14: Immunological products and vaccines
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1 File name: Immunological Products and s Formulary BNF Original Date of issue: 30/10/2005 Last Reviewed: 23/11/2012 Version:4 Page 1 of 6 14: Immunological products and vaccines 14.1 Active immunity Live vaccines Listed below are the live vaccines: BCG Measles Mumps and Rubella Varicella Zoster Yellow Fever Oral Typhoid vaccine (Vivotif) Live vaccines should not be administered routinely to pregnant women because of possible harm to the foetus but hwere there is significant exposure to (e.g. yellow fever) the need for vaccinations outweighs the risk to the fetus. Live vaccines should not be given to individuals with impaired immune response, whether caused by disease or treatment of high dose corticosteroids or other immunosupressive drugs. Live vaccines should not be given to individuals being treated for malignant conditions with chemotherapy of generalised radiotherapy. For HIV +ve patients see BNF section 14.1LINK s and Asplenia The following vaccines are recommended for asplenic patients or those with asplenic dysfunction: Hib/Men C vaccine Haemophilus influenzae type B Meningococcal group C conjugate vaccine Pneumococcal vaccine Influenza For antibiotic prophylaxis in asplenia see BNFsection Passive immunity NIL 14.3 Storage and usage Refer to the BNF and the new chapter in Immunisation against infections disease (The green book) book
2 File name: Immunological Products and s Formulary BNF Original Date of issue: 30/10/2005 Last Reviewed: 23/11/2012 Version:4 Page 2 of and antisera Link immunisation schedule BNF 14.1 Link to the green book D = diphtheria d = low dose diptheria T = tetanus 5aP = pertussis (five component acellular vaccine) 3aP = pertussis (three component acellular vaccine) IPV = poliomyelitis (inactivated vaccine) Hib = Haemophilus influenzae type b HPV = Human Papilloma Virus BCG SSI (Intradermal 10-dose with diluent) Adsorbed Diphtheria (low dose) Tetanus and Inactivated Poliomyelitis (3 in 1 Td IPV) Adsorbed Diphtheria ( low dose) Tetanus Pertussis (Acellular Component) and Inactivated Poliomyelitis ( 4 in 1) dt5ap-ipv Trade name Dose Dose 0.1mL Children less than 12 months 0.05mL ( REVAXIS) Comments (REPEVAX ) Repevax is also being used in community for pregnant women in view of increasing nuber of cases of pertussis in babies. Diphtheria Tetanus Pertussis (PEDIACEL) ( Acellular Component) Poliomyelitis ( Inactivated) and Hib/Men C vaccine Hib/Men C (MENITORIX) Hepatitis A HAVRIX ADULT MONODOSE Dose 1mL Link to DoH advice on Whooping cough
3 File name: Immunological Products and s Formulary BNF Original Date of issue: 30/10/2005 Last Reviewed: 23/11/2012 Version:4 Page 3 of 6 Hepatitis A paediatric vaccines Hepatitis B Adult (1mL) Hepatitis B paediatric vaccine 0.5mL Human Papilloma Virus Trade name HAVRIX Junior Monodose ENGERIX B 20micrograms/1m L HBvaxPRO 10micrograms/1m L ENGERIX B 10micrograms/0.5 ml HBvaxPRO 5micrograms/0.5 ml. GUARDASIL HPV types 6,11,16,and 18 Dose (children 1-15 years) Adult dose 1mL dose Adult dose 1mL dose Paediatric dose 0.5mL dose Paediatric dose mLs Comments 1 st line 2 nd line for non or poor responders 1 st line 2 nd line for non or poor responders. Vaccinations usually done in school therefore not kept in stock Inactivated Influenza (Syringe) Measles Mumps and Rubella (MMR) Meningococcal Group C Conjugate Pneumococcal Polysaccharide 23 valent Pneumococcal Polysaccharide Conjugate 13 valent (MMR VaxPro single dose brand contains porcine gelatine) or PRIORIX vial MENJUGATE 2012/2013 Trust purchased supplies for staff and asplenic patients only, other patients to obtain from GPs on discharge. See Kevin Frost for further information PNEUMOVAX II Adults, and children from 2 years PREVENAR 13 Children 2 months to 5 years.
4 File name: Immunological Products and s Formulary BNF Original Date of issue: 30/10/2005 Last Reviewed: 23/11/2012 Version:4 Page 4 of 6 Trade name Dose Comments Rabies 2.5units/1ml RABIPUR Requires consultant virologist at Seacroft hospital LEEDS to agree to requests from medical staff to release supply of vaccine and immunoglobulin in view of Tuberculin PPD RT 23 SSI 2TU Polysaccharide Typhoid 0.5mL limited stocks. Dose 0.1mL For Mantoux tests TYPHIM VI Reserved for laboratory staff handling specimens from suspected cases. Currently unavailable Varicella Zoster VARIVAX For seronegative staff in direct contact with patients. For paediatric patients on Consultant request only Formulary Product Restriction status C Poliomyelitis Inactivated Consultant Paediatrician use only.
5 File name: Immunological Products and s Formulary BNF Original Date of issue: 30/10/2005 Last Reviewed: 23/11/2012 Version:4 Page 5 of Immunoglobulins Normal immunoglobulins Link to normal immunoglobulins (IVIG) SOP Normal Immunoglobulin 10% (5g/50ml, 10g/100ml, 20g/200ml) Infusion for Intravenous Use (Privigen) is currently our standard product Normal Immunoglobulin 5% (5g/100mL) Infusion for Intravenous Use (Vigam, Intratect, Kiovig) can also be obtained Normal Immunoglobulin 750mg (Subgam) Subcutaneous injection or IM injection Formulary Product status R Normal Immunoglobulin 16% (Subcuvia) 800mg/5ml 1600mg/10ml Restriction Consultant Paediatrician use only.
6 File name: Immunological Products and s Formulary BNF Original Date of issue: 30/10/2005 Last Reviewed: 23/11/2012 Version:4 Page 6 of Disease specific immunoglobulins Tetanus Immunoglobulin 250units/1mL Syringe BPL, (Tetabulin [unlicensed ]) IM injection limited supplies of licensed immunoglobulin available from BPL. Specific Immunoglobulins not listed above should be requested from haematology department Hepatitis B immunoglobulin, Rabies immunoglobulin* Varicella zoster immunoglobulin (VZIG)* Discuss with Sara Keogh Antenatal Co-ordinator. * Medical staff need to discuss both with consultant virologist at Seacroft hospital Leeds who needs to authorise supply of these products due to very limited stocks Anti D (Rh 0 ) immunoglobulin NICE guidance Routine antenatal anti-d prophylaxis should be offered to all non sensitised pregnant women who are rhesus negative. If both the biological mother and biological father are rhesus negative then anti-d prophylaxis is not required. Anti-D (Rh o ) immunoglobulin 300mcg/2mLs (1500 Units Rhophylac syringe, for IM or IV use. (From pharmacy, restricted to ANDAU for antenatal prophylaxis). Anti-D (Rh o ) immunoglobulin 250 units, 500 units D-GAM deep IM injection should be requested from haematology department International Travel NIL
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