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SLMA Guidelines and Information on Vaccines Editors Dr SLMA GUIDELINES & INFORMATION ON VACCINES SIXTH EDITION SRI LANKA MEDICAL ASSOCIATION COLOMBO 2017 Joint Editors Dr. Lucian Jayasuriya MBBS, DTPH, FCMA, FCV, FCGP Privileges of Board Certification in Medical Administration (PGIM) Hony. Senior Fellow of the PGIM (Col.) former Additional Secretary, Ministry of Health former Medical Director GlaxoSmithKline Moratuwa Dr. Omala Wimalaratne MBBS, Dip. Med. Micro, MD Senior Consultant Virologist & Vaccinologist Former, Head, Department of Rabies & Vaccines Medical Research Institute Colombo Prof. Jennifer Perera MBBS, MD, Dip. Med. Edu Senior Professor of Microbiology University of Colombo Dr. Geethani Galagoda MBBS, Dip Med Micro, MD ConsultantVirologist Head of Laboratories Lanka Hospitals Diagnostics Lanka Hospitals PLC Colombo Core Review Group The Editors Dr. Dennis Aloysius, Senior Family Physician, Ratmalana Dr. Naomal Gunaratne, Senior Consultant Paediatrician, Colombo Dr. Dulmini Kumarasinghe, Consultant Virologist, Medical Research Institute, Colombo Dr. Darshanie Mallikarachchi, Consultant Venereologist, District General Hospital Ratnapura Prof. Sanath Lamabadusuriya, Emeritus Professor of Paediatrics, University of Colombo Dr. Kanthi Nanayakkara, Consultant Virologist and Vaccinologist, Medical Research, Institute, Colombo Dr. Rajiva de Silva, Consultant Immunologist, Medical Research Institute, Colombo ISBN 978-955-9386-41-4 First Edition 2001 SLMA Guidelines on Non-EPI Vaccines Editors Dr. Lucian Jayasuriya & Dr. Anura Weerasinghe Second Edition 2004 SLMA Guidelines on Vaccines Editors Dr. Lucian Jayasuriya, Dr. Anura Weerasinghe, Dr. Omala Wimalaratne Third Edition 2008 SLMA Guidelines on Vaccines and Information on Vaccines Editors Dr. Omala Wimalaratne, Prof. Anura Weerasinghe, Dr. Lucian Jayasuriya First Print 2008 - 5000 copies Second Print 2009 – 3,500 copies Fourth Edition 2011 SLMA Guidelines and Information on Vaccines Editors Dr. Omala Wimalaratne, Prof. Anura Weerasinghe, Prof. Jennifer Perera, Dr. Lucian Jayasuriya First Print 2011 – 4000 copies Second Print 2012 – 5000 copies Third Print 2013-3000 copies Fifth Edition 2014 SLMA Guidelines and Information on Vaccines Editors Dr. Lucian Jayasuriya, Dr. Omala Wimalaratne, Prof. Jennifer Perera, Prof. Anura Weerasinghe First Print – 2000 copies 2014 Second Print – 5000 copies 2015 Third Print – 2000 copies 2016 iii CONTRIBUTORS Dr. Ananda Amerasinghe, MD Senior Consultant Epidemiologist Dr. Ranjith Batuwantudawe, MBBS, MSc, MD Consultant Community Physician, Ministry of Health Dr. Enoka Corea, MBBS, Dip. Med. Micro, MD Senior Lecturer in Microbiology, Faculty of Medicine, University of Colombo. Dr. Maxie Fernandopulle, MBBS, MRCP Senior Consultant Paediatrician, Colombo Prof. Rohini Fernandopulle, MBBS, PhD Clinical Pharmacologist, General Sir John Kotelawala Defence University, Ratmalana Dr. Geethani Galagoda, MBBS, Dip.Med.Micro, MD Head of Laboratories, Lanka Hospitals Diagnostics, Lanka Hospitals PLC, Colombo Dr. Deepa Gamage, MBBS, MSc, MD Consultant Epidemiologist, Ministry of Health Dr. Naomal Gunaratne, MBBS, FRCP, FCCP, DCH, FSLCP Senior Consultant Paediatrician, Colombo Dr. Jude Jayamaha, MBBS, Dip. Med. Micro, MD Consultant Virologist, National Influenza Centre, Medical Research Institute, Colombo Dr. Dulmini Kumarasinghe, MBBS, Dip.Med.Micro, MD Consultant Virologist, Medical Research Institute, Colombo Prof. Sanath Lamabadusuriya, MBE, MBBS, PhD, DSc, FRCP(Eng.), FRCP(Edin.), FRCP(Glasg.), FRCPCH(UK), FCCP, FSLCP, FSLCGP, DCH Emeritus Professor of Paediatrics, University of Colombo Prof. Neelika Malavige, MBBS, MRCP, DPhil, FRCP(Lond.), FRCPath Professor and Immunologist, Faculty of Medical Sciences, University of Sri Jayawardenapura iv Dr. Darshanie Mallikarachchi, MBBS, Dip. Ven. MD Consultant Venereologist, District General Hospital, Ratnapura Dr. Kanthi Nanayakkara, MBBS, Dip.Med. Micro, MD Consultant Virologist and Vaccinologist, Medical Research Institute, Colombo Prof. Jennifer Perera, MBBS, MD, Dip. Med. Ed Senior Professor of Microbiology, University of Colombo Dr. Paba Palihawadana, MBBS, MSc, MD Chief Epidemiologist, Ministry of Health Dr. Risintha Premaratne, MBBS, MPH, MSc, MD Consultant Community Physician Dr. Rajiva de Silva, MBBS, Dip. Med. Micro, MD Consultant Immunologist, Medical Research Institute, Colombo Dr. Prasanna Siriwardena, MBBS, MD(Fam.Med.), MRCGP(Int.), DFM, DCH Consultant Family Physician, Piliyandala Prof. Shalini Sri Ranganathan, MBBS,MD,DCH, MRCP, PhD, Dip.Med.Tox. Department of Pharmacology, Faculty of Medicine, Colombo Dr. Hasitha Tissera, MBBS, MSc, MD Consultant Epidemiologist, National Coordinator for Dengue Prevention and Control. Ministry of Health Dr. Pushpa Ranjan Wijesinghe, MD, MPH, MSc, MD Consultant Epidemiologist