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 Formulary Chapter 14: Immunological products and vaccines - Full Chapter
Notes:

Prescribing Guidance

Please see our Prescribing Guidelines page for all prescribing guidance relating to this chapter.

Shared Care Agreements

There are no Shared Care Agreements relating to this chapter.

 

Chapter Links...
 Details...
14.01  Active immunity
14.02  Passive immunity
14.03  Storage and use
14.04  Vaccines and antisera
14.04  Anthrax vaccine to top
14.04  BCG vaccines
BCG vaccine diagnostic agent

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Formulary
Green
  • Tuberculline purified protein derivative (PPD) (Mantoux test) - named patient. 
 
Link  Green book chapter 32
   
BCG vaccine Intradermal

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Formulary
Green
  • Bacillus calmette-guerin vaccine
  • The BCG vaccine (which stands for Bacillus Calmette-Guérin vaccine) is not given as part of the routine NHS vaccination schedule. It's given on the NHS only when a child or adult is thought to have an increased risk of coming into contact with TB
 
Link  Green Book - Chapter 32
Link  NHSE items that should not be prescribed in primary care quick guide (includes some vaccines)
   
14.04  Botulism antitoxin
14.04  Cholera vaccine
Cholera vaccine (Dukoral)
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Formulary
Green
  • This vaccine is not indicated for most travellers
 
Link  Green Book - Chapter 14
   
14.04  Diphtheria vaccines
Boostrix IPV

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Formulary
Green
  • Boostrix-IPV suspension for injection in pre-filled syringe
  • Diphtheria, tetanus, pertussis (acellular, component) and poliomyelitis (inactivated) vaccine (adsorbed, reduced antigen(s) content) (schedule between 3yrs & 4/12 to 5 years)
 
Link  SPS Change of maternal pertussis vaccine, Jan 2020
   
Infanrix hexa

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Formulary
Green
  • Powder and suspension for suspension for injection.
  • Diphtheria (D), tetanus (T), pertussis (acellular, component) (Pa), hepatitis B (rDNA) (HBV), poliomyelitis (inactivated) (IPV) and Haemophilus influenzae type b (Hib) conjugate vaccine (adsorbed).
  • Infanrix hexa is indicated for primary and booster vaccination of infants and toddlers against diphtheria, tetanus, pertussis, hepatitis B, poliomyelitis and disease caused by Haemophilus influenzae type b.
  • (schedule at 2, 3, 4 months)
 
   
Infanrix IPV

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Formulary
Green
  • Infanrix®-IPV, suspension for injection in pre-filled syringe
  • Diphtheria, tetanus, pertussis (acellular, component) and poliomyelitis (inactivated) vaccine (adsorbed) (schedule between 3yrs & 4/12 to 5 years)
 
   
Pediacel

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Formulary
Green
  • Suspension for injection in pre-filled syringe
  • Diphtheria, tetanus, pertussis (acellular, component), poliomyelitis (inactivated) and Haemophilus type b conjugate vaccine (adsorbed)
 
   
Repevax

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Formulary
Green
  • Suspension for injection, in pre-filled syringe
  • Diphtheria, Tetanus, Pertussis (acellular, component) and Poliomyelitis (inactivated) Vaccine (adsorbed, reduced antigen(s) content) (schedule between 3yrs & 4/12 to 5 years)
 
   
Revaxis

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Formulary
Green
  • Suspension for injection in pre-filled syringe
  • Diphtheria, tetanus and poliomyelitis (inactivated) vaccine (adsorbed, reduced antigen(s) content. (schedule 13-18 yrs and adults if not previously immunised)
 
   
14.04  Haemophilus influenzae type B vaccine to top
Haemophilus influenzae type B Combined Vaccine
(Menitorix)
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Formulary
Green
  • Bath - not on formulary
 
Link  Green Book _ Chapter 16
   
14.04  Hepatitis A vaccine
Hepatitis A vaccine Single Component
(Avaxim)
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Formulary
Green
 
Link  Green Book - Chapter 17
   
Hepatitis A vaccine Single Component
(Havrix Monodose)
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Formulary
Green
  • Adult and Junior
 
Link  Green Book - Chapter 17
   
Hepatitis A vaccine Single Component
(Vaqta )
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Formulary
Green
  • Adult and Paediatric
 
Link  Green Book - Chapter 17
   
Hepatitis A vaccine with Hepatitis B vaccine
(Ambirix )
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Formulary
Green
  • Hepatitis B NOT routinely available on the NHS for the purposes of travel therefore combination vaccine not commissioned locally on the NHS.
 
   
Hepatitis A vaccine with Hepatitis B vaccine
(Twinrix)
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Formulary
Green
  • Adult and Paediatric 
  • Hepatitis B NOT routinely available on the NHS for the purposes of travel therefore combination vaccine not commissioned locally on the NHS.
 
