completed before 16 weeks of age to provide protection
before the main burden of disease, and to avoid a temporal
association between vaccination and intussusception; the
course must be completed before^24 weeks of age.
The rotavirus vaccine virus is excreted in the stool and
may be transmitted to close contacts; however, vaccination
of those withimmunosuppressedclose contacts may protect
the contacts from wild-type rotavirus disease and outweigh
any risk from transmission of vaccine virus. Carers of a
recently vaccinated baby should be advised of the need to
wash their hands after changing the baby’s nappies.Smallpox vaccine
Limited supplies ofsmallpox vaccineare held at the
Specialist and Reference Microbiology Division, Public
Health England Colindale (Tel. ( 020 )8200 4400) for the
exclusive use of workers in laboratories where pox viruses
(such as vaccinia) are handled.
If a wider use of the vaccine is being considered,Guidelines
for smallpox response and management in the post-eradication
erashould be consulted atwww.gov.uk/phe.Tetanus vaccine
Tetanus vaccinecontains a cell-free purified toxin of
Clostridium tetaniadsorbed on aluminium hydroxide or
aluminium phosphate to improve antigenicity.
Primary immunisation for children under 10 years consists
of 3 doses of a combined preparation containing adsorbed
tetanus vaccine, with an interval of 1 month between doses.
Following routine childhood vaccination, 2 booster doses of
a preparation containing adsorbed tetanus vaccine are
recommended, thefirst before school entry and the second
before leaving school (see Immunisation schedule).
The recommended schedule of tetanus vaccination not
only gives protection against tetanus in childhood but also
gives the basic immunity for subsequent booster doses. In
most circumstances, a total of 5 doses of tetanus vaccine is
considered sufficient for long term protection.
For primary immunisation of adults and children over
10 years previously unimmunised against tetanus, 3 doses of
adsorbed diphtheria [low dose], tetanus and
poliomyelitis (inactivated) vaccineare given with an
interval of 1 month between doses.
When an individual presents for a booster dose but has
been vaccinated following a tetanus-prone wound, the
vaccine preparation administered at the time of injury
should be determined. If this is not possible, the booster
should still be given to ensure adequate protection against
all antigens in the booster vaccine.
Very rarely, tetanus has developed after abdominal
surgery; patients awaiting elective surgery should be asked
about tetanus immunisation and immunised if necessary.
Parenteral drug abuse is also associated with tetanus;
those abusing drugs by injection should be vaccinated if
unimmunised—booster doses should be given if there is any
doubt about their immunisation status.
All laboratory staff should be offered a primary course if
unimmunised.
Wounds
Wounds are considered to be tetanus-prone if they are
sustained more than 6 hours before surgical treatment or at
any interval after injury and are puncture-type (particularly
if contaminated with soil or manure)orshow much
devitalised tissueorare septicorare compound fracturesor
contain foreign bodies. All wounds should receive thorough
cleansing.
.Forclean wounds: fully immunised individuals (those who
have received a total of 5 doses of a tetanus-containing
vaccine at appropriate intervals) and those whose primary
immunisation is complete (with boosters up to date), do
not require tetanus vaccine; individuals whose primary
immunisation is incomplete or whose boosters are not upto date require a reinforcing dose of a tetanus-containing
vaccine (followed by further doses as required to complete
the schedule); non-immunised individuals (or those whose
immunisation status is not known or who have been fully
immunised but are now immunocompromised) should be
given a dose of the appropriate tetanus-containing vaccine
immediately (followed by completion of the full course of
the vaccine if records confirm the need)
.Fortetanus-prone wounds: management is as for clean
wounds with the addition of a dose of tetanus
immunoglobulin given at a different site; in fully
immunised individuals and those whose primary
immunisation is complete (with boosters up to date) the
immunoglobulin is needed only if the risk of infection is
especially high (e.g. contamination with manure).
Antibacterial prophylaxis (with benzylpenicillin, co-
amoxiclav, or metronidazole) may also be required for
tetanus-prone wounds.Tick-borne encephalitis vaccine
Tick-borne encephalitis vaccine, inactivated p. 801 contains
inactivated tick-borne encephalitis virus cultivated in chick
embryo cells. It is recommended for immunisation of those
working in, or visiting, high-risk areas (see International
Travel). Those working, walking or camping in warm forested
areas of Central and Eastern Europe, Scandinavia, Northern
and Eastern China, and some parts of Japan, particularly
from April to November when ticks are most prevalent, are at
greatest risk of tick-borne encephalitis. For full protection,
3 doses of the vaccine are required; booster doses are
required every 3 – 5 years for those still at risk. Ideally,
immunisation should be completed at least one month
before travel.Typhoid vaccine
Typhoid vaccine p. 794 is available as Vi capsular
polysaccharide (fromSalmonella typhi) vaccine for injection
and as live attenuatedSalmonella typhivaccine for oral use.
Typhoid immunisation is advised for children travelling to:
.areas where typhoid is endemic, especially if staying with
or visiting local people;
.endemic areas where frequent or prolonged exposure to
poor sanitation and poor food hygiene is likely;
Typhoid vaccination is not a substitute for scrupulous
personal hygiene.
Capsularpolysaccharide typhoid vaccineis usually given
byintramuscularinjection. Children under 2 years may
respond suboptimally to the vaccine, but children aged
between 1 – 2 years should be immunised if the risk of
typhoid fever is considered high (immunisation is not
recommended for infants under 12 months). Revaccination
is needed every 3 years on continued exposure.
Oraltyphoid vaccine p. 794 is alive attenuatedvaccine
contained in an enteric-coated capsule. One capsule taken
on alternate days for a total of 3 doses provides protection
7 – 10 days after the last dose. Protection may persist for up
to 3 years in those constantly (or repeatedly) exposed to
Salmonella typhi, but those who only occasionally travel to
endemic areas require further courses at intervals of 1 year.Varicella-zoster vaccine
Varicella-zoster vaccine (live) p. 801 is licensed for
immunisation against varicella (chickenpox) in seronegative
individuals. It is not recommended for routine use in
children but can be given to seronegative healthy children
over 1 year who come into close contact with individuals at
high risk of severe varicella infections.
Rarely, the varicella-zoster vaccine virus has been
transmitted from the vaccinated individual to close contacts.
Therefore, contact with the following should be avoided if a
vaccine-related cutaneous rash develops within 4 – 6 weeks of
thefirst or second dose:786 Vaccination BNFC 2018 – 2019
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