BNF 78 (British National Formulary) September 2019
Summary study book BNF 78 (British National Formulary) September 2019 of Joint Formulary Committee (Chapter 14 - Vaccines) - ISBN: 9780857113511, Edition: 78, Year of publication: - (Summary of Vaccines)
Immunoglobulin therapy
Passive immunity – obtained by injecting preps made from the plasma of immune individuals with adequate
levels of antibody to the disease for which protection is sought
PHE – use normal immunoglobin with vaccine to prevent infection in >60
years age, chronic liver disease, HIV or immunosuppressed
Hepatitis A
Hep A and normal immunoglobulin can be given at the same time but
should be given at separate injection sites
Most effective within 72hrs but can be given within 6 days
Measles Consider immunoglobulin if in contact with confirmed case, non-immune
pregnant women and infants < 9 months
Immunoglobulin after exposure does NOT prevent infection and is NOT
Rubella
advised in pregnancy
Site of the bite should be washed with soapy water and all of the dose
should be injected around the wound site.
Rabies
If there’s delay giving the rabies immunoglobulin, it should be given
within 7 days of starting the course of rabies vaccine
Varicella-zoster Advised in individuals who are at increased risk – neonates, pregnancy,
immunoglobulin immunosuppressed
Tetanus Use together with wound cleansing and antibacterial prophylaxis
immunoglobulin For established cases, use with metronidazole as treatment
Vaccination
Vaccines that can be received by HIV +ve Pts AVOID in HIV +ve Pts
MMR (live) Influenza
Varicella zoster (live) Meningococcal
Rotavirus (live) Pertussis
BCG
Anthrax Pneumococcal
Influenza nasal spray
Cholera (oral) Poliomyelitis
Typhoid (oral)
Diphtheria Rabies
Yellow fever
Haemophilus influenzae type B Tetanus
Hep A and B Tick-borne encephalitis
Human papillomavirus Typhoid (injection)
Anthrax vaccine – 4-dose regimen used as primary immunisation. All suspected cases must be reported
BCG vaccine – advised in the following groups:
All neonates/infants born in high incidence areas
Contacts aged < 36 years of those with active respiratory TB
Healthcare workers and lab staff who’ve been in contact (occupational risk)
Individuals < 16 years intending to live in a high incidence area for > 3 months
Neonates with a F/H of TB in last 5 years
Neonates, infants and children < 16 years with parent/grandparent born in a high incidence area
, New immigrants aged < 16 years who were born in or lived for > 3 months in a high incidence area
New immigrants aged 16-35 years from Sub-Saharan Africa or very high incidence area
Botulism antitoxin – neutralises toxins produced by Clostridium botulinum types A, B and E
Cholera vaccine (oral) – licensed for ages > 2 years going to endemic areas. It’s given at least 1 week before.
Hepatitis A vaccine – recommended for:
Lab staff working with the virus or with Prevention of secondary cases in close
primates contacts of confirmed Hepatitis A cases
Parenteral drug abusers Staff and residents of homes for those with
Patients with severe/chronic liver disease, severe learning difficulties
haemophilia and other clotting disorders Workers exposed to untreated sewage
Human papillomavirus vaccine – to prevent cervical and anal cancers, genital warts and anal lesions caused
by HPMV types 6, 11, 16 and 18. It’s most effective when given before sexual activity starts. Females in
England can receive the vaccine up to the age of 18 years if they didn’t receive it before.
Influenza vaccination – recommended in individuals over 6 months and with the following conditions:
> 65 years HIV infection
Carers of individuals whose welfare may be at Household contacts of immunocompromised
risk if the carer falls ill individuals
Children (ages 2-17 years should be offered Immunosuppression due to disease or
live nasal spray) treatment (incl. prolonged corticosteroid Tx
Chronic respiratory, heart, liver, neurological and chemo)
or renal disease at stage 3, 4 or 5 Morbid obesity (BMI >40kg/m2)
Complement disorders (e.g. C2 deficiency) Pregnant women
Diabetes mellitus Residents of nursing or residential homes for
Frontline health and social care workers elderly and other long-stay facilities
Japanese encephalitis vaccine – course of 2 doses should be completed at least 1 week before travel.
Pertussis vaccine (whooping cough) – should be offered to pregnant women around 18-20 weeks.
Pneumococcal vaccine – recommended for all >65s and children >2yrs and the following risk groups:
Asplenia Conditions where leakage of CSF may occur
Chronic heart, liver or renal disease Diabetes mellitus
Chronic respiratory disease (severe asthma or Immunosuppression
long-term steroids) Presence of cochlear implant
Rotavirus vaccine – live, oral vaccine that protects against gastroenteritis.
National shingles immunisation programme and live varicella-zoster vaccine (‘Zostavax’) – aims to lower
incidence and severity of shingles. It’s offered to patients aged 70 and more recently 70-79 year olds.
Yellow fever vaccine – live vaccine recommended for lab workers handling infected materials and
individuals aged >9 months who are travelling to countries at risk and those that require an ICVP certificate.
A single-dose provides lifetime protection. Children <9 months are at risk of vaccine-associated encephalitis.
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