BNF for Children (BNFC) 2018-2019

information in measles, mumps and rubella vaccine, live

p. 799.

Vaccines should not be given intravenously. Most

vaccines are given by the intramuscular route, although

some are given by either the intradermal, deep

subcutaneous, or oral route. The intramuscular route

should not be used in patients withbleeding disorders

such as haemophilia or thrombocytopenia, vaccines

usually given by the intramuscular route should be given

by deep subcutaneous injection instead.

The Department of Health has advisedagainst the use of

jet gunsfor vaccination owing to the risk of transmitting

blood borne infections, such as HIV.

Particular attention must be paid to instructions on the

use of diluents. Vaccines which are liquid suspensions or

are reconstituted before use should be adequately mixed

to ensure uniformity of the material to be injected.

lHANDLING AND STORAGECare must be taken to store all
vaccines under the conditions recommended in the
product literature, otherwise the preparation may become
ineffective.Refrigerated storageis usually necessary;
many vaccines need to be stored at 2 – 8 °C and not allowed
to freeze. Vaccines should be protected from light.
Reconstituted vaccines and opened multidose vials must
be used within the period recommended in the product
literature. Unused vaccines should be disposed of by
incineration at a registered disposal contractor.

VACCINES›BACTERIAL AND VIRAL

VACCINES, COMBINED
eiiiiF 788

Diphtheria with haemophilus

influenzae type b vaccine, pertussis,

poliomyelitis and tetanus

lINDICATIONS AND DOSE

Primary immunisation

▶BY INTRAMUSCULAR INJECTION

▶Child 2 months–9 years: 0. 5 mL every month for 3 doses

lUNLICENSED USEInfanrix-IPV+Hib®not licensed for use
in children over 36 months;Pediacel®not licensed in
children over 4 years. However, the Department of Health
recommends that these be used for children up to 10 years.

lSIDE-EFFECTS
▶Common or very commonCrying abnormal.drowsiness.
restlessness
▶UncommonCough.extensive swelling of vaccinated limb.
increased risk of infection.rhinorrhoea
▶Frequency not knownAnaphylactoid reaction.angioedema
.apnoea.hypotonic-hyporesponsiveness episode.seizure
SIDE-EFFECTS, FURTHER INFORMATIONThe incidence of
local and systemic reactions is lower with acellular
pertussis vaccines than with whole-cell pertussis vaccines
used previously.
Compared with primary vaccination, injection site
reactions are more common with booster doses of vaccines
containing acellular pertussis.
Public Health England has advised ( 2016 ) that the
vaccine should not be withheld from children with a
history to a preceding dose of: fever, irrespective of
severity; hypotonic-hyporesonsive episodes; persistent
crying or screaming for more than 3 hours; severe local
reaction, irrespective of extent.

lPRESCRIBING AND DISPENSING INFORMATIONAvailable as
part of childhood schedule from health organisations or
ImmForm.

lMEDICINAL FORMS

There can be variation in the licensing of different medicines

containing the same drug.

Powder and suspension for suspension for injection

▶Infanrix-IPV + Hib(GlaxoSmithKline UK Ltd)

Infanrix-IPV + Hib vaccine powder and suspension for suspension for

injection 0. 5 ml pre-filled syringes| 1 pre-filled disposable

injectionP£ 27. 86

eiiiiF 788

Diphtheria with pertussis,

poliomyelitis vaccine and tetanus

lINDICATIONS AND DOSE

First booster dose

▶BY INTRAMUSCULAR INJECTION

▶Child 3–9 years: 0. 5 mL, to be given 3 years after

primary immunisation

Vaccination of pregnant women against pertussis (using

low dose vaccines)

▶BY INTRAMUSCULAR INJECTION

▶Females of childbearing potential: 0. 5 mL for 1 dose

lSIDE-EFFECTS

▶Common or very commonAbdominal pain

▶UncommonApathy.asthma.chills.drowsiness.dry

throat.extensive swelling of vaccinated limb.oral herpes.

pain.paraesthesia.sleep disorder

▶Frequency not knownAnaphylactoid reaction.angioedema

.asthenia.hypotonic-hyporesponsiveness episode.

seizure

SIDE-EFFECTS, FURTHER INFORMATIONThe incidence of

local and systemic reactions is lower with acellular

pertussis vaccines than with whole-cell pertussis vaccines

used previously.

Compared with primary vaccination, injection site

reactions are more common with booster doses of vaccines

containing acellular pertussis.

Public Health England has advised ( 2016 ) that the

vaccine should not be withheld from children with a

history to a preceding dose of: fever, irrespective of

severity; hypotonic-hyporesonsive episodes; persistent

crying or screaming for more than 3 hours; severe local

reaction, irrespective of extent.

lPREGNANCYContra-indicated in pregnant women with a

history of encephalopathy of unknown origin within 7 days

of previous immunisation with a pertussis-containing

vaccine. Contra-indicated in pregnant women with a

history of transient thrombocytopenia or neurological

complications following previous immunisation against

diphtheria or tetanus.

lPRESCRIBING AND DISPENSING INFORMATIONPregnant

women should be vaccinated using low dose vaccines

(brands may includeBoostrix-IPV®orRepevax®).

Available as part of childhood immunisation schedule

from health organisations or ImmForm.

Available for vaccination of pregnant women from

ImmForm.

lMEDICINAL FORMS

There can be variation in the licensing of different medicines

containing the same drug.

Suspension for injection

EXCIPIENTS:May contain Neomycin, polymyxin b, streptomycin

▶Boostrix-IPV(GlaxoSmithKline UK Ltd)

Boostrix-IPV suspension for injection 0. 5 ml pre-filled syringes| 1 pre-

filled disposable injectionP£ 22. 74

▶Repevax(Sanofi Pasteur)

Repevax vaccine suspension for injection 0. 5 ml pre-filled syringes|

1 pre-filled disposable injectionP£ 20. 00

BNFC 2018 – 2019 Vaccination 789

Vaccines

14