   
Hepatitis A vaccine with typhoid vaccine
(VIATIM)
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Formulary
Green
 
   
14.04  Hepatitis B vaccine
Hepatitis B vaccine Single Component
(Engerix B)
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Formulary
Green
  • This vaccine is not available at NHS expense in Wiltshire/Bath/Swindon for Overseas Travel
 
Link  Green Book - Chapter 18
   
Hepatitis B vaccine Single Component
(Fendrix)
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Formulary
Green
  • Bath - not on formulary
  • This vaccine is not available at NHS expense in Wiltshire/Bath/Swindon for Overseas Travel
 
Link  Green Book - Chapter 18
   
Hepatitis B vaccine Single Component
(HBvaxPRO)
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Formulary
Green
  • This vaccine is not available at NHS expense in Wiltshire/Bath/Swindon for Overseas Travel
 
Link  Green Book - Chapter 18
   
14.04  Human papilloma virus vaccine
Human papilloma virus vaccine
(Gardasil)
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First Choice
Green
  • Vaccine of choice for the national immunisation program (see Green Book)
  • a quadravalent vaccine which also covers anal lesions, anal cancer and   genital warts
  • Gardasil is currently the only HPV vaccine supplied for the national HPV programme (for both adolescents and men who have sex with men).
 
14.04  Influenza vaccine
 note 

Winter 2019/20 PHE Flu vaccine  

Who should have it and why? Includes information for children and pregnant women

Influenza vaccine ovalbumin content

Influenza vaccine  
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Formulary
Green
  • Brands include: Inactivated Influenza Vaccine (Split Virion), Agrippal CSL, Inactivated Influenz Vaccine Enzira Imuvac Influvac, Fluarix Tetra, Fluad
 
Link  Green Book - Chapter 19
Link  Vaccine ordering for 2019-20 influenza season: letters
   
Influenza vaccine
(Fluenz Tetra)
(nasal)
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Formulary
Green
  • Primary Care Only : Please note that flu vaccines for children should be ordered via IMMFORM and should NOT be reclaimed via NHS prescription services (PPA).
 
   
14.04  Measles vaccine to top
14.04  Measles, Mumps and Rubella (MMR) vaccine
Measles, Mumps and Rubella Vaccine, Live (MMR)
(MMRvaxPro Priorix)
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Formulary
Green
 
Link  PHE Jan 2014: Measles, mumps, rubella (MMR): use of combined vaccine instead of single vaccines
   
14.04  Meningococcal vaccines
Meningococcal polysaccharide A, C, W135 and Y vaccine
(ACWY Vax)
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Formulary
Green
  • This vaccine is not available at NHS expense in Wiltshire/Bath/Swindon for Overseas Travel
 
Link  Green Book - Chapter 22
Link  NHSE Items which should not be routinely prescribed in primary care (includes some vaccines)
   
Meningococcal A, C, W135, and Y conjugate vaccine
(Menveo)
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Formulary
Green
  • Menveo powder and solution for solution for injection
  • Meningococcal Group A, C, W-135 and Y conjugate vaccine
  • This vaccine is not available at NHS expense in Wiltshire/Bath/Swindon for Overseas Travel
 
Link  Green Book - Chapter 22
Link  NHSE Items which should not be routinely prescribed in primary care (includes some vaccines)
   
Meningococcal group A, C, W-135 and Y conjugate vaccine
(Nimenrix)
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Formulary
Green
  • This vaccine is not available at NHS expense in Wiltshire/Bath/Swindon for Overseas Travel
 
Link  Green Book - Chapter 22
Link  NHSE Items which should not be routinely prescribed in primary care (includes some vaccines)
   
Meningococcal group B Vaccine
(Bexsero)
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Formulary
Green
 
Link  Green Book - Chapter 22
   
Meningococcal Group C Polysaccharide Conjugate Vaccine Adsorbed
(NeisVac-C)
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Formulary
Green
 
Link  Green Book- Chapter 22
   
14.04  Mumps vaccine
14.04  Pertussis vaccine
14.04  Pneumococcal vaccines to top
23-valent pneumococcal polysaccharide vaccine
(Previously known as Pneumovax II)
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Formulary
Green
  • Primary Care:  at NHS expense for patients in accordance with the national immunisation programme. Adults over 65 years and at risk groups, as listed in the Green Book, chapter 25.
  • Use practice stock and claim on FP34 appendix form. 
 
