Immunisation Protocol for Neonatal Unit ( NNU )

Publication: 12/11/2004  --
Last review: 01/08/2017  
Next review: 01/08/2020  
Clinical Protocol
CURRENT 
ID: 271 
Approved By:  
Copyright© Leeds Teaching Hospitals NHS Trust 2017  

 

This Clinical Protocol is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

Immunisation Protocol for NNU

Time of Administration

The following vaccines are administered to new born infants as part of the national immunisation schedule (as updated by Public Health England, summer 2017). 
Changes to schedule from September 2015:
Men B: introduction of routine meningococcal B vaccination of infants at 2, 4 and 12 months of age
Changes to schedule from July 2016:
Men C: meningococcal C conjugate vaccine has been removed from the immunisation schedule at 3 months of age
Changes to schedule from August 2017:
Hep B: introduction of Hepatitis B to the immunisation schedule at 2, 3 and 4 months of age (replacing  Infanrix®-IPV+Hib and Pediacel®  with Infanrix hexa
® - a hexavalent DTaP/IPV/Hib/HepB combination vaccine.)

  • Diphtheria (D)
  • Tetanus (T)
  • Accellular Pertussis (aP)
  • Hepatitis B (HepB)
  • Inactivated Polio (iPV)
  • Haemophilus influenzae Type B (HiB)
  • Pneumococcal vaccine (PCV)
  • Rotavirus
  • Meningococcal B (Men B)

NOTE: BCG and MMR are the only live IM/Intradermal vaccines routinely administered to infants

The neonate should be at least 8 weeks old AND

  • No further immunisation should be given in the arm used for BCG immunisation for at least three months because of the risk of regional lymphadenitis ‘
  • No less than 3 days away from discharge
  • Do not give BCG and MMR vaccinations within 3 months of a course of high dose dexamethasone (maxi-dex) *
    * Immunisation need not be delayed if the baby has received "mini-dex" or a course of steroids lasting for less than one week. See Green Book Chapter 6.
  • The first dose of Rotarix® must be given before 15 weeks of age and dose the 2nd dose must be administered before 24 weeks of age.  There should be an interval of at least 4 weeks between doses.

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Surgery and Routine Immunisations

Surgery following immunisation with inactivated vaccines

  • Delay surgery 48 hours post vaccination to avoid post vaccination symptoms causing diagnostic concern peri-operatively.

Surgery following immunisation with live attenuated vaccines

  • No reason to delay if child well at time of immediate preoperative assessment.

 Vaccination after surgery

  • There is no contraindication to vaccination immediately after surgery, once the child is well and has recovered from the procedure.
  • Previous abdominal surgery or anastomoses are NOT a contraindication to Rotarix

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Consent

Signed consent must always be obtained from the parents / those with parental responsibility BEFORE the immunisations are prescribed.

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Documentation

The following information should be recorded accurately:

  • Vaccine name, product name, batch number and expiry date
  • Dose administered
  • Site(s) used – including, clear description of which injection was administered in each site, especially where two injections were administered in the same limb
  • Date immunisation(s) were given
  • Name and signature of vaccinator.

The following documentation should also be completed:

  • Immunisation consent form with a copy in the patients notes
  • Badger database record completed
  • Personal child health record (Red Book)
  • Immunisation notification card to be forwarded to St. Mary's Hospital, LTHT.

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Prescribing

  • Immunisations should be prescribed by medical staff (see table for doses) on a Paediatric Immunisation Prescription Chart.
  • The mother should be advised to breastfeed during the procedure if breastfeeding, as this has proven analgesic effects
    • If mother does not choose to breastfeed, the baby should be prescribed some sucrose (see Pain Protocol) for administration 2 minutes before the immunisation
      • over 1.5kg body weight sucrose 24% = 1 mL
      • less than 1.5kg body weight sucrose 24% = 0.5mL
  • When administering Men B vaccine, paracetamol should be prescribed for around the time of the immunisation and for two further doses at 6-8 hourly intervals to reduce the risk/intensity of fever (this is not required for the immunisation at 12 months of age). Use an oral dose of 60mg if >4kg or 15mg/kg if <4kg.
  • If pyrexia develops after immunisation and the infant seems distressed babies should be prescribed oral paracetamol for a maximum of 48 hours post immunisations.

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Storage

The vaccines must be stored in the appropriate fridge until administration.

