McKenna's Pharmacology for Nursing, 2e

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C H A P T E R 1 8  Vaccines and sera

TABLE 18.1

DRUGS IN FOCUS Vaccines (continued)

Drug name

Dosage/route

Usual indications

Viral vaccines (continued) measles, mumps, rubella vaccine (Priorix)

0.5 mL SC or IM Adult: single dose Paediatric: dose at 1 year with booster 4–6 years 0.5 mL SC × 3 doses 8 weeks apart, and 4th dose 12 months after the 3rd Rabipur : Pre-exposure: 1 mL IM on days 0, 7, 21 and 28 Merieux: Pre-exposure: 1 mL IM or deep SC on days 0, 7, 28. Post-exposure: 1 mL IM or deep SC on days 0, 3, 7, 14, 30, 90 Three doses of 2 mL PO starting at age 6–12 weeks, with subsequent doses at 4- to 10-week intervals (third dose should be given at 32 weeks) One drop of live virus in two to three prepared punctures on the upper arm; inspect after 6–8 days; a scab should form, leaving a scar; if only a mild reaction occurs, repeat vaccination using 15 punctures in the area where a drop of vaccine is placed Zostavax: Adult >50 years: 0.65 mL SC injection Varilrix: Adult and paediatric >9 months: 0.5 mL SC with another 0.5 mL SC 6 weeks later Adult and paediatric >6 years: 1 sachet × two doses at least 1 week apart Paediatric 2–6 years: ½ sachet × three doses at least 1 week apart Adult and paediatric >9 months: 0.5 mL SC or IM. Booster every 10 years

Immunisation against measles, mumps and rubella in adults and children >15 months of age Immunisation against polio infections in adults and children Pre-exposure immunisation against rabies for high-risk people; postexposure antirabies regimen with rabies immune globulin

poliomyelitis vaccine, inactivated (Ipol) rabies vaccine (Merieux, Rabipur)

rotavirus vaccine, live, oral pentavalent (RotaTeq, Rotarix)

Prevention of rotavirus gastroenteritis in infants and children

smallpox vaccine (Dryvax)

Active immunisation against smallpox disease

varicella zoster vaccine (Zostavax Varilrix)

Prevention of herpes zoster (shingles and chicken pox) infection

vibrio cholerae vaccine-cholera toxin B (Dukoral)

Active immunisation against cholera

yellow fever vaccine (Stamaril)

Immunisation of travellers to areas where yellow fever is endemic

The evidence

BOX 18.4

Vaccine to protect against cervical cancer In 2006, the AustralianTherapeutic Goods Administration (TGA) approved the first vaccine to protect against cancer caused by a virus.The human papillomavirus (HPV) is one of the most common sexually transmitted infections in Australia and New Zealand. Most of the time, the body’s defence system will clear the virus, but some types of HPV can be more virulent.There are many types of HPV; some cause genital warts, and others are known to cause abnormal cells on the lining of the cervix, which can lead to cervical cancer years later. The vaccine Gardasil is effective against HPV types 16 and 18 (which account for 70% of cervical cancers) and against types 6 and 11 (which are responsible for 90% of genital warts).The vaccine is recommended for girls and women aged 9 to 26 years. Studies have shown that it is only effective if it is given before HPV infection occurs, so it is best given before the girl or woman becomes sexually active.The vaccine is given as a series of three injections.

The second injection given about 2 months after the first, and the last injection given about 6 months later.Tests are being done to evaluate the effectiveness of the vaccine in males and to monitor the long-term effectiveness of the vaccine. Because it is new, it is not yet known whether a booster injection will be needed later and what would be its effects if given inadvertently to a pregnant woman. Side effects that have been reported include the usual flu-like symptoms seen with immunisation and pain at the injection site. In Australia, from February 2013, both males and females aged 12–13 years will receive the HPV vaccine, while a catch-up program for males aged 14–15 years is to be completed by the end of 2014. This is the first vaccine to protect against cancer, and it is hoped that more such vaccines will be developed in the future.The willingness of parents to listen to the pros and cons and accept the need for this vaccine will have a big impact on the success of this and other such vaccines.