Link  Green Book - Chapter 25
   
Pneumococcal polysaccharide conjugate vaccine (adsorbed)
(Prevenar 13)
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Formulary
Green
  • Primary Care:  at NHS expense for infants as part of the routine childhood immunisation programme (order free of charge via Immform)
 
Link  Green Book - Chapter 25
   
14.04  Poliomyelitis vaccines
14.04  Rabies vaccine
Rabies vaccine (Rabipur)
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Formulary
Green
  • Only on formulary for NHS use for Rabies Post-Exposure treatment in accordance with PHE guidelines. 
  • This immunisation is not remunerated by the NHS as part of additional services and is available from Private Clinics (prices may vary) if used for travel purposes (pre-exposure).  
 
Link  PHE: Guidelines on managing rabies post-exposure April 2019
   
14.04  Rotavirus vaccine
Rotavirus vaccine (Rotarix)
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Formulary
Green
  • Oral suspension
 
Link  Green Book - Chapter 27b
   
14.04  Rubella vaccine
14.04  Smallpox vaccine to top
14.04  Tetanus vaccines
14.04  Tick-borne encephalitis vaccine
Tick-borne encephalitis vaccine
(TicoVac )
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Formulary
Green
  • Available on a named patient basis from MASTA
  • This immunisation is not remunerated by the NHS as part of additional services and is available from Private Clinics (prices may vary).

 

 
   
14.04  Typhoid vaccines
Polysaccharide Typhoid Vaccine
(Typherix)
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Formulary
Green
 
Link  Green Book - Chapter 33
   
Polysaccharide vaccine for injection
(Typhim Vi)
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Formulary
Green
 
Link  Green Book - Chapter 33
   
14.04  Varicella-zoster vaccine
Varicella Zoster vaccine
(Zostavax)
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Formulary
Green
  • The aim of the national shingles immunisation programme is to lower the incidence and severity of shingles in older people. It is recommended that it be routinely offered to people aged 70 years.
  • Whilst the vaccine is authorised for use from age 50 years and is effective in this age group, the burden of shingles disease is generally not as severe in those aged 50-69 years when compared with older ages. Furthermore, given that the duration of protection is not known to last for more than ten years and the need for a second dose is not known, the vaccine is not recommended to be offered routinely below 70 years of age. Administration after 80 years of age is less cost-effective due to the limited effectiveness of the vaccine in older individuals.
 
Link  Green Book - Chapter 28a
   
Varicella-zoster vaccine
(Varilrix)
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Formulary
Green
  • Varilrix is indicated for active immunisation against varicella of healthy subjects (from the age of 9 months).
  • Vaccination of susceptible healthy close contacts of subjects at risk of severe varicella is recommended, in order to reduce the risk of transmission of wild-type virus to these patients. Close contacts include parents and siblings of high-risk patients, and medical and paramedical personnel.
  • Use as per green book only.
 
Link  Green Book - Chapter 34
   
Varicella-zoster vaccine
(Varivax)
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Formulary
Green
  • VARIVAX is indicated for vaccination against varicella in individuals from 12 months of age.
  • VARIVAX can be administered to infants from 9 months of age under special circumstances, such as to conform with national vaccination schedules or in outbreak situations.
  • VARIVAX may also be administered to susceptible individuals who have been exposed to varicella. Vaccination within 3 days of exposure may prevent a clinically apparent infection or modify the course of the infection. In addition, there are limited data that indicate that vaccination up to 5 days after exposure may modify the course of the infection
  • Use as per green book only.
 
Link  Green Book - Chapter 34
   
14.04  Yellow fever vaccine to top
Yellow fever vaccine (Live)
(Stamaril )
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Formulary
Green
  • This immunisation is not remunerated by the NHS as part of additional services and is available from Private Clinics (prices may vary):  
 
Link  MHRA November 2019 Yellow fever vaccine: stronger precautions in people with weakened immunity and in those aged 60 years or older
Link  MHRA April 2019 - Stamaril extreme caution needed in people who may be immunosuppressed and those 60 years and older
   
14.05  Immunoglobulins
Rabies immunoglobulin

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Formulary
Red
  • Human Rabies Immunoglobulin, not less than 150 IU/mL solution for injection. 
  • Microbiology request only.
 
Link  Green Book - Chapter 27
Link  PHE June 2019: Guidelines on managing rabies post-exposure
   
14.05  Normal immunoglobulin
 note 

NHSE Updated Commissioning Criteria for the use of therapeutic immunoglobulin (Ig) in immunology, haematology, neurology and infectious diseases in England January 2019

For indications not covered by above guidance:

Clinical guidelines for immunoglobulin use (second edition update) 2011

Human normal immunoglobulin

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Formulary
Red
High Cost Medicine
NHS England
BlueTeq
  • Commissioned by NHS England in line with 'Updated Commissioning Criteria for the use of therapeutic immunoglobulin (Ig) in immunology, haematology, neurology and infectious diseases in England (January 2019)'. For indications not covered by these commissioning criteria, commissioning is in line with the 'DoH Clinical Guidelines for Immunoglobulin Use (second edition update, July 2011)'.
  • Note: Guidance from NHS England (October 2017) states that the recommended dose of IVIg for the treatment of ITP is a single dose of 1g/kg. A repeat dose of 1g/kg should only be considered at day 7 if there is a failure to achieve a haemostatically adequate platelet count (approval from the local immunoglobulin approval panel is required if earlier use is contemplated in cases of exceptional clinical circumstances such as active mucosal bleeding or the need for emergency surgery).
  • Prescribe by brand. Various brands available.
  • NOTE Subgam is the HNIG to use when Tetanus IG is unavailable but indicated as per national guidance. See link below.
 
