Children without a documented history of vaccination are recommended to have a full course of vaccinations appropriate for their age. In cases of doubt, it is safe to repeat vaccine doses: it is preferable for the individual to receive an unnecessary dose than to miss out a required dose s and not be fully protected. Whenever adults are seen in general practice or by immunisation providers, there is an opportunity to ensure they have been adequately protected against the following diseases and have received at least a primary immunisation course as described in Table 2.
If the requisite number of doses has not been received, catch-up vaccination is recommended and funded see Appendix 2.
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Women of childbearing age should know whether or not they are immune to rubella see chapter 18 and varicella see chapter See Table 2. For patients who are pre- or post-splenectomy or with functional asplenia; with HIV; with complement deficiency acquired, including monoclonal antibody therapy against C5, or inherited ; who are pre- or post-solid organ transplant. Tdap for re- vaccination of patients who are post-HSCT or chemotherapy; pre- or post-splenectomy; pre- or post-solid organ transplant, renal dialysis and other severely immunosuppressive regimens.
HIV-positive patients who are non-immune to varicella, with mild or moderate immunosuppression h. Household contacts of paediatric patients who are immunocompromised or undergoing a procedure leading to immunocompromise, where the household contact has no clinical history of varicella. See also section 2. Correct vaccine administration is important, and vaccinators have a responsibility to see that vaccines are given:.
For children, sit them upright and talk quietly to the child before and during immunisation. Make eye contact and explain what is going to happen. Advice for removal of air in the syringe before vaccine administration is dependent on the vaccine presentation. Skin preparation or cleansing when the injection site is clean is not necessary. However, if an alcohol swab is used, it must be allowed to dry for at least two minutes, otherwise alcohol may be tracked into the muscle, causing local irritation. Alcohol may also inactivate a live attenuated vaccine such as MMR.
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A dirty injection site may be washed with soap and water and thoroughly dried before the immunisation event. Where possible, vaccinators should refer to the vaccine data sheet available on the Medsafe website: www. Most Schedule vaccines with the exception of MMR, VV and IPV, which are administered subcutaneously, and rotavirus, which is administered orally are administered by intramuscular injection. Intramuscular injections should be administered at a 90 degree angle to the skin plane.
BCG vaccine which can only be administered by authorised vaccinators with BCG endorsement is given by intradermal injection. Injectable vaccines should be administered in healthy, well-developed muscle, in a site as free as possible from the risk of local, neural, vascular and tissue injury. Incorrectly administered vaccines incorrect sites and poor administration techniques contribute to vaccine failure, injection site nodules or sterile abscesses, and increased local reactions.
The recommended sites for intramuscular IM vaccines based on proven uptake and safety data are:. The deltoid muscle is not routinely used in infants and young children aged under 15 months, due to the potential for deltoid or radial nerve injury.
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However, when there is no access to the vastus lateralis eg, the infant is in a spica cast , the deltoid muscle is used to administer intramuscular vaccines. Use of the buttock is not recommended for adult vaccinations either, because the buttock subcutaneous layer can vary from 1 to 9 cm and IM deposition may not occur. A subcutaneous SC injection should be given into healthy tissue that is away from bony prominences and free of large blood vessels or nerves. The recommended site for subcutaneous vaccine administration is the upper arm overlying the deltoid muscle. The principles for locating the upper arm site for an SC injection are the same as for an IM injection.
However, needle length is more critical than angle of insertion for subcutaneous injections. See also Table 2.
The intradermal injection technique for BCG vaccine see section 2. The rotavirus vaccine is administered orally. Do not inject oral vaccines. For specific oral vaccine administration instructions, refer to the vaccine data sheet available on the Medsafe website: www. At this age, excessive restraint increases their fear as well as muscle tautness. Most vaccinators choose to administer all the injections due quickly and soothe the infant or child afterwards see section 2.
