vaccine after their second birthday and at least 2 months
after thefinal dose of the 13 - valent pneumococcal
polysaccharide conjugate vaccine (adsorbed).
Children over^5 years who are at increased risk of
pneumococcal disease should receive a single dose of the
23 -valent unconjugated pneumococcal polysaccharide
vaccine.
Revaccination
In individuals with higher concentrations of antibodies to
pneumococcal polysaccharides, revaccination with the
23 -valent pneumococcal polysaccharide vaccine more
commonly produces adverse reactions. Revaccination is
therefore not recommended, except every 5 years in
individuals in whom the antibody concentration is likely to
decline rapidly (e.g. asplenia, splenic dysfunction and
nephrotic syndrome). If there is doubt, the need for
revaccination should be discussed with a haematologist,
immunologist, or microbiologist.
Poliomyelitis vaccine
Two types of poliomyelitis vaccines (containing strains of
poliovirus types 1 , 2 , and 3 ) are available, inactivated
poliomyelitis vaccines (for injection) and live (oral)
poliomyelitis vaccines.Inactivatedpoliomyelitis vaccines,
only available in combined preparation, is recommended for
routine immunisation; it is given by injection and contains
inactivated strains of human poliovirus types 1 , 2 and 3.
A course of primary immunisation consists of 3 doses of a
combined preparation containing inactivated poliomyelitis
vaccines starting at 2 months of age with intervals of
1 month between doses (see Immunisation schedule). A
course of 3 doses should also be given to all unimmunised
children; no child should remain unimmunised against
poliomyelitis.
Two booster doses of a preparation containing inactivated
poliomyelitis vaccines are recommended, thefirst before
school entry and the second before leaving school (see
Immunisation schedule). Further booster doses should be
given every 10 years only to individuals at special risk.
Live (oral)poliomyelitis vaccines is no longer available for
routine use; its use may be considered during large
outbreaks, but advice should be sought from Public Health
England. The live (oral) vaccine poses a very rare risk of
vaccine-associated paralytic polio because the attenuated
strain of the virus can revert to a virulent form. For this
reason the live (oral) vaccine mustnotbe used for
immunosuppressed individuals or their household contacts.
The use of inactivated poliomyelitis vaccines removes the
risk of vaccine-associated paralytic polio altogether.
Travel
Unimmunised travellers to areas with a high incidence of
poliomyelitis should receive a full 3 – dose course of a
preparation containing inactivated poliomyelitis vaccines.
Those who have not been vaccinated in the last 10 years
should receive a booster dose ofadsorbed diphtheria [low
dose], tetanus and poliomyelitis (inactivated) vaccine.
Information about countries with a high incidence of
poliomyelitis can be obtained fromwww.travax.nhs.ukor from
the National Travel Health Network and Centre,
(www.nathnac.org).
Rabies vaccine
Rabies vaccine p. 800 contains inactivated rabies virus
cultivated in either human diploid cells or purified chick
embryo cells; vaccines are used for pre- and postexposure
prophylaxis.
Pre-exposure prophylaxis
Immunisation should be offered to children at high risk of
exposure to rabies—where there is limited access to prompt
medical care for those living in areas where rabies is
enzootic, for those travelling to such areas for longer than
1 month, and for those on shorter visits who may be exposed
to unusual risk. Transmission of rabies by humans has not
been recorded but it is advised that those caring for children
with the disease should be vaccinated.
Up-to-date country-by-country information on the
incidence of rabies can be obtained from the National Travel
Health Network and Centre (www.nathnac.org) and, in
Scotland, from Health Protection Scotland (www.hps.scot.nhs.
uk).
Immunisation against rabies requires 3 doses of rabies
vaccine, with further booster doses for those who remain at
frequent risk.Post-exposure management
Following potential exposure to rabies, the wound or site of
exposure (e.g. mucous membrane) should be cleansed under
running water and washed for several minutes with soapy
water as soon as possible after exposure. Disinfectant and a
simple dressing can be applied, but suturing should be
delayed because it may increase the risk of introducing
rabies virus into the nerves.
Post-exposure prophylaxis against rabies depends on the
level of risk in the country, the nature of exposure, and the
individual’s immunity. In each case, expert risk assessment
and advice on appropriate management should be obtained
from the local Public Health England Centre or Public Health
England’s Virus Reference Department, Colindale (tel. ( 020 )
8200 4400) or the PHE Colindale Duty Doctor (tel. ( 020 ) 8200
6868 ), in Wales from the Public Health Wales local Health
Protection Team or Public Health Wales Virus Reference
Laboratory (tel. ( 029 )2074 7747), in Scotland from the local
on-call infectious diseases consultant, and in Northern
Ireland from the Public Health Agency Duty Room (tel ( 028 )
9055 3997/( 028 )9063 2662) or the Regional Virology Service
(tel. ( 028 )9024 0503).
There are no specific contra-indications to the use of
rabies vaccine for post-exposure prophylaxis and its use
should be considered whenever a child has been attacked by
an animal in a country where rabies is enzootic, even if there
is no direct evidence of rabies in the attacking animal.
Because of the potential consequences of untreated rabies
exposure and because rabies vaccination has not been
associated with fetal abnormalities, pregnancy is not
considered a contra-indication to post-exposure
prophylaxis.
For post-exposure prophylaxis offully immunised
individuals (who have previously received pre-exposure or
post-exposure prophylaxis with cell-derived rabies vaccine),
2 doses of cell-derived vaccine are likely to be sufficient; the
first dose is given on day 0 and the second dose is given
between day 3 – 7. Rabies immunoglobulin p. 775 is not
necessary in such cases.
Post-exposure treatment forunimmunised individuals(or
those whose prophylaxis is possibly incomplete) comprises
5 doses of rabies vaccine p. 800 given over 1 month (on days
0 , 3 , 7 , 14 , and thefifth dose is given between day 28 – 30 );
also, depending on the level of risk (determined by factors
such as the nature of the bite and the country where it was
sustained), rabies immunoglobulin is given to unimmunised
individuals on day 0 or within 7 days of starting the course of
rabies vaccine. The immunisation course can be
discontinued if it is proved that the child was not at risk.Rotavirus vaccine
Rotavirus vaccine p. 801 is a live, oral vaccine that protects
young children against gastro-enteritis caused by rotavirus
infection. The recommended schedule consists of 2 doses,
thefirst at 2 months of age, and the second at 3 months of
age (see Immunisation schedule). Thefirst dose of rotavirus
vaccine must be given between 6 – 15 weeks of age and the
second dose should be given after an interval of at least
4 weeks; the vaccine should not be started in children
15 weeks of age or older. Ideally, the full course should beBNFC 2018 – 2019 Vaccination 785
Vaccines14