first—see Immunisation schedule). If the course is
interrupted, it should be resumed (using the same vaccine)
but not repeated, even if more than 24 months have elapsed
since thefirst dose or if the girl is then aged^15 years or
more.
Females aged 15 years or older require a 3 -dose schedule
(seeCervarix®andGardasil®), with the second and third
doses given 1 and 4 – 6 months after thefirst dose; all 3 doses
should be given within a 12 -month period. If the course is
interrupted, it should be resumed (using the same vaccine)
but not repeated, allowing the appropriate interval between
the remaining doses.
If a 3 -dose course of vaccination had been started before
September 2014 in a female aged under 15 years, then where
possible this should be completed; the interrupted course
should be resumed (using the same vaccine) but not
repeated, allowing the appropriate interval between the
remaining doses.
Under the national programme in England, females remain
eligible to receive the vaccine up to the age of 18 years if they
did not receive the vaccine when scheduled. Where
appropriate, immunisation with human papillomavirus
vaccine should be offered to females coming into the UK as
they may not have been offered protection in their country
of origin. The duration of protection has not been
established, but current studies suggest that protection is
maintained for at least 6 years after completion of the
primary course.Influenza vaccine
While most viruses are antigenically stable, the influenza
viruses A and B (especially A) are constantly altering their
antigenic structure as indicated by changes in the
haemagglutinins (H) and neuraminidases (N) on the surface
of the viruses. It is essential that influenza vaccine p. 798 in
use contain the H and N components of the prevalent strain
or strains recommended each year by the World Health
Organization.
The inactivated influenza vaccine is recommended for
children aged 6 months– 2 years in an at risk group (see
below), those aged 18 years and over, in pregnancy and in
children with a contra-indication to the live influenza
vaccine.
Unless contra-indicated, the live influenza vaccine,
administered as a nasal spray (Fluenz Tetra®), is preferred in
children aged 2 – 17 years because it provides a higher level of
protection than the inactivatedinfluenza vaccine.
Immunisation is recommendedfor persons at high risk, and
to reduce transmission of infection. Annual immunisation is
strongly recommended for children (including infants that
were preterm or low birth-weight) aged over 6 months with
the following conditions:
.chronic respiratory disease (includes asthma treated with
continuous or repeated use of inhaled or systemic
corticosteroids or asthma with previous exacerbations
requiring hospital admission);
.chronic heart disease;
.chronic liver disease;
.chronic renal disease at stage 3 , 4 or 5 ;
.chronic neurological disease;
.complement disorders;
.diabetes mellitus;
.immunosuppression because of disease (including
asplenia or splenic dysfunction) or treatment (including
prolonged systemic corticosteroid treatment [for over
1 month at dose equivalents of prednisolone:child under
20 kg, 1 mg/kg or more daily;child over 20 kg, 20 mg or
more daily] and chemotherapy);
.HIV infection (regardless of immune status).
Seasonal influenza vaccine is also recommended for all
pregnant women, for children living in long-stay facilities,
and for carers of children whose welfare may be at risk if thecarer falls ill. Influenza immunisation should also be
considered for household contacts of immunocompromised
individuals.
In the^2017 /^2018 national influenza immunisation
programme, seasonal influenza vaccine will also be offered
to all children who were aged 2 – 8 years on 31 August 2017
(including those in school years 1 , 2 , 3 and 4 ), and all
primary school-aged children in former primary school pilot
areas.
Further information on pandemic influenza, avian
influenza, and swine influenza may be found atwww.dh.gov.
uk/pandemicfluand atwww.gov.uk/phe.Japanese encephalitis vaccine
Japanese encephalitis vaccine p. 799 is indicated for
travellers to areas in Asia and the Far East where infection is
endemic and for laboratory staff at risk of exposure to the
virus. The primary immunisation course of 2 doses should be
completed at least one week before potential exposure to
Japanese encephalitis virus.
Up-to-date information on the risk of Japanese
encephalitis in specific countries can be obtained from the
National Travel Health Network and Centre (www.nathnac.
org).Management of Measles, Mumps and Rubella
Measles vaccinehas been replaced by a combined measles,
mumps and rubella vaccine, live (MMR vaccine) p. 799.
A combined measles, mumps and rubella vaccine, live
(MMR vaccine) aims to eliminate measles, mumps, and
rubella (German measles) and congenital rubella syndrome.
Every child should receive two doses of measles, mumps and
rubella vaccine, live p. 799 by entry to primary school, unless
there is a valid contra-indication. Measles, mumps and
rubella vaccine, live should be given irrespective of previous
measles, mumps, or rubella infection or vaccination.
Thefirst dose of measles, mumps and rubella vaccine, live
is given to children aged 12 – 13 months. A second dose is
given before starting school at 3 years and 4 months– 5 years
of age (see Immunisation Schedule).
Children presenting for pre-school booster who have not
received thefirst dose of measles, mumps and rubella
vaccine, live should be given a dose of measles, mumps and
rubella vaccine, live followed 3 months later by a second
dose.
At school-leaving age or at entry into further education,
MMR immunisation should be offered to individuals of both
sexes who have not received 2 doses during childhood. In
those who have received only a single dose of MMR in
childhood, a second dose is recommended to achieve full
protection. If 2 doses of measles, mumps and rubella
vaccine, live are required, the second dose should be given
one month after the initial dose.
Measles, mumps and rubella vaccine, live should be used
to protect against rubella inseronegative women of child-
bearing age(see Immunisation Schedule); unimmunised
healthcare workers who might put pregnant women and
other vulnerable groups at risk of rubella or measles should
be vaccinated. Measles, mumps and rubella vaccine, live may
also be offered to previouslyunimmunised and seronegative
post-partum women(see measles, mumps and rubella
vaccine, live)—vaccination a few days after delivery is
important because about 60 % of congenital abnormalities
from rubella infection occur in babies of women who have
borne more than one child. Immigrants arriving after the age
of school immunisation are particularly likely to require
immunisation.Contacts
Measles, mumps and rubella vaccine, live may also be used
in the control of outbreaks of measles and should be offered
to susceptible children aged over 6 months who are contacts
of a case, within 3 days of exposure to infection. Children782 Vaccination BNFC 2018 – 2019
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