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Administration

  • Oral sucrose as analgesia should be administered according to protocol.
  • Men B should be administered into the left thigh (antero-lateral aspect); if other immunisations are administered at the same time, they should be a minimum of 2.5cm apart.
  • Rotavirus vaccination (Rotarix®) should only be administered orally.
  • The identity of the vaccine should be checked.
  • The expiry date should be noted.
  • The site for injection (antero-lateral aspect of the thigh) should be cleaned with an alcohol wipe. The skin should then be allowed to dry entirely.
  • A 25G needle should be used to administer the vaccine by the intra-muscular route.
  • Document in the patients notes (and their Red Book, if available):
    1. The site of immunisation: When 2 vaccines are given simultaneously the relevant site should be recorded to allow for any reactions to be related to the correct vaccine.
    2. Date
    3. Name of the vaccine
    4. Batch number

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Instructions for administration of Rotarix®

 

 

 

1. Remove the protective tip cap from the oral applicator.

2. This vaccine is for oral administration only. The child should be seated in a reclining position. Administer orally (i.e. into the child's mouth, towards the inner cheek) the entire content of the oral applicator.

3. Do not inject.

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Schedule (for infants born before 1st August 2017)

When to immunise

Diseases protected against

Vaccine given

Neonates at risk only

BCG Vaccine
see BCG Neonatal Immunisation Protocol
Hepatitis B Vaccine
See Hepatitis B - Management of At-Risk Newborn Infants

 

2 months

Diphtheria, Tetanus, Pertussis (Acellular, Component), Poliomyelitis (Inactivated), and Haemophilus Type b Conjugate Vaccine (Adsorbed) ®
First dose

Infanrix IPV-Hib®

Or
Pediacel® 

Pneumococcal Polysaccharide Conjugate Vaccine (Adsorbed)
First dose

Prevenar 13®

Meningococcal Group B Vaccine (rDNA, component, adsorbed)
First dose

Bexsero®

Oral  Rotavirus vaccine (live, attenuated) *
First dose

Rotarix®

3 months

Diphtheria, Tetanus, Pertussis (Acellular, Component), Poliomyelitis (Inactivated), and Haemophilus Type b Conjugate Vaccine (Adsorbed) ®
Second dose

Infanrix IPV-Hib®

Or
Pediacel® 

Oral  Rotavirus vaccine (live, attenuated) *
Second dose 

Rotarix®

4 months

Diphtheria, Tetanus, Pertussis (Acellular, Component), Poliomyelitis (Inactivated), and Haemophilus Type b Conjugate Vaccine (Adsorbed) ®
Third dose

Infanrix IPV-Hib®

Or
Pediacel® 

Pneumococcal Polysaccharide Conjugate Vaccine (Adsorbed)
Second dose 

Prevenar 13®

Meningococcal Group B Vaccine (rDNA, component, adsorbed)
Second dose

Bexsero®

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Schedule (for infants born on or after 1st August 2017) ®

When to immunise

Diseases protected against

Vaccine given

Neonates at risk only

BCG Vaccine
see BCG Neonatal Immunisation Protocol
Hepatitis B Monovalent Vaccine
See Hepatitis B - Management of At-Risk Newborn Infants

 

2 months

Diphtheria,Tetanus, Pertussis (acellular, component),Hepatitis B (rDNA), Poliomyelitis (inactivated) and Haemophilus influenzae Type b conjugate vaccine (Adsorbed) ®
First dose

 
Infanrix hexa®

Pneumococcal Polysaccharide Conjugate Vaccine (Adsorbed)
First dose

Prevenar 13®

Meningococcal Group B Vaccine (rDNA, component, adsorbed)
First dose

Bexsero®

Oral  Rotavirus vaccine (live, attenuated) *
First dose

Rotarix®

3 months

Diphtheria,Tetanus, Pertussis (acellular, component),Hepatitis B (rDNA), Poliomyelitis (inactivated) and Haemophilus influenzae Type b conjugate vaccine (Adsorbed) ®

Second dose

Infanrix hexa®

Oral  Rotavirus vaccine (live, attenuated) *
Second dose 

Rotarix®

4 months

Diphtheria,Tetanus, Pertussis (acellular, component),Hepatitis B (rDNA), Poliomyelitis (inactivated) and Haemophilus influenzae Type b conjugate vaccine (Adsorbed) ®

