Post-exposure treatment for unimmunised individuals (or
those whose prophylaxis is possibly incomplete)
▶ Child (administered on expert advice): 1 mL 5 times a
month for 1 month, doses should be given on days 0, 3,
7, 14, and the fifth dose is given between day 28–30, to
be administered in deltoid region or anterolateral thigh
in infants, depending on the level of risk (determined
by factors such as the nature of the bite and the
country where it was sustained), rabies
immunoglobulin is given to unimmunised individuals
on day 0 or within 7 days of starting the course of
rabies vaccine, the immunisation course can be
discontinued if it is proved that the individual was not
▶ Adult (administered on expert advice): 1 mL 5 times a
month for 1 month, doses should be given on days 0, 3,
7, 14, and the fifth dose is given between day 28–30, to
be administered in deltoid region, depending on the
level of risk (determined by factors such as the nature
of the bite and the country where it was sustained),
rabies immunoglobulin is given to unimmunised
individuals on day 0 or within 7 days of starting the
course of rabies vaccine, the immunisation course can
be discontinued if it is proved that the individual was
l INTERACTIONS → Appendix 1: rabies vaccine
▶ Common or very common Asthenia . gastrointestinal
l PREGNANCY Because of the potential consequences of
untreated rabies exposure and because rabies vaccination
has not been associated with fetal abnormalities,
indicated during pregnancy if there is substantial risk of
exposure to rabies and rapid access to post-exposure
prophylaxis is likely to be limited.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
Powder and solvent for suspension for injection
EXCIPIENTS: May contain Neomycin
▶ Rabies vaccine (Non-proprietary)
Rabies vaccine powder and solvent for suspension for injection 1ml
Powder and solvent for solution for injection
EXCIPIENTS: May contain Neomycin
▶ Rabipur (GlaxoSmithKline UK Ltd)
Rabipur vaccine powder and solvent for solution for injection 1ml vials
l DRUG ACTION Rotavirus vaccine is a live, oral vaccine that
protects young children against gastro-enteritis caused by
Immunisation against gastro-enteritis caused by rotavirus
▶ Child 6–23 weeks: 1.5 mL for 2 doses separated by an
interval of at least 4 weeks, first dose must be given
between 6–14 weeks of age; course should be
completed before 24 weeks of age (preferably before
PUBLIC HEALTH ENGLAND: UPDATE TO GREEN BOOK (OCTOBER
Public Health England advises that immunisation with
live vaccines should be delayed until 6 months of age in
children born to mothers who received
immunosuppressive biological therapy during
pregnancy. In practice, this means that children born to
mothers who were on immunosuppressive biological
therapy during pregnancy will not be eligible to receive
CONTRA-INDICATIONS, FURTHER INFORMATION
▶ Immunosuppression With the exception of severe combined
immunodeficiency (and children born to mothers who
received immunosuppressive biological therapy during
pregnancy, see Important safety information), rotavirus
vaccine is not contra-indicated in immunosuppressed
patients—benefit from vaccination is likely to outweigh
the risk, if there is any doubt, seek specialist advice.
l CAUTIONS Diarrhoea (postpone vaccination). immunosuppressed close contacts . vomiting (postpone
CAUTIONS, FURTHER INFORMATION The rotavirus vaccine
virus is excreted in the stool and may be transmitted to
close contacts; however, vaccination of those with
immunosuppressed close contacts may protect the
contacts from wild-type rotavirus disease and outweigh
any risk from transmission of vaccine virus.