The injection site is at the junction of the upper and middle thirds and slightly anterior to above the imaginary line, in the bulkiest part of the muscle. Inject the vaccine at a controlled rate. To avoid tracking, make sure all the vaccine has been injected before smoothly withdrawing the needle. Do not massage or rub the injection site afterwards. However, infants with a bleeding disorder may require firm pressure over the injection site without rubbing for at least 10 minutes.
The reconstituted BCG vaccine is given by intradermal injection slightly above the insertion of the deltoid muscle on the lateral surface of the left arm.
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The syringe should be held with the bevel uppermost, parallel with the skin of the arm see Figure 2. Inject the vaccine slowly see Figure 2. The injection is given slowly to avoid leakage around the needle or vaccine being squirted.
Safety glasses should be used to protect the eyes of those involved. If BCG vaccine is accidentally squirted into the eyes, wash them immediately with water. Following BCG vaccination a white weal should appear see Figure 2. The vaccination site requires no swabbing or dressing. If using the straddle position, both the deltoid and vastus lateralis muscle are likely to be more tense or taut, and the injection may therefore be more painful.
The deltoid muscle is located in the lateral aspect of the upper arm. The entire deltoid muscle must be exposed to avoid the risk of radial nerve injury an injection at the junction of the middle and upper thirds of the lateral aspect of the upper arm may damage the nerve see Figure 2.
Reproduced with permission: Cook IF. Human Vaccines 7 8 : —8. The vaccinee should be seated with their arm removed from the garment sleeve and hanging relaxed at their side. The injection site is at the axilla line, between these anatomical landmarks. The vaccine should be deposited at the bulkiest part of the muscle Figure 2. When more than one vaccine is scheduled at the same visit, vaccinators are recommended to give all of the scheduled vaccines at that visit. This particularly applies to the month event see below , when four vaccines are scheduled.
The IM injections should be given in the vastus lateralis and the SC injections in the deltoid. When giving two injections to be given in the same limb, the vastus lateralis is preferred because of its greater muscle mass see Figure 2. If multiple injections in the deltoid are required, the sites should be separated by at least 2 cm.
Measles component: Fever which lasts 1—2 days; rash not infectious 6—12 days after immunisation. The use of paracetamol or ibuprofen around the time of immunisation in anticipation of immunisation-related fever or localised pain occurring is not recommended. However, use of these medicines is recommended if the child is distressed due to fever or pain following immunisation. Paracetamol use may lower the immune response to some vaccines. Health care providers are encouraged to discuss with parents possible immunisation responses and non-pharmaceutical management of fever or pain, as well as the role of medicines.
While a high fever alone does not need treatment, antipyretic analgesics paracetamol or ibuprofen may be used for distress or pain in a febrile child who has not responded to the cooling measures described above. For infants aged under 12 months, breastfeeding before, during and after the injection can provide comfort and pain relief. Give the rotavirus vaccine 1—2 minutes before the other immunisations; rotavirus vaccines contain sucrose that has been shown to reduce pain. Using age-appropriate distraction has been shown to reduce pain and distress.
Do not rub the injection site after the injection as it increases the risk of vaccine reactogenicity. For infants and children, the use of a topical anaesthetic cream or patch has been found to be effective for immunisation pain management. The correct dose for infants needs to be followed particularly carefully due to risk of methaemoglobinaemia.
Topical anaesthetics may have a role in managing immunisation pain and anxiety, particularly for children who have had previous multiple medical interventions or needle phobias. Following immunisation, if an infant or child is distressed by pain or swelling at the injection site, placing a cold, wet cloth on the area may help relieve the discomfort.
Anaphylaxis is a very rare, unexpected and potentially fatal allergic reaction.
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It develops over several minutes and usually involves multiple body systems. Unconsciousness is rarely the sole manifestation and only occurs as a late event in severe cases. A strong central pulse eg, carotid is maintained during a faint vasovagal syncope , but not in anaphylaxis. In general, the more severe the reaction, the more rapid the onset.