Third dose

Infanrix hexa®

Pneumococcal Polysaccharide Conjugate Vaccine (Adsorbed)
Second dose

Prevenar 13®

Meningococcal Group B Vaccine (rDNA, component, adsorbed)
Second dose

Bexsero®

* The first dose of Rotarix® must be given before 15 weeks of age and dose the 2nd dose must be administered before 24 weeks of age.  There should be an interval of at least 4 weeks between doses.
In the unlikely event that an infant spits out or regurgitates most of the Rotarix ® vaccine, a single replacement dose may be given at the same vaccination visit. 
® Infants born before 1st August 2017 should complete the course with pentavalent vaccine (Pediacel® or Infanrix-IPV+Hib®). Infanrix hexa® should only be given to babies born before 1st August if no further Pediacel® or Infanrix-IPV+Hib® is readily available - vaccination should never be delayed in order to obtain the pentavalent vaccine. This will provide equivalent protection against diphtheria, tetanus, pertussis, polio and Hib but the child will not be fully protected against hepatitis B.

Immunisation cards must be completed and sent to:
Vaccination and Immunisation Department
St Mary's Hospital, Leeds

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Table of Immunisation Doses

Vaccine

Dose

Route

Notes

Diptheria
Tetanus
Acellular pertussus
Inactivated polio
Haemophilus influenza b

0.5mL

IM

This should be prescribed as “DTaP/IPV/Hib”

Administer either
Infanrix IPV-Hib®
or
Pediacel® 

Diptheria
Tetanus
Acellular pertussis
Inactivated polio
Haemophilus influenza b
Hepatitis B

0.5mL

IM

This should be prescribed as “DTaP/IPV/Hib/HepB”

Trade name is
Infanrix hexa®

Pneumococcal - 13 capsular types

0.5mL

IM

Trade name is
Prevenar 13®

Meningococcal group B vaccine

0.5mL

IM

Trade name is Bexsero®

BCG

0.05mL

Intradermal

Administer into upper arm
see BCG Neonatal Immunisation Protocol
There is no longer a requirement to delay BCG vaccination in relation to rotavirus, Live attenuated influenza vaccine (LAIV), oral typhoid vaccine, varicella, zoster and MMR vaccinations.  See PHE

Hepatitis B monovalent vaccine

0.5mL

IM or Deep S/C

Administer only to at risk infants Hepatitis B - Management of At-Risk Newborn Infants

Rotavirus

1.5mL

ORAL

Trade name is Rotarix®

Provenance

Record: 271
Objective:
Clinical condition:

Immunisation

Target patient group: Neonatal patients
Target professional group(s): Secondary Care Doctors
Secondary Care Nurses
Adapted from:

N/A


Evidence base

Evidence base
Association of Paediatric Anaesthetists of Great Britain and Ireland, Immunisation guideline: The timing of vaccination with respect to anaesthesia and surgery

Public Health England, Vaccine update, Issue 202, May/June 2013

Summary of Product Characteristics. Electronic Medicines Compendium. Datapharm Communications Ltd. (Rotarix®).  http://emc.medicines.org.uk/  (07/07/2017; date last updated on the eMC: 28/04/2017

Summary of Product Characteristics. Electronic Medicines Compendium. Novartis Vaccines. (Bexsero®).  http://emc.medicines.org.uk/  (06/08/2015; date last updated on the eMC: 06/02/2015)

Summary of Product Characteristics. Electronic Medicines Compendium. GlaxoSmithKline UK  (Infanrix hexa®).  http://emc.medicines.org.uk/  (07/07/2017; date last updated on the eMC: 17/05/2017)

Public Health England, Meningococcal B Vaccination Programme 24th July 2015 https://www.gov.uk/government/collections/meningococcal-b-menb-vaccination-programme

Public Health England, Meningococcal B Training Slideset for Healthcare Professionals 3rd July 2015 https://www.gov.uk/government/publications/meningococcal-b-training-slideset

Public Health England, MenC vaccination schedule: planned changes from July 2016, 24th March 2016 https://www.gov.uk/government/publications/menc-vaccination-schedule-planned-changes-from-july-2016

Public Health England, The hexavalent DTaP/IPV/Hib/HepB combination vaccine, June 2017 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/623743/Hexavalent_combination_vaccine_guidance_routine.pdf

Document history

LHP version 1.1

Related information

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