Meridian Court,
5 Cadogan Street,
Glasgow, G 26 QE
Tel: (^0141 )300 1130
( 2 – 4 p.m. Monday to Wednesday, 9 : 30 – 11 : 30 a.m. Friday; for
registered TRAVAX users only)www.travax.nhs.uk
(TRAVAX is free for NHS Scotland users (registration
required); subscription fee may be payable for users outside
NHS Scotland)
Welsh Assembly Government
Tel ( 029 )2082 5397
( 9 a.m.– 5 : 30 p.m. weekdays)
Department of Health, Social Services and Public Safety
Castle Buildings,
Stormont,
Belfast, BT 43 SQ
Tel: ( 028 )9052 2118
( 9 a.m.– 5 p.m. weekdays)www.dhsspsni.gov.ukVACCINES
Vaccines f
IMPORTANT SAFETY INFORMATION
MHRA/CHM ADVICE (UPDATED NOVEMBER 2017)
Following reports of death in neonates who received a
live attenuated vaccine after exposure to a tumor
necrosis factor alpha (TNF-a) inhibitor in utero, the
MHRA has issued the following advice:
.any infant who has been exposed to
immunosuppressive treatment from the mother either
in utero during pregnancy or via breastfeeding should
have any live attenuated vaccination deferred for as
long as a postnatal influence on the immune status of
the infant remains possible;
.in the case of infants who have been exposed to TNF-a
inhibitors and other immunosuppressive biological
medicines in utero, PHE advise that any live
attenuated vaccination (e.g. BCG vaccine) should be
deferred until the infant is age 6 months;
.PHE advise if there is any doubt as to whether an
infant due to receive a live attenuated vaccine may be
immunosuppressed due to the mother’s therapy,
including exposure through breast-feeding, specialist
advice should be sought.lCONTRA-INDICATIONS
CONTRA-INDICATIONS, FURTHER INFORMATION
▶Impaired immune responseSeverely immunosuppressed
patients should not be given live vaccines (including those
with severe primary immunodeficiency).
lCAUTIONSAcute illness.minor illnesses
CAUTIONS, FURTHER INFORMATIONVaccination may be
postponed if the individual is suffering from an acute
illness; however, it is not necessary to postpone
immunisation in patients with minor illnesses without
fever or systemic upset.
▶Impaired immune response and drugs affecting immune
responseImmune response to vaccines may be reduced in
immunosuppressed patients and there is also a risk of
generalised infection with live vaccines.
Specialist advice should be sought for those being
treated with high doses of corticosteroids (dose
equivalents of prednisolone:adults, at least 40 mg daily
for more than 1 week;children, 2 mg/kg (or more than
40 mg) daily for at least 1 week or 1 mg/kg daily for
1 month), or other immunosuppressive drugs, and those
being treated for malignant conditions with chemotherapy
or generalised radiotherapy. Live vaccines should be
postponed until at least 3 months after stopping high-dosesystemic corticosteroids and at least 6 months after
stopping other immunosuppressive drugs or generalised
radiotherapy (at least 12 months after discontinuing
immunosuppressants following bone-marrow
transplantation).
The Royal College of Paediatrics and Child Health has
produced a statement,Immunisation of the
Immunocompromised Child ( 2002 )(available atwww.rcpch.
ac.uk).
▶Predisposition to neurological problemsWhen there is a
personal or family history offebrileconvulsions, there is an
increased risk of these occurring during fever from any
cause including immunisation, but this is not a contra-
indication to immunisation. In children who have had a
seizure associated with fever without neurological
deterioration, immunisation isrecommended; advice on
themanagement of fever(see Post-immunisation Pyrexia in
Infants) should be given before immunisation. When a
child has had a convulsion not associated with fever, and
the neurological condition is not deteriorating,
immunisation isrecommended.
Children with stable neurological disorders (e.g. spina
bifida, congenital brain abnormality, and peri-natal
hypoxic-ischaemic encephalopathy) should be immunised
according to the recommended schedule.
When there is astill evolving neurological problem,
including poorly controlled epilepsy, immunisation should
be deferred and the child referred to a specialist.
Immunisation is recommended if a cause for the
neurological disorder is identified. If a cause is not
identified, immunisation should be deferred until the
condition is stable.
lSIDE-EFFECTS
▶Common or very commonAppetite decreased.arthralgia.
diarrhoea.dizziness.fatigue.fever.headache.irritability
.lymphadenopathy.malaise.myalgia.nausea.skin
reactions.vomiting
▶UncommonHypersensitivity
lALLERGY AND CROSS-SENSITIVITYContra-indicated in
patients with a confirmed anaphylactic reaction to a
preceding dose of a vaccine containing the same antigens
or vaccine component (such as antibacterials in viral
vaccines).
lPREGNANCYLive vaccines should not be administered
routinely to pregnant women because of the theoretical
risk of fetal infection but where there is a significant risk of
exposure to disease, the need for vaccination usually
outweighs any possible risk to the fetus. Termination of
pregnancy following inadvertent immunisation is not
recommended. There is no evidence of risk from
vaccinating pregnant women with inactivated viral or
bacterial vaccines or toxoids.
lBREAST FEEDINGAlthough there is a theoretical risk of
live vaccine being present in breast milk, vaccination is not
contra-indicated for women who are breast-feeding when
there is significant risk of exposure to disease. There is no
evidence of risk from vaccinating women who are breast-
feeding, with inactivated viral or bacterial vaccines or
toxoids.
lDIRECTIONS FOR ADMINISTRATIONIf alcohol or
disinfectant is used for cleansing the skin it should be
allowed to evaporate before vaccination to prevent
possible inactivation of live vaccines.
When 2 or more live vaccines are required (and are not
available as a combined preparation), they can be
administered at any time before or after each other at
different sites, preferably in a different limb; if more than
one injection is to be given in the same limb, they should
be administered at least 2. 5 cm apart. See also Bacillus
Calmette-Guérin vaccine p. 790 , and Cautions, further788 Vaccination BNFC 2018 – 2019
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