14.0 Immunological Products and Vaccines

Active imunity can be acquired by natural disease or by vaccination. 

Vaccines stimulate production of antibodies and other componenets of the immune mechanism. They consist of either: 

• a live attenuated form of a virus (e.g. measles, mumps and rubella vaccine) or bacteria (e.g. BCG vaccine) or
  
• inactivated preparations of the virus (e.g. influenza vaccine) or bacteria, or
  
• detoxified exotoxins produced by the micro-organism (e.g. tetanus vaccine), or
  
• extracts of a micro-organism, which may be derived from the organism (e.g. pneumococcal vaccine) or produced by recombinant DNA technology (e.g. hepatitis B vaccine)

All healthcare support workers required to administer vaccinations should be appropriately trained. For guidance on the minimum standards of training please click here.

Non-clinical healthcare support workers will administer vaccinations following Patient Group Directions (PGDs). For a full list of Patient Group Directions please click here.

Immunity with immediate protection against certain infective organisms can be obtained by injecting preparations made from the plasma of immune individuals with adequate levels of antibody to the disease for which protection is sought. The duration of this passive immunity varies according to the dose and the type of immunoglobulin. 

Passive immunity may last only a few weeks; when necessary, passive immunisation can be repeated. 

Antibodies of human origin are usually termed immunoglobulins. 

Antibodies prepared in animals are usually termed antiserum. However because of serum sickness and other allergic-type reactions, antisera therapy has been replaced wherever possible by the use of immunoglobulins.

Care must be taken to store all vaccines and immunological products under the conditions recommended in the product literature, otherwise the preparations may become ineffective. 

Refridgerated storage is usually necessary; many vaccines and immunoglobulins need to be stored at 2-8°C and not allowed to freeze. Vaccines and immunoglobulins should be protected from light. 

Reconstituted vaccines and opened multi-dose vaccines must be used within the period recommended in the product literature. 

Unused vaccines should be disposed of by incineration at a registered disposal contractor.

Prevention of herpes zoster (shingles)

Information on the use of immunoglobulins is included in the Health Protection Agency's Immunoglobulin Handbook available at www.hpa.org.uk and in the Department of Health's publication Immunisation against Infectious Disease, www.dh.gov.uk

14.5.1 Normal immunoglobulins

14.5.2 Disease specific immunoglobulins

14.5.3 Anti-D (Rh0) immunuglobulin 

NICE guidance TA156 (August 2008) recommends routine antinatal anti-D prophylaxis should be offered to all non-sentitised pregnant women who are rhesus negative.Two doses should be given: 1000-1650 units  of anti-D immunoglobulin ahould be given at 28 weeks gestationand then at 34 weeks. Alternatively a single dose of 1500 units can be given between 28 and 30 weeks.

RED     Anti-D (Rh0) immunoglobulin injection

            250 units, 500 units, 1500 units, 2500 units

Travellers who have not had a tetanus booster in the last 10 years and are visiting areas where medical attention may not be accessible should receive a booster dose of adsorbed diphtheria, tetanus and poliomyelitis vaccine, even if they have received 5 doses of a tetanus-containing vaccine previously. 

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 appropriate country or from the National Travel Health Network and Centre (nathnac). 

Information for health professionals and travellers is available on www.nathnac.org 

For malaria chemoprophylaxis please see Chapter 5>4>1