Archive for the ‘MMR’ Tag

MMRV: Priorix-Tetra™   Leave a comment

Priorix-Tetra™ (GSK, Belgium)
(Measles, mumps, rubella and varicella vaccine)

Vaccine Type: live attentuated vaccine for all 4 viruses
Composition:

  • live attenuated measles virus (Schwarz strain)*
  • live attenuated mumps virus (RIT 4385 strain)*
  • live attenuated rubella virus (Wistar RA 27/3 strain) produced in human diploid (MRC-5) cells
  • live attenuated varicella virus (OKA strain)*

* produced in chick embryo cells

Dosage:

  • 0.5ml per dose: subcutaneous inj preferably outer aspect of upper arm
  • see Singapore’s childhood immunisation schedule
  • preferably at least 6-week interval between doses: must not be < 4 weeks
  • indicated for active immunisation from 12 months to 12 years

Contraindicated in:

  • hypersensitivity to neomycin
  • impaired immune systems eg. primary/secondary immunodeficiency
  • pregnant females
  • anaphylactoid/acute reaction to egg: at higher risk of similar reaction but not common; vaccinate with extreme caution
  • history of febrile convulsions: follow-up closely 4-12 days for vaccine-related fever
  • acute febrile illness: postpone
  • transmission of varicella vaccine virus rarely possible; MMR transmission never documented
  • vaccinate asymptomatic HIV patients with caution, at physician’s discretion

Pregnancy: contraindicated
and avoid getting pregnant for three months after vaccination. There is inadequate data on use during lactation.

Drug interactions:

  • tuberculin testing: to be carried out before or simultaneously with vaccination (as MMR may cause temporary depression in tuberculin skin sensitivity), otherwise withhold for up to 6 weeks to avoid false negative results
  • gammaglobulins, blood transfusion: delay for at least 3 months due to passively acquired antibodies causing vaccine failure
  • salicylates: avoid for 6 weeks after vaccination as Reye’s syndrome may occur when salicylates are used following natural varicella infection

 

Ref:

  1. Package insert, International Data Sheet version 1 SI (14/02/2007)

What are the routine childhood vaccines in Singapore?   2 comments

from: the National Childhood Immunisation Programme, NCIP updated Nov 2009
**revised: 11 Nov 2011, effective 1 Dec 2011
***updated: 23 May 2013, effective 1 Jun 2013

Age BCG HepB DTaP Polio Hib 5in1 6in1 Mod PCV MMR
birth 1 BCG BCG BCG
birth D1 HepB HepB HepB
1 month D2 HepB HepB
2 month 6in1
3 month D1 D1-IPV*** D1*** 5in1 5in1 D1
4 month D2 D2-IPV*** D2 5in1 6in1 5in1
5 month (D3) D3 D3-IPV*** 5in1 6in1 D2
6 month D3 D3 HepB 6in1
12 month b1 D1**
15-18 month D2**
18 month b1 b1-IPV*** b1 5in1 5in1 5in1
6-7year (Pr1) b2*** * * * D2
10-11year (Pr5) b2** b3 b2-OPV*** * * *

 
Legend:

    D = dose number (primary schedule)
    b = booster
    BCG = Bacille Calmette Guérin (tuberculosis vaccine)
    DTaP = diphtheria, tetanus, acellular pertussis
    Polio = polio vaccine (oral Sabin OPV or injectable Salk IPV)
    Hib = Haemophilus influenza B (NCIS from 1 Jun 2013)
    PCV = pneumococcal conjugate vaccine

  • BCG 1 dose is always given at birth regardless of regime

  • measles, diphtheria vaccinations are mandated by law (Infectious Disease Act, IDA). BCG, Hep B, DTaP, Polio, MMR, PCV, Hib should be routinely offered as standard of care in Singapore unless contraindicated. HPV is recommended for females 9-26y/o.

  • ***from 1 Jun 2013, all vaccines in the NCIS can be paid for using Medisave.
  • in addition, the following vaccines are fully subsidised for children who are Singapore citizens, at all polyclinics: BCG, DTP, polio, MMR
  • **b2 of DTaP previously required Td-containing vaccine (reduced diphtheria component); as of 1 Dec 2011 a combined TdaP vaccine is recommended

  • TDaP comes combined with IPV as Infanrix-IPV; OPV carries a minute risk of vaccine-associated paralytic poliomyelitis (VAPP).

  • ***from 1 June 2013, the OPV-based polio vaccination schedule has been updated to a 5-dose regime: IPV for D1-D3 + b1; OPV for b2 at 10-11y/o.

  • IPV is contraindicated in allergy to streptomycin, polymyxin B, neomycin

  • Hib:*** children who previously received DTaP & OPV but have not completed primary and/or booster doses should complete their vaccination series up to first booster dose at 18m with DTp, IPV and Hib combination vaccines. Catch-up doses for Hib are not required for those who did not receive earlier doses.

  • 5in1: DTaP comes combined with IPV and Hib as Infanrix-IPV+Hib (5-in-1 vaccine); this regime utilises 5-in-1 and Hep B vaccine only.

  • 6in1: DTaP comes combined with IPV, Hib and Hep B vaccine as Infanrix hexa (6-in-1 vaccine); this regime utilises 6-in-1 and Hep B vaccine only, and boasts a total of only 4 injections in place of the conventional 6 injections in the first 6 months of life.

  • Mod(modified): a regime started with Hep B vaccine and 5-in-1 may be completed with 6-in-1 which replaces the final dose of both; this reduces the total jab count by 1 (to a total of 5).

  • *: the recommended schedules for 5-in-1 and 6-in-1 finish at 6 months with a booster dose at 18 months; after that the schedules follow the usual vaccination programme. Boostrix-IPV may be used for the DTaP-IPV booster at 11 years.

  • minimum interval between 1st & 2nd doses of Hep B-containing vaccine is 4 weeks; between 1st & 3rd doses is 16 weeks

  • children born to Hep B positive mothers should receive monovalent Hep B vaccine for D1 and D2; 6-in-1 vaccine can be used for D3.
  • PCV: PCV7 (Prevenar®) has been superceded by PCV13. PCV7 covers serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F. In addition, PCV13 covers 1, 3, 5, 6A, 7F and 19A. Serotype 19A is believed to be an emerging serotype responsible for serious invasive pneumococcal disease.

 

Ref:

  1. MOH Circular No.15/2013: Changes To The National Childhood Immunisation Schedule (MH 34:09/1 V16). MInistry of Health, Singapore. 23 May 2013.
  2. MOH Circular 27/2011: Changes in National Childhood Immunisation Schedule (MH 34:09/1). Ministry of Health, Singapore. 11 Nov 2011.
  3. MOH Circular 103/2009: Pneumococcal Vaccination (MH 34:55/2). Ministry of Health, Singapore. 13 Oct 2009.
  4. Polyclinic (NHG) Child Health Services website: http://www.nhgp.com.sg/Our_Services/General_Medical_Services/Child_Health_Services/