Routine use of paracetamol around immunisation

We do not routinely recommend the giving of paracetamol before immunisation with childhood vaccines just in case a child gets a fever or has injection site pain. This is because a high fever or injection site pain are not very common responses. However, this is different with the Bexsero vaccine.

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Paracetamol is recommended to prevent and treat fever after Bexsero for children under 2 years of age.

The recommendation around the use of paracetamol for Bexsero, the meningococcal group B vaccine offered to all infants on the National Immunisation Schedule, is different. Fever can occur in some infants as part of their normal response to Bexsero, usually peaking around 6 hours after immunisation and settling over 24–48 hours.

• A fever over 38°C is more likely to occur in infants and children aged under 2 years after immunisation with Bexsero compared with other routinely used infant vaccines.

• When Bexsero is administered at the same visit as other Immunisation Schedule vaccines, a fever over 38°C is almost twice as likely as when the Immunisation Schedule vaccines are given alone.

Similarly, redness, swelling and/or mild–moderate pain around the injection site are also common expected immune responses to Bexsero, peaking on the day of vaccination and settling from around 24 hours after immunisation.

For these reasons, routine use of paracetamol with every dose of Bexsero in children aged under 2 years, whether given alone or with other vaccines, is recommended to reduce the risk of high fever and injection site pain. Some infants will still develop a fever and/or injection site pain even though they have received paracetamol doses.

Bexsero is routinely offered on the NIS at the 3–month, 5–month and 12 month immunisation events. Paracetamol should be used for all infants receiving Bexsero at these events and will not reduce the effectiveness of other vaccines received.

Paracetamol should also be used for infants receiving Bexsero on the alternate schedule, at 2–months, 4–months and 12 months.

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Recommendations for paracetamol use with Bexsero in children aged under 2 years

Three doses of paracetamol are recommended with 4 to 6 hours between each dose, whether the child has a fever or not.

• The first dose of paracetamol should be given from 30 minutes before Bexsero, or can be administered by the vaccinator at the time of, or just after immunisation under a Standing Order or prescription.

• The child should be offered a weight-based dose of liquid 120mg/5ml paracetamol with two further doses recommended at 4 to 6 hour intervals.

• Children do not need to be woken up to receive these doses and can receive the dose when they wake up, as long as it is around 6 hours since the previous dose.

• If the child is miserable or distressed because of a fever or injection site pain 6 hours after the third paracetamol dose and is otherwise well, further doses of paracetamol can be administered with a minimum of 6 hours between doses until the discomfort resolves or until it is 48 hours after immunisation was given, whichever occurs first.
• No more than four doses of paracetamol can be given in a 24-hour period.
• A child who is miserable or distressed because of fever or injection site pain for more than 48 hours after the immunisation was given, should be seen by their doctor.

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Using paracetamol for infants and children

Liquid paracetamol is available with a prescription from your doctor or as an ‘over the counter’ purchase at a pharmacy.

• Liquid paracetamol is available in two strengths; please ensure you have the correct infant strength of 120mg/5ml.

• Note: The other paracetamol liquid is more than twice as strong as the infant strength

• Know the right dose to give, follow the advice of your doctor or the dosage instructions on the bottle.

• Check the dose with your doctor, nurse or pharmacist if you are unsure

• Measure the paracetamol dose using a measuring spoon or syringe.

• No more than four doses of paracetamol can be given in a 24-hour period.

• Too much paracetamol can be dangerous.

If you are concerned about your child after their immunisation, contact your family doctor or nurse. You can also call Healthline on 0800 611 116 day or night.

If your child gets hot or has a fever

• Give lots of breastfeeds or fluids

• Undress them to a single layer, for example a singlet and pants

• Make sure the room is not too hot or too cold

• Give lots of cuddles

Other ways to help managing injection site discomfort or pain

If your child has injection site discomfort or pain

• Do not rub the injection site

• Hold a cool damp cloth or an ice pack well wrapped in a dry cloth on the injection site

• Give lots of cuddles