requires 3 doses of an acellular pertussis-containing vaccine
(see Immunisation schedule), given at intervals of 1 month
from the age of 2 months.
All children up to the age of^10 years should receive
primary immunisation with a combination vaccine of
diphtheria with tetanus, pertussis, hepatitis B, poliomyelitis
and haemophilus influenzae type b vaccine p. 790 (Infanrix
hexa®).
A booster dose of an acellular pertussis-containing vaccine
should ideally be given 3 years after the primary course,
although, the interval can be reduced to 1 year if the primary
course was delayed.
Children aged 1 – 10 years who have not received a
pertussis-containingvaccine as part of their primary
immunisation should be offered 1 dose of a suitable
pertussis-containing vaccine; after an interval of at least
1 year, a booster dose of a suitable pertussis-containing
vaccine should be given. Immunisation against pertussis is
not routinely recommended in individuals over 10 years of
age.
Vaccination of pregnant women against pertussis
In response to the pertussis outbreak, the UK health
departments introduced a temporary programme (October
2012 ) to vaccinate pregnant women against pertussis, and
this programme will continue until further notice. The aim of
the programme is to boost the levels of pertussis–specific
antibodies that are transferred, through the placenta, from
the mother to the fetus, so that the newborn is protected
before routine immunisation begins at 2 months of age.
Pregnant women should be offered a single dose of
acellular pertussis-containing vaccine (as adsorbed
diphtheria [low dose], tetanus, pertussis (acellular,
component) and poliomyelitis (inactivated) vaccine;
Boostrix-IPV®) between 16 and 32 weeks of pregnancy.
Public Health England has advised ( 2016 ) that the vaccine is
probably best offered on or after the fetal anomaly scan at
around 18 – 20 weeks. Pregnant women should be offered a
single dose of acellular pertussis-containing vaccine up to
the onset of labour if they missed the opportunity for
vaccination at 16 – 32 weeks of pregnancy. A single dose of
acellular pertussis-containing vaccine may also be offered to
new mothers, who have never previously been vaccinated
against pertussis, until the child receives thefirst
vaccination.
While this programme is in place, women who become
pregnant again should be offered vaccination during each
pregnancy to maximise transplacental transfer of antibody.
Contacts
Vaccination against pertussis should be considered for close
contacts of cases with pertussis who have been offered
antibacterial prophylaxis. Unimmunised or partially
immunised contacts under 10 years of age should complete
their vaccination against pertussis. A booster dose of an
acellular pertussis-containing vaccine is recommended for
contacts aged over 10 years who have not received a
pertussis-containing vaccine in the last 5 years and who have
not received adsorbed diphtheria [low dose], tetanus, and
poliomyelitis (inactivated) vaccine in the last month.
Side-effects
Local reactions do not contra-indicate further doses.
The vaccine should not be withheld from children with a
history to a preceding dose of:
.fever, irrespective of severity;
.persistent crying or screaming for more than 3 hours;
.severe local reaction, irrespective of extent.Pneumococcal vaccine
The pneumococcal polysaccharide conjugate vaccine
(adsorbed) p. 793 and the pneumococcal polysaccharide
vaccine p. 793 protect against infection withStreptococcus
pneumoniae(pneumococcus). Both vaccines containpolysaccharide from capsular pneumococci. The
pneumococcal polysaccharide vaccine contains purified
polysaccharide from 23 capsular typesof pneumococci,
whereas the pneumococcal polysaccharide conjugate vaccine
(adsorbed) contains polysaccharide from either 10 capsular
types(Synflorix®)or 13 capsular types(Prevenar 13 ®), with
the polysaccharide being conjugated to protein.
Prevenar 13 ®,isthe 13 -valent pneumococcal
polysaccharide conjugate vaccine (adsorbed) used for
childhood immunisation. The recommended schedule
consists of 3 doses, thefirst at 2 months of age, the second at
4 months, and the third at 12 – 13 months (seeImmunisation
Schedule).
The 23 -valent pneumococcal polysaccharide vaccine is
recommended for children aged 2 years or over at increased
risk of pneumococcal infection as follows:
.child under 5 years with a history of invasive
pneumococcal disease;
.asplenia or splenic dysfunction (including homozygous
sickle cell disease and coeliac disease which could lead to
splenic dysfunction);
.chronic respiratory disease (includes asthma treated with
continuous or frequent use of a systemic corticosteroid);
.chronic heart disease;
.chronic renal disease;
.chronic liver disease;
.chronic neurological conditions;
.complement disorders;
.diabetes mellitus;
.immune deficiency because of disease (e.g. HIV infection)
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);
.presence of cochlear implant;
.conditions where leakage of cerebrospinalfluid could
occur.
Where possible, the vaccine should be given at least 2 weeks
before splenectomy, cochlear implant surgery,
chemotherapy, or radiotherapy; children and carers should
be given advice about increased risk of pneumococcal
infection. If it is not practical to vaccinate at least 2 weeks
before splenectomy, chemotherapy, or radiotherapy, the
vaccine should be given at least 2 weeks after the
splenectomy or, where possible, at least 3 months after
completion of chemotherapy or radiotherapy. Prophylactic
antibacterial therapy against pneumococcal infection should
not be stopped after immunisation. A patient card and
information leaflet for patients with asplenia are available
from the Department of Health or in Scotland from the
Scottish Government, Health Protection Division (Tel ( 0131 )
244 2879).Choice of vaccine
Children under 2 years of age, at increased risk of
pneumococcal infection (see list above), should receive the
13 -valent pneumococcal polysaccharide conjugate vaccine
(adsorbed) p. 793 at the recommended ages, followed by a
single dose of the 23 -valent pneumococcal polysaccharide
vaccine p. 793 after their second birthday. Children at
increased risk of pneumococcal infection presenting late for
vaccination should receive 2 doses (separated by at least
1 month) of the 13 -valent pneumococcal polysaccharide
conjugate vaccine (adsorbed) before the age of 12 months,
and a third dose at 12 – 13 months. Children over 12 months
and under 5 years (who have not been vaccinated or not
completed the primary course) should receive a single dose
of 13 -valent pneumococcal polysaccharide conjugate
vaccine (adsorbed) ( 2 doses separated by an interval of
2 months in the immunocompromised or those with asplenia
or splenic dysfunction). All children under 5 years at
increased risk of pneumococcal infection should receive a
single dose of the 23 -valent pneumococcal polysaccharide784 Vaccination BNFC 2018 – 2019
Vaccines14