the form of 3 doses (separated by 1 -month intervals) of
diphtheria with tetanus, pertussis, hepatitis B, poliomyelitis
and haemophilus influenzae type b vaccine p. 790 (Infanrix
hexa®) (see Immunisation schedule). In unimmunised
individuals agedover 10 yearsthe primary course comprises
of 3 doses ofadsorbed diphtheria[low dose],tetanus and
poliomyelitis (inactivated) vaccine.
A booster dose should be given 3 years after the primary
course (this interval can be reduced to a minimum of 1 year if
the primary course was delayed). Childrenunder 10 years
should receiveeitheradsorbed diphtheria, tetanus,
pertussis (acellular, component) and poliomyelitis
(inactivated) vaccineoradsorbed diphtheria[low dose],
tetanus, pertussis (acellular, component) and
poliomyelitis (inactivated) vaccine. Individuals agedover
10 yearsshould receiveadsorbed diphtheria[low dose],
tetanus, and poliomyelitis (inactivated) vaccine.
A second booster dose, of adsorbed diphtheria [low dose],
tetanus and poliomyelitis (inactivated) vaccine, should be
given^10 years after the previous booster dose (this interval
can be reduced to a minimum of 5 years if previous doses
were delayed). For children who have been vaccinated
following a tetanus-prone wound, see tetanus vaccines.
Travel
Those intending to travel to areas with a risk of diphtheria
infection should be fully immunised according to the UK
schedule. If more than 10 years have lapsed since completion
of the UK schedule, a dose ofadsorbed diphtheria[low
dose],tetanus and poliomyelitis (inactivated) vaccine
should be administered.Contacts
Advice on the management of cases of diphtheria, carriers,
contacts and outbreaks must be sought from health
protection units. The immunisation history of infected
children and their contacts should be determined; those whohave been incompletely immunised should complete their
immunisation and fully immunised individuals should
receive a reinforcing dose. Also see advice on antibacterial
treatment to prevent a secondary case of diphtheria in a
non-immune child.Haemophilus influenzae type b conjugate vaccine
Haemophilus influenzae type b (Hib) vaccineis made
from capsular polysaccharide; it is conjugated with a protein
such as tetanus toxoid to increase immunogenicity,
especially in young children.Haemophilus influenzae type b
vaccineimmunisation is given in combination with
diphtheria, tetanus, pertussis, hepatitis B and poliomyelitis
vaccine (Infanrix hexa®), as a component of the primary
course of childhood immunisation (see Immunisation
schedule). For infants under 1 year, the course consists of
3 doses of a vaccine containingHaemophilus influenzaetype
b component with an interval of 1 month between doses. A
booster dose of haemophilus influenzae type b vaccine
(combined with meningococcal group C conjugate vaccine)
should be given at 12 – 13 months of age.
Children 1 – 10 years who have not been immunised against
Haemophilus influenzaetype b need to receive only 1 dose of
Haemophilus influenzaetype b vaccine (combined with
meningococcal group C conjugate vaccine). However, if a
primary course of immunisation has not been completed,
children born before August 2017 should be given 3 doses of
the combined vaccine they were started on. The risk of
infection falls sharply in older children and the vaccine is not
normally required for children over 10 years.
Haemophilus influenzae type b vaccine may be given to
those over 10 years who are considered to be at increased
risk of invasiveH. influenzaetype b disease (such as those
with sickle-cell disease or complement deficiency, or those
receiving treatment for malignancy).InvasiveHaemophilus influenzaetype b disease
After recovery from infection, unimmunised and partially
immunised index cases under 10 years of age should
complete their age-specific course of immunisation.
Previously vaccinated cases under 10 years of age should be
given an additional dose of haemophilus influenzae type b
vaccine (combined with meningococcal group C conjugate
vaccine) if Hib antibody concentrations are low or if it is not
possible to measure antibody concentrations. Index cases of
any age with asplenia or splenic dysfunction should
complete their immunisation according to the
recommendations below; fully vaccinated cases with
asplenia or splenic dysfunction should be given an additional
dose of haemophilus influenzae type b vaccine (combined
with meningococcal group C conjugate vaccine) if they
received their previous dose over 1 year ago.
Also see use of rifampicin p. 364 in the prevention of
secondary cases ofHaemophilus influenzaetype b disease.Hepatitis A vaccine
Hepatitis A vaccine p. 795 is prepared from formaldehyde-
inactivated hepatitis A virus grown in human diploid cells.
Immunisation is recommended for:
.residents of homes for those with severe learning
difficulties;
.children with haemophilia or other conditions treated with
plasma-derived clotting factors;
.children with severe liver disease;
.children travelling to high-risk areas;
.adolescents who are at risk due to their sexual behaviour;
.parenteral drug abusers.
Immunisation should be considered for:
.children with chronic liver disease including chronic
hepatitis B or chronic hepatitis C;
.prevention of secondary cases in close contacts of
confirmed cases of hepatitis A, within 14 days of exposure780 Vaccination BNFC 2018 – 2019
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