Dr. Omala Wimalaratne, MBBS, Dip. Med. Micro, MD Senior Consultant Virologist and Vaccinologist, Colombo v TABLE OF CONTENTS Page Preface x Introduction xii Abbreviations xvi Precautions before vaccination xxiii Chapter 1 Immunological basis of vaccination 1 Dr. Rajiva de Silva Chapter 2 BCG 11 Prof. Jennifer Perera Chapter 3 Cholera vaccine 17 Dr. Risintha Premaratne Dr. Dulmini Kumarasinghe Chapter 4 Dengue vaccine 22 Dr. Hasitha Tissera Chapter 5 Dipththeria, tetanus and pertussis vaccine 28 Dr. Ananda Amarasinghe Chapter 6 Haemophilus influenzae type b vaccine 38 Dr. Ranjan Wijesinghe Dr. Ranjith Batuwantudawe Chapter 7 Hepatitis A vaccine 44 Dr. Geethani Galagoda Chapter 8 Hepatitis B vaccine 49 Prof. Jennifer Perera Chapter 9 Human papillomavirus vaccine 57 Dr. Deepa Gamage Chapter 10 Influenza vaccine 62 Dr. Jude Jayamaha Chapter 11 Japanese encephalitis vaccine 67 Dr. Omala Wimalaratne vii Chapter 12 Measles mumps and rubella vaccine 74 Dr. Prasanna Siriwardena Chapter 13 Meningococcal vacccine 83 Prof. Jennifer Perera Chapter 14 Pneumococcal vaccine 89 Prof. Sanath Lamabadusuriya Chapter 15 Poliomyelitis vaccine 96 Dr. Paba Palihawadana Dr. Deepa Gamage Chapter 16 Rabies vaccine 101 Dr. Omala Wimalaratne Chapter 17 Rotavirus vaccine 113 Dr. Geethani Galagoda Chapter 18 Tetanus vaccine 118 Dr. Kanthi Nanayakkara Chapter 19 Typhoid vaccine 125 Dr. Enoka Corea Chapter 20 Varicella vaccine 130 Prof. Neelika Malavige Chapter 21 Yellow fever vaccine 136 Dr. Dulmini Kumarasinghe Chapter 22 Immunization of HIV infected persons 143 Dr. Darshanie Mallikarachchi Chapter 23 Immunization for the elderly 158 Dr. Kanthi Nanayakkara Chapter 24 Immunization of transplant recipients 162 Dr. Rajiva de Silva Dr. Kanthi Nanayakkara Chapter 25 Passive immunization 176 Prof. Neelika Malavige Chapter 26 Adverse events following immunization 182 Dr. Ananda Amarasinghe viii Chapter 27 Management of anaphylaxis 187 Prof. Rohini Fernandopulle Prof. Shalini Sri Ranganathan Dr. Rajiva de Silva Chapter 28 Immunization for international travel 203 Prof. Jennifer Perera Chapter 29 Immunization in special clinical circumstances 211 Dr. Naomal Gunaratne Chapter 30 Storage and transport of vaccines 220 Prof. Jennifer Perera Chapter 31 General information on vaccines 233 Dr. Kanthi Nanayakkara Chapter 32 Frequently asked questions 240 Dr. Prasanna Siriwardena ANNEXES Annex I National Immunization Programme of Sri Lanka Annex II Vaccines outside National Immunization Programme of Sri Lanka Annex III Recommendations for route and site of immunization Annex IV Notification form for adverse events following immunization Annex V Anaphylaxis event record ix PREFACE It is my pleasure and privilege to write this preface for the 6th edition of ‘Guidelines and Information on Vaccines’. I express my sincere appreciation to SLMA’s Expert Committee on Communicable Diseases for this valuable output. Their sustained commitment to update our profession with a user-friendly compilation of time appropriate information on current immunization needs of our citizens is highly commendable. This practical guide has enjoyed a very high rating by local practitioners over sixteen successive years, indeed a very remarkable achievement for an entirely volunteer group of medical professionals. I thank Past President Dr. Lucian Jayasuriya for his unstinting commitment and coordination in ensuring this project to have such a successful continuity. I have observed with humility the diligent announcements and regular reminders of the numerous meetings of the highly capable editorial team. My heartfelt gratitude is extended to each and every author for his or her valuable time, excellent contribution and for maintaining the high standards. Sri Lanka has enjoyed the unique achievement of maintaining a continuum of a near universal coverage, at grass root level, of its national immunization programme. It is noteworthy that the national policy on immunization (NPI) aims at prioritizing vaccine preventable diseases. The past six decades have witnessed the successful implementation of the NPI, particularly in the fields of maternal and child health. More recently, the rapidly changing population dynamics, advances in immunology and temporal trends in the epidemiology of communicable diseases have led to the need for the development of newer vaccines. Hence the busy practitioner requires a parallel update on the long list of vaccines with their scientific basis and cost effectiveness. The Sri Lanka Medical Association is proud to have given the required leadership for this distinct need in developing and updating a comprehensive handbook on vaccines for the Sri Lankan medical profession. The inclusion of SLMA as the lead professional body with x many members of its Expert Committee on Communicable
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