bottled water, or tap water that has been boiled or treated
with sterilising tablets, should be used for drinking.
Information on health advice for travellers
Health professionals and travellers can find the latest
information on immunisation requirements and precautions
for avoiding disease while travelling from: www.nathnac.org.
The handbook, Health Information for Overseas Travel
(2010), which draws together essential information for
healthcare professionals regarding health advice for
travellers, can also be obtained from this website.
Immunisation requirements change from time to time, and
information on the current requirements for any particular
country may be obtained from the embassy or legation of the
National Travel Health Network and Centre
(Monday and Friday: 9–11 a.m. and 1–2 p.m., Tuesday to
Thursday: 9–11 a.m. and 1–3:30 p.m. For healthcare
(2–4 p.m. Monday to Wednesday, 9:30–11:30 a.m. Friday;
for registered TRAVAX users only)
(TRAVAX is free for NHS Scotland users (registration
required); subscription fee may be payable for users
Department of Health, Social Services and Public
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
. 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
CONTRA-INDICATIONS, FURTHER INFORMATION
▶ Impaired immune response Severely immunosuppressed
patients should not be given live vaccines (including those
with severe primary immunodeficiency).
l CAUTIONS Acute illness . minor illnesses
CAUTIONS, FURTHER INFORMATION Vaccination 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
▶ Impaired immune response and drugs affecting immune
response Immune 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-dose
systemic corticosteroids and at least 6 months after
stopping other immunosuppressive drugs or generalised
radiotherapy (at least 12 months after discontinuing
immunosuppressants following bone-marrow
The Royal College of Paediatrics and Child Health has
produced a statement, Immunisation of the
Immunocompromised Child (2002)(available at www.rcpch.
▶ Predisposition to neurological problems When there is a
personal or family history of febrile convulsions, there is an
increased risk of these occurring during fever from any
seizure associated with fever without neurological
deterioration, immunisation is recommended; advice on
the management 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,
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 a still 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
▶ Common or very common Appetite decreased . arthralgia
(frequency not known in elderly). diarrhoea (uncommon
(uncommon in elderly). malaise . myalgia . nausea
(uncommon in elderly). skin reactions (rare in elderly). vomiting (uncommon in elderly)
▶ Uncommon Hypersensitivity (frequency not known in
l ALLERGY AND CROSS-SENSITIVITY Contra-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
l PREGNANCY Live 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.
l BREAST FEEDING Although 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
l DIRECTIONS FOR ADMINISTRATION If 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. 1313, and Cautions, further
information in measles, mumps and rubella vaccine, live
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 with bleeding 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 advised against the use of
jet guns for 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.
l HANDLING AND STORAGE Care must be taken to store all
vaccines under the conditions recommended in the
product literature, otherwise the preparation may become
ineffective. Refrigerated storage is 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 eiiiF 1310i
influenzae type b vaccine, pertussis,
▶ Child 2 months–9 years: 0.5 mL every month for 3 doses
l UNLICENSED USE Infanrix-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.
▶ Common or very common Crying abnormal . drowsiness . restlessness
▶ Uncommon Cough . extensive swelling of vaccinated limb . increased risk of infection .rhinorrhoea
▶ Frequency not known Angioedema . apnoea . hypotonichyporesponsiveness episode . seizure
SIDE-EFFECTS, FURTHER INFORMATION The incidence of
local and systemic reactions is lower with acellular
pertussis vaccines than with whole-cell pertussis vaccines
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.
l PRESCRIBING AND DISPENSING INFORMATION Available as
part of childhood schedule from health organisations or
l MEDICINAL 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 0.5ml pre-filled syringes | 1 pre-filled disposable
poliomyelitis vaccine and tetanus
▶ Child 3–9 years: 0.5 mL, to be given 3 years after
Vaccination of pregnant women against pertussis (using
▶ Females of childbearing potential: 0.5 mL for 1 dose
▶ Common or very common Abdominal pain
children). extensive swelling of vaccinated limb (very
common in children). oral herpes . pain . paraesthesia . sleep disorder (in children)
▶ Frequency not known Angioedema . asthenia . hypotonichyporesponsiveness episode . seizure
SIDE-EFFECTS, FURTHER INFORMATION The incidence of
local and systemic reactions is lower with acellular
pertussis vaccines than with whole-cell pertussis vaccines
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.
l PREGNANCY Contra-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
l PRESCRIBING AND DISPENSING INFORMATION Pregnant
women should be vaccinated using low dose vaccines
(brands may include Boostrix-IPV ® or Repevax ®).
Available as part of childhood immunisation schedule
from health organisations or ImmForm.
Available for vaccination of pregnant women from
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
EXCIPIENTS: May contain Neomycin, polymyxin b, streptomycin
▶ Boostrix-IPV (GlaxoSmithKline UK Ltd)
Diphtheria with poliomyelitis and
▶ Child 10–17 years: 0.5 mL every month for 3 doses
▶ Adult: 0.5 mL every month for 3 doses
▶ Child 10–17 years: 0.5 mL for 1 dose, first booster dose—
should be given 3 years after primary course (this
interval can be reduced to a minimum of 1 year if the
primary course was delayed), then 0.5 mL for 1 dose,
second booster dose—should be given 10 years after
first booster dose (this interval can be reduced to a
minimum of 5 years if previous doses were delayed),
second booster dose may also be used as first booster
dose in those over 10 years who have received only
3 previous doses of a diphtheria-containing vaccine
▶ Adult: 0.5 mL for 1 dose, first booster dose—should be
given 3 years after primary course (this interval can be
reduced to a minimum of 1 year if the primary course
was delayed), then 0.5 mL for 1 dose, second booster
dose—should be given 10 years after first booster dose
(this interval can be reduced to a minimum of 5 years if
previous doses were delayed), second booster dose may
also be used as first booster dose in those over 10 years
who have received only 3 previous doses of a
▶ Common or very common Vertigo
l PRESCRIBING AND DISPENSING INFORMATION Available as
part of childhood schedule from health organisations or
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
EXCIPIENTS: May contain Neomycin, polymyxin b, streptomycin
Diphtheria with tetanus, pertussis,
hepatitis B, poliomyelitis and
Primary immunisation (first dose)
▶ BY DEEP INTRAMUSCULAR INJECTION
▶ Child 2 months: 0.5 mL for 1 dose
Primary immunisation (second dose)
▶ BY DEEP INTRAMUSCULAR INJECTION
▶ Child 3 months: 0.5 mL for 1 dose, preferably administer
at a different injection site to that of first dose
Primary immunisation (third dose)
▶ BY DEEP INTRAMUSCULAR INJECTION
▶ Child 4 months: 0.5 mL for 1 dose, preferably administer
at a different injection site to that of second dose
▶ Common or very common Anxiety . crying abnormal
▶ Uncommon Cough . drowsiness . extensive swelling of
vaccinated limb . increased risk of infection
l PRESCRIBING AND DISPENSING INFORMATION Available as
part of childhood schedule from health organisations or
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
Powder and suspension for suspension for injection
EXCIPIENTS: May contain Neomycin, polymyxin b
▶ Infanrix Hexa (GlaxoSmithKline UK Ltd)
Infanrix Hexa vaccine powder and suspension for suspension for
injection 0.5ml pre-filled syringes | 1 pre-filled disposable
▶ Adult: Initially 0.5 mL every 3 weeks for 3 doses,
followed by 0.5 mL after 6 months, to be administered
▶ Adult: 0.5 mL every 10 years for up to 3 doses, to be
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