C H A P T E R 1 8
Vaccines and sera
281
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
Immunisation against measles, mumps
and rubella in adults and children
>15 months of age
poliomyelitis vaccine, inactivated
(Ipol)
0.5 mL SC × 3 doses 8 weeks apart, and
4th dose 12 months after the 3rd
Immunisation against polio infections in
adults and children
rabies vaccine (Merieux, Rabipur)
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
Pre-exposure immunisation against
rabies for high-risk people;
postexposure antirabies regimen
with rabies immune globulin
rotavirus vaccine, live, oral
pentavalent (RotaTeq, Rotarix)
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)
Prevention of rotavirus gastroenteritis
in infants and children
smallpox vaccine (Dryvax)
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
Active immunisation against smallpox
disease
varicella zoster vaccine (Zostavax
Varilrix)
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
Prevention of herpes zoster (shingles
and chicken pox) infection
vibrio cholerae vaccine-cholera
toxin B (Dukoral)
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
Active immunisation against cholera
yellow fever vaccine (Stamaril)
Adult and paediatric >9 months: 0.5 mL SC
or IM. Booster every 10 years
Immunisation of travellers to areas
where yellow fever is endemic
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.
The evidence
BOX 18.4