Link  NHSE National demand management programme for immunoglobulin database
Link  PHE Tetanus July 2019 Guidance on the management of suspected tetanus cases and on the assessment and management of tetanus-prone wounds
   
14.05  Specific immunoglobulins
14.05  Anti-D (Rho) immunoglobulin
14.05  Interferons to top
14.05.01  Normal immunoglobulin
 note 

 

14.05.02  Disease-specific immunoglobulins
Hepatitis B immunoglobulin
(HBIG)
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Formulary
Amber
  •  Advice on the usage and availability can be obtained from the Microbiologist. 
 
Link  Green Book - Chapter 18
   
Tetanus immunoglobulin

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Formulary
Red
  • 100 IU/ml sterile solution
  • Intramuscular injection

NOTE Subgam to be added as the HNIG to use when Tetanus IG is unavailable but indicated as per national guidance. See link below.

 
Link  Green Book - Chapter 30
Link  PHE Tetanus July 2019 Guidance on the management of suspected tetanus cases and on the assessment and management of tetanus-prone wounds
   
Varicella-Zoster immunoglobulin
(VZIG)
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Formulary
Amber
  • In the first instance where VZIG may be required the midwife or doctor should contact the acute trust Microbiologist on call for immunology screening prior to prescribing and supplying.
  • RUH Pharmacy keep a supply of VZIG which is dispensed only following advice of Consultant Microbiologist. See protocol above for process for obtaining and administering VZIG. NB It is NOT available via community pharmacies.
 
Link  Green Book - Chapter 34
Link  PHE June 2019: Updated guidelines on post exposure prophylaxis (PEP) for varicella/shingles
Link  PHE Varicella zoster immunoglobulin Guidance on the use and ordering of varicella zoster immunoglobulin (VZIG).
   
14.05.03  Anti-D (Rho) immunoglobulin
Anti-D (Rh0) Immunoglobulin

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Formulary
  • Red GWH and SFT
  • Amber Bath
 
Link  NICE TA156: Anti-D in pregnant women
   
14.06  International travel
 ....
 Non Formulary Items
Anthrax vaccine 

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Non Formulary
 
Botulism antitoxin 

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Non Formulary
 
Hepatitis A vaccine Single Component
(Epaxal)

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Non Formulary
Green

DISCONTINUED

Link  Green Book - Chapter 17
 
Hepatitis A vaccine with typhoid vaccine
(Hepatyrix)

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Non Formulary
Green

DISCONTINUED

 
INTERFERON GAMMA-1b
(Immukin)

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Non Formulary
 
Japanese Encephalitis Vaccine
(Ixiaro)

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Non Formulary
  • This vaccine is not available at NHS expense in Wiltshire/Swindon/Bath for Overseas Travel.
 
Malaria vaccine (Mosquirix)

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Non Formulary
 
Meningococcal Group C Polysaccharide Conjugate Vaccine Adsorbed
(Menjugate )

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Non Formulary
Green

DISCONTINUED

Link  Green Book- Chapter 22
 
  
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG
Blueteq
High Cost Drug Approval System

Traffic Light Status Information

Status Description

Red

RED - Hospital only to be prescribed by a specialist and supplied from secondary care ONLY throughout treatment.  

Amber

Amber medicines are considered suitable for GP prescribing following specialist initiation or recommendation.  

Amber with Shared Care

Shared Care - these medicines require specialist initiation and stabilisation. Ongoing division of responsibility for drug and disease monitoring between specialist and GP by a Shared Care Guideline (SCG). If no SCG in place status reverts to red.  

Green

These medicines are appropriate for initiation in both primary and secondary care. Prescribing is appropriate within licensed or local recommendations.  

Self

Suitable for patient to be directed to buy themselves  

Grey

Not currently used. We intend to include this TLS in future to highlight where a decision to use this medicine is under review.   

Black

(In use from Oct 2020) Used where a decision has been made by the BSW APC not to routinely commission this preparation for its licensed indications. Do not prescribe.   

Red Specialist Centre

Not currently used. We intend to include this TLS in future to highlight where this medicine and indication is ONLY available through a Specialist Centre according to a NICE Highly Specialised Technology or NHSE Specialised Commission Circular / Policy.  

netFormulary