l INTERACTIONS → Appendix 1: live vaccines
▶ Uncommon Abdominal pain . gastrointestinal disorders
▶ Frequency not known Apnoea . haematochezia
l PATIENT AND CARER ADVICE The rotavirus vaccine virus is
excreted in the stool and may be transmitted to close
contacts; carers of a recently vaccinated baby should be
advised of the need to wash their hands after changing the
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
▶ Rotarix (GlaxoSmithKline UK Ltd)
Rotarix vaccine live oral suspension 1.5ml pre-filled syringes | 1 unit
Rotarix vaccine live oral suspension 1.5ml tube | 1 tube P £34.76
Tick-borne encephalitis vaccine,
Initial immunisation against tick-borne encephalitis
▶ Child 1–15 years: 0.25 mL for 1 dose, followed by 0.25 mL
after 1–3 months for 1 dose, then 0.25 mL after further
5–12 months for 1 dose, to achieve more rapid
protection, second dose may be given 14 days after first
dose, dose to be administered in deltoid region or
anterolateral thigh in infants, in immunocompromised
patients (including those receiving
immunosuppressants), antibody concentration may be
measured 4 weeks after second dose and dose repeated
if protective levels not achieved continued→
▶ Child 16–17 years: 0.5 mL for 1 dose, followed by 0.5 mL
after 1–3 months for 1 dose, then 0.5 mL after further
5–12 months for 1 dose, to achieve more rapid
protection, second dose may be given 14 days after first
dose, dose to be administered in deltoid region, in
immunocompromised patients (including those
receiving immunosuppressants), antibody
concentration may be measured 4 weeks after second
dose and dose repeated if protective levels not
▶ Adult: 0.5 mL for 1 dose, followed by 0.5 mL after
1–3 months for 1 dose, then 0.5 mL after further
5–12 months for 1 dose, to achieve more rapid
protection, second dose may be given 14 days after first
dose, dose to be administered in deltoid region, in
immunocompromised patients (including those
receiving immunosuppressants), antibody
concentration may be measured 4 weeks after second
dose and dose repeated if protective levels not
▶ Elderly: 0.5 mL for 1 dose, followed by 0.5 mL after
1–3 months for 1 dose, then 0.5 mL after further
5–12 months for 1 dose, to achieve more rapid
protection, second dose may be given 14 days after first
dose, dose to be administered in deltoid region,
antibody concentration may be measured 4 weeks after
second dose and dose repeated if protective levels not
Immunisation against tick-borne encephalitis, booster
▶ Child 1–17 years: First dose to be given within 3 years
after initial course completed and then every
3–5 years, dose to be administered in deltoid region or
anterolateral thigh in infants (consult product
▶ Adult: First dose to be given within 3 years after initial
course completed and then every 3–5 years, dose to be
administered in deltoid region (consult product
▶ Common or very common Restlessness (in children). sleep
▶ Rare or very rare Asthenia . autoimmune disorder (in
adults). chills (uncommon in children). demyelination (in
adults). drowsiness (in adults). dyspnoea . eye pain . gait
abnormal . gastrointestinal discomfort (uncommon in
adults).tinnitus . vertigo . vision disorders
l ALLERGY AND CROSS-SENSITIVITY Individuals with
evidence of previous anaphylactic reaction to egg should
not be given tick-borne encephalitis vaccine.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
EXCIPIENTS: May contain Gentamicin, neomycin
TicoVac Junior vaccine suspension for injection 0.25ml pre-filled
syringes | 1 pre-filled disposable injection P £28.00
Prevention of varicella infection (chickenpox)
▶ Child 1–17 years: 0.5 mL every 4–6 weeks for 2 doses, to
be administered into the deltoid region or anterolateral
▶ Adult: 0.5 mL every 4–6 weeks for 2 doses, to be
administered into the deltoid region or anterolateral
Prevention of varicella infection (chickenpox)
▶ BY SUBCUTANEOUS INJECTION, OR BY INTRAMUSCULAR
▶ Child 1–12 years: 0.5 mL for 2 doses, interval of at least
4 weeks between each dose, to be administered into the
deltoid region (or higher anterolateral thigh in young
▶ Child 13–17 years: 0.5 mL for 2 doses, interval of
4–8 weeks between each dose, to be administered
preferably into the deltoid region
▶ Adult: 0.5 mL for 2 doses, interval of 4–8 weeks
between each dose, to be administered preferably into
Prevention of varicella infection (chickenpox) in children
with asymptomatic HIV infection
▶ BY SUBCUTANEOUS INJECTION, OR BY INTRAMUSCULAR
▶ Child 1–12 years: 0.5 mL for 2 doses, interval of 12 weeks
between each dose, to be administered into the deltoid
region (or higher anterolateral thigh in young children)
Prevention of herpes zoster (shingles)
▶ Adult 70–79 years: 0.65 mL for 1 dose, to be
administered preferably into the deltoid region
l CAUTIONS Post-vaccination close contact with susceptible
CAUTIONS, FURTHER INFORMATION Rarely, the varicella–
zoster vaccine virus has been transmitted from the
vaccinated individual to close contacts. Therefore, contact
with the following should be avoided if a vaccine-related
cutaneous rash develops within 4–6 weeks of the first or
. varicella-susceptible pregnant women;
. individuals at high risk of severe varicella, including
those with immunodeficiency or those receiving
Healthcare workers who develop a generalised papular
or vesicular rash on vaccination should avoid contact with
patients until the lesions have crusted. Those who develop
a localised rash after vaccination should cover the lesions
and be allowed to continue working unless in contact with
patients at high risk of severe varicella.
