§ The Countess of Mar
asked Her Majesty's Government:
What is the normal regime for the administration of live vaccines when more than one is required; and whether this was complied with when members of HM Armed Forces were treated prior to and during Operation Granby; and [HL467]
What is the normal practice for the administration of immunoglobulins in conjunction with other vaccines, particularly live vaccines; and whether this practice was complied with when members of HM Armed Forces were treated prior to and during Operation Granby. [HL468]
§ Baroness Symons of Vernham Dean
The Ministry of Defence currently follows the guidance provided by the Department of Health (DOH) in its booklet:Immunisation against Infectious Disease; 1996. This guidance is communicated throughout the Department as part of Joint Service Publication (lSP) 311, the Joint Services Manual of Immunological Procedures. Chapter 7 of the DOH booklet discusses indications and contraindications. The guidance given is as follows:
"7.5 Immunisation Intervals
7.5.1 Live virus vaccines, with the exception of yellow fever vaccine, should not be given during the three months following injection of immunoglobulin because the immune response may be inhibited. Human normal immunoglobulin obtained from UK residents is unlikely to contain antibody to yellow fever virus, which would inactivate the vaccine. In travellers, when time is short and there is a significant risk of exposure to polio, vaccine should be given even if immunoglobulin has been given at any time in the previous three months.
7.5.2 If it is necessary to administer more than one live vaccine at the same time, they should be given simultaneously in different sites (unless a combination preparation is used) or in theory be separated by a period of at least three weeks. There are no current data using presently available vaccines to support this recommendation, which came from earlier observations about "take rates" of smallpox vaccination; these may have been reduced if 71WA another live vaccine had been given shortly before smallpox vaccination. It probably has little relevance for intervals between oral polio vaccine and other presently used live virus vaccines. It is recommended that a three-week interval should be allowed between the administration of live virus vaccines, especially measles vaccine and tuberculin testing; there is experience that shows that measles infection or immunisation can give false negative results in tuberculin positive individuals. No interval needs to be observed between the administration of live and inactivated vaccines."
Concurrent administration of immunoglobulin and live vaccines to Service personnel who deployed to the Gulf was in accordance with recommended practice extant at the time, which was the same as current practice.