through epidermis during insertion). Tense raised
blanched bleb showing tips of hair follicles is sign of
correct injection; 7 mm bleb: 0. 1 mL injection, 3 mm bleb
:^0.^05 mL injection; if considerable resistance not felt,
needle too deep and should be removed and reinserted
before giving more vaccine.lPRESCRIBING AND DISPENSING INFORMATIONAvailable
from health organisations or direct from ImmForm
[http://www.immform.dh.gov.uk(SSI](http://www.immform.dh.gov.uk(SSI) brand, multidose vial with
diluent).
lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Powder and solvent for suspension for injection
▶Bacillus calmette-guérin vaccine (Non-proprietary)
Bacillus Calmette-Guerin vaccine powder and solvent for suspension
for injection vials| 10 vialPs
eiiiiF 788
Cholera vaccine
lINDICATIONS AND DOSE
Immunisation against cholera (for travellers to endemic
or epidemic areas on the basis of current
recommendations)
▶BY MOUTH
▶Child 2–5 years: 1 dose every 1 – 6 weeks for 3 doses, if
more than 6 weeks have elapsed between doses, the
primary course should be restarted, immunisation
should be completed at least one week before potential
exposure
▶Child 6–17 years: 1 dose every 1 – 6 weeks for 2 doses, if
more than 6 weeks have elapsed between doses, the
primary course should be restarted, immunisation
should be completed at least one week before potential
exposure
Booster
▶BY MOUTH
▶Child 2–5 years:A single booster dose can be given
within 6 months after primary course, if more than
6 months have elapsed since the last vaccination, the
primary course should be repeated
▶Child 6–17 years:A single booster dose can be given
within 2 years after primary course, if more than
2 years have elapsed since the last vaccination, the
primary course should be repeatedlCONTRA-INDICATIONSAcute gastro-intestinal illness
lINTERACTIONS→Appendix 1 : cholera vaccine
lSIDE-EFFECTS
▶UncommonGastrointestinal discomfort.gastrointestinal
disorders
▶Rare or very rareChills.cough.dehydration.drowsiness.
hyperhidrosis.increased risk of infection.insomnia.
pulmonary reaction.syncope.taste altered.throat pain
▶Frequency not knownAngioedema.asthenia.dyspnoea.
hypertension.influenza like illness.lymphadenitis.pain.
paraesthesia.sputum increased
lDIRECTIONS FOR ADMINISTRATIONDissolve effervescent
sodium bicarbonate granules in a glassful of wateror
chlorinated water (approximately 150 mL). For children
over 6 years, add vaccine suspension to make one dose. For
child 2 – 5 years, discard half (approximately 75 mL) of the
solution, then add vaccine suspension to make one dose.
Drink within 2 hours. Food, drink, and other oral
medicines should be avoided for 1 hour before and after
vaccination.
lPATIENT AND CARER ADVICECounselling on
administration advised. Immunisation with cholera
vaccine does not provide complete protection and all
travellers to a country where cholera exists should be
warned that scrupulous attention to food, water, and
personal hygiene isessential.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Oral suspension
▶Dukoral(Valneva UK Ltd)
Dukoral cholera vaccine oral suspension| 2 doseP£ 26. 35 DT =
£ 26. 35eiiiiF 788Haemophilus influenzae type b with
meningococcal group C vaccine
lINDICATIONS AND DOSE
Booster dose (for infants who have received primary
immunisation with a vaccine containingHaemophilus
influenzaetype b component) and primary
immunisation againstNeisseria meningitidis
▶BY INTRAMUSCULAR INJECTION
▶Child 12–13 months: 0. 5 mL for 1 dose
Immunisation againstNeisseria meningitidisin an
unimmunised patient
▶BY INTRAMUSCULAR INJECTION
▶Child 1–9 years: 0. 5 mL for 1 dose
Booster dose (for children who have not been immunised
againstHaemophilus influenzatype b)|Booster dose
after recovery fromHaemophilus influenzaetype b
disease (for index cases previously vaccinated, with low
Hib antibody concentration or if it is not possible to
measure antibody concentration)
▶BY INTRAMUSCULAR INJECTION
▶Child 1–9 years: 0. 5 mL for 1 dose
Booster dose after recovery fromHaemophilus influenzae
type b disease (for fully vaccinated index cases with
asplenia or splenic dysfunction, if previous dose
received over 1 year ago)
▶BY INTRAMUSCULAR INJECTION
▶Child 1–17 years: 0. 5 mL for 1 dose
Booster dose (for patients diagnosed with asplenia,
splenic dysfunction or complement deficiency at under
2 years of age)
▶BY INTRAMUSCULAR INJECTION
▶Child 2–17 years: 0. 5 mL for 1 dose, this booster dose
should be given after the second birthday, this is the
second dose of haemophilus influenzae type b vaccine
combined with meningococcal group C conjugate
vaccine (thefirst dose is given during the routine
immunisation schedule)
Booster dose (for patients diagnosed with asplenia,
splenic dysfunction or complement deficiency at over
2 years of age)
▶BY INTRAMUSCULAR INJECTION
▶Child 2–17 years: 0. 5 mL for 1 dose, this booster dose
should be followed 2 months later by one dose of
meningococcal A, C, W 135 , and Y conjugate vaccine (in
patients from 11 years of age, this interval can be
reduced to one month)lUNLICENSED USENot licensed for use in patients over
2 years.
lSIDE-EFFECTS
▶Common or very commonDrowsiness
▶UncommonCrying
▶Rare or very rareAbdominal pain.insomnia
▶Frequency not knownAnaphylactoid reaction.apnoea (in
neonates).febrile seizure.meningism (but no evidence
that vaccine causes meningococcal C meningitis).muscle
tone decreasedBNFC 2018 – 2019 Vaccination 791
Vaccines14