▶ Administration with MMR vaccine Varicella–zoster and MMR
vaccines can be given on the same day or separated by a
4-week minimum interval. When protection is rapidly
required, the vaccines can be given at any interval and an
additional dose of the vaccine given second may be
l INTERACTIONS → Appendix 1: live vaccines
▶ Uncommon Cough . drowsiness . increased risk of infection
l CONCEPTION AND CONTRACEPTION Avoid pregnancy for
l PRESCRIBING AND DISPENSING INFORMATION
ZOSTAVAX ® Advice in the BNF may differ from that in
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
Powder and solvent for suspension for injection
EXCIPIENTS: May contain Gelatin, neomycin
▶ Varivax (Merck Sharp & Dohme Ltd)
Varivax vaccine powder and solvent for suspension for injection 0.5ml
▶ Zostavax (Merck Sharp & Dohme Ltd)
Zostavax vaccine powder and solvent for suspension for injection
0.65ml pre-filled syringes | 1 pre-filled disposable injection P £99.96 DT = £99.96
Powder and solvent for solution for injection
EXCIPIENTS: May contain Neomycin
▶ Varilrix (GlaxoSmithKline UK Ltd)
Varilrix vaccine powder and solvent for solution for injection 0.5ml
Yellow fever vaccine, live 22-May-2019
Immunisation against yellow fever
▶ BY DEEP SUBCUTANEOUS INJECTION
▶ Child 6–8 months (administered on expert advice): Infants
under 9 months should be vaccinated only if the risk of
yellow fever is high and unavoidable (consult product
literature or local protocols)
▶ Child 9 months–17 years: 0.5 mL for 1 dose
MHRA/CHM ADVICE: YELLOW FEVER VACCINE (STAMARIL ®) AND
FATAL ADVERSE REACTIONS: EXTREME CAUTION NEEDED IN
PEOPLE WHO MAY BE IMMUNOSUPPRESSED AND THOSE 60 YEARS
The yellow fever vaccine (Stamaril ®) has been associated
with an increased risk of life-threatening reactions and
must not be given to patients with a history of thymus
dysfunction (including myasthenia gravis and
thymoma), to patients that are immunosuppressed, or
that have had a thymectomy. Vaccination in patients
aged 60 years and older should be administered with
extreme caution, following a careful risk assessment.
Prior to administering yellow fever vaccines, healthcare
professionals are advised to familiarise themselves with
any contra-indications and special precautions, and to
defer vaccination if it is suspected that a patient is
immunosuppressed, until specialist advice can be
sought. Healthcare professionals administering vaccines
should consult information in the YF Vaccine Centre
code of practice and strengthen protocols and checklists
to avoid inappropriate administration.
l CONTRA-INDICATIONS Children under 6 months . history of
l CAUTIONS Individuals over 60 years—greater risk of
vaccine-associated adverse effects
▶ Administration with MMR vaccine Yellow fever and MMR
vaccines should not be administered on the same day;
there should be a 4-week minimum interval between the
vaccines. When protection is rapidly required, the vaccines
can be given at any interval and an additional dose of MMR
l INTERACTIONS → Appendix 1: live vaccines
▶ Common or very common Asthenia . crying (in children). drowsiness (in children)
▶ Rare or very rare Rhinitis . yellow fever vaccine-associated
neurotropic disease . yellow fever vaccine-associated
▶ Frequency not known Angioedema . influenza like illness . paraesthesia
disease (yellow-fever vaccine-associated viscerotropic
disease, YEL-AVD), a syndrome which may include
encephalitis have also been reported. These very rare
adverse effects usually occur after the first dose of yellow
fever vaccine in those with no previous immunity.
Increased risk of fatal reactions reported in patients aged
60 years and older and those who are immunosuppressed.
l ALLERGY AND CROSS-SENSITIVITY Yellow fever vaccine
should only be considered under the guidance of a
specialist in individuals with evidence of previous
l PREGNANCY Live yellow fever vaccine should not be given
during pregnancy because there is a theoretical risk of fetal
infection. Pregnant women should be advised not to travel
to areas at high risk of yellow fever. If exposure cannot be
avoided during pregnancy, then the vaccine should be
given if the risk from disease in the mother outweighs the
risk to the fetus from vaccination.
l BREAST FEEDING Avoid; seek specialist advice if exposure
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
Powder and solvent for suspension for injection
Stamaril vaccine powder and solvent for suspension for injection 0.5ml
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