A number of new chapters have been included in this edition, with more detailed information on contraindications and adverse reactions. A new chapter has been included on immunisation of laboratory staff. The individual vaccine chapters are in alphabetical order. Details of designated yellow fever immunisation centres are available in 'Health Information for Overseas Travel, 1995'. At the end of the memorandum, you will find a list of addresses of local computer centres where immunisation data are managed. In conjunction with existing local arrangements, you may find this helpful for updating information, or for speeding up the transfer of information for children who have moved into, or out of, your locality. England, Scotland, Wales and Northern Ireland have now harmonised their processes for collection and analysis of immunisation coverage data. Future editions will therefore better reflect UK data on coverage, and on surveillance of target diseases.
A low dose booster for school leavers is recommended as a combined vaccine (Td) in place of single antigen tetanus. This is to improve the immunity of adults, in whom low levels of antibodies had been identified, and counters the threat of the re-emergence of diphtheria as has been seen in Eastern Europe. Td can be used in place of tetanus for the treatment of tetanus prone wounds in Accident and Emergency Departments for young people aged over 13, if the school-leaving booster has not already been given. The local Health Authority, NHS Trust, or Health Board should be informed, by return of an 'unscheduled immunisation' form.
From October 1996 a second dose of MMR vaccine is recommended for all children, to be given at the same time as the pre-school boosters. Children who have had their pre-school boosters but who were too young to be included in the measles-rubella immunisation campaign of 1994 should be given a second dose of MMR vaccine. The purpose of this programme is to prevent the re-accumulation of sufficient susceptible children to sustain future epidemics, as happens with a single dose programme. The schoolgirl rubella immunisation programme has been brought to an end.
Since the publication of the 1992 edition of 'Immunisation against Infectious Disease', Hib vaccine has become established in the routine immunisation programme. There is now good evidence that a course of Hib vaccine started with one product can be completed with another manufacturer's product without any deleterious effect. Combined products, where Hib is reconstituted with DTP for a single injection, are now being provided.
Reducing the risk of overwhelming infection in asplenic and hyposplenic patients is addressed in the chapter on pneumococcal vaccine. Guidelines from the British Committee for Standards in Haematology, Clinical Haematology Task Force were published in 1996.
BCG immunisation policy was reviewed during 1995/96. Immunisation of school children between the ages of 10 and 14 years continues to be part of national policy in addition to selective immunisation of higher risk groups. All health authorities should ensure BCG immunisation is offered to all appropriate children. The BCG chapter draws attention to the importance of ordering and using the correct preparation of BCG vaccine for the technique being used: 'intradermal' vaccine is for routine intradermal administration using a separate needle and syringe for each recipient; 'percutaneous' BCG should be used when the vaccine is administered by the multiple puncture technique - this technique is suitable for infants and very young children only. A new single use disposable Heaf testing device has recently become available.
Travel vaccines continue to be included in this memorandum, although detailed country by country risks, recommendations and a list of yellow fever centres are now contained in the new companion volume 'Health Information for Overseas Travel'.
The recommendations for re-inforcing doses of rabies vaccine have changed: subjects who have received a full three dose primary course of vaccine do not require further reinforcing doses if, as in the UK, post-exposure treatment is readily available, unless they are at continuous risk. The recommendations for post-exposure rabies specific immunoglobulin have also changed and are based on a risk assessment in each individual case.