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For: Hla KH, Thein SAM, Aye A, Han HH, Bock HL, David MP, Schuerman L. Reactogenicity and immunogenicity profiles of a novel pentavalent diphtheria-tetanus-whole cell pertussis-hepatitis B and Haemophilus influenzae type B vaccine: a randomized dose-ranging trial of the Hib tetanus-conjugate content. Pediatr Infect Dis J 2006;25:706-12. [PMID: 16874170 DOI: 10.1097/01.inf.0000223488.80814.df] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Indexed: 11/26/2022]

For:	Hla KH, Thein SAM, Aye A, Han HH, Bock HL, David MP, Schuerman L. Reactogenicity and immunogenicity profiles of a novel pentavalent diphtheria-tetanus-whole cell pertussis-hepatitis B and Haemophilus influenzae type B vaccine: a randomized dose-ranging trial of the Hib tetanus-conjugate content. Pediatr Infect Dis J 2006;25:706-12. [PMID: 16874170 DOI: 10.1097/01.inf.0000223488.80814.df] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Indexed: 11/26/2022]

Number

Cited by Other Article(s)

Gallagher KE, Lucinde R, Bottomley C, Kaniu M, Suaad B, Mutahi M, Mwalekwa L, Ragab S, Twi-Yeboah L, Berkley JA, Hamaluba M, Karani A, Shangala J, Otiende M, Gardiner E, Mugo D, Smith PG, Tabu C, Were F, Goldblatt D, Scott JAG. Fractional Doses of Pneumococcal Conjugate Vaccine - A Noninferiority Trial. N Engl J Med 2024;391:2003-2013. [PMID: 39330966 PMCID: PMC7616702 DOI: 10.1056/nejmoa2314620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Indexed: 09/28/2024]

Abstract

BACKGROUND

Pneumococcal conjugate vaccines are an expensive component of the routine immunization schedule. Fractional-dose regimens may be one option to increase the sustainability of the vaccine program.

METHODS

We assessed whether the immunogenicity of fractional doses of the 10-valent and 13-valent pneumococcal conjugate vaccines (PCV10 [GSK] and PCV13 [Pfizer], respectively) would be noninferior to that of the full doses and analyzed the prevalence of vaccine-serotype carriage. We randomly assigned healthy infants in Kenya to one of seven equal-sized trial groups. Participants in groups A through F were assigned to receive either a fractional or full dose of PCV10 or PCV13, administered as two primary doses plus one booster dose. In group A, participants received a full dose of PCV13; group B, a 40% dose of PCV13; group C, a 20% dose of PCV13; group D, a full dose of PCV10; group E, a 40% dose of PCV10; and group F, a 20% dose of PCV10. Participants in the seventh group (group G) received a full dose of PCV10 as three primary doses without a booster. Immunogenicity was assessed 4 weeks after the primary series of doses and 4 weeks after the booster dose. Noninferiority could be declared 4 weeks after the primary series if the difference in the percentage of participants with a threshold response was not more than 10% and 4 weeks after administration of the booster if the ratio of the geometric mean concentration (GMC) of IgG was more than 0.5. A vaccine dose was prespecified as noninferior if it met the noninferiority criterion for at least 8 of the 10 vaccine types in the PCV10 groups or at least 10 of the 13 vaccine types in the PCV13 groups. Carriage was assessed when participants were 9 months and 18 months of age.

RESULTS

In the per-protocol analysis, 40% of a full dose of PCV13 met the noninferiority criterion for 12 of 13 serotypes after the primary series and for 13 of 13 serotypes after the booster. The immunogenicity of the 20% dose of PCV13 and of the 40% and 20% doses of PCV10 was not noninferior to that of the full doses. The prevalence of vaccine-serotype carriage was similar across the PCV13 groups at 9 months and 18 months of age.

CONCLUSIONS

In a three-dose schedule (two primary doses and a booster), 40% doses of PCV13 were noninferior to full doses for all included serotypes. Lower doses of PCV13 and PCV10 did not meet the criteria for noninferiority. (Funded by the Bill and Melinda Gates Foundation and others; ClinicalTrials.gov number, NCT03489018; Pan African Clinical Trial Registry number, PACTR202104717648755.).

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Affiliation(s)

Katherine E Gallagher From the Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine (K.E.G., C.B., P.G.S., J.A.G.S.), and the Great Ormond Street Institute of Child Health, University College London (S.R., L.T.-Y., D.G.), London, and the Centre for Tropical Medicine and Global Health, University of Oxford, Oxford (J.A.B.) - all in the United Kingdom; and the KEMRI-Wellcome Trust Research Programme, Kilifi (K.E.G., R.L., M.K., M.M., L.M., J.A.B., M.H., A.K., J.S., M.O., E.G., D.M., J.A.G.S.), the Department of Paediatrics, Coast General Teaching and Referral Hospital, Mombasa (B.S.), and Immunization, UNICEF (C.T.), and the School of Medicine, University of Nairobi (F.W.), Nairobi - all in Kenya
Ruth Lucinde From the Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine (K.E.G., C.B., P.G.S., J.A.G.S.), and the Great Ormond Street Institute of Child Health, University College London (S.R., L.T.-Y., D.G.), London, and the Centre for Tropical Medicine and Global Health, University of Oxford, Oxford (J.A.B.) - all in the United Kingdom; and the KEMRI-Wellcome Trust Research Programme, Kilifi (K.E.G., R.L., M.K., M.M., L.M., J.A.B., M.H., A.K., J.S., M.O., E.G., D.M., J.A.G.S.), the Department of Paediatrics, Coast General Teaching and Referral Hospital, Mombasa (B.S.), and Immunization, UNICEF (C.T.), and the School of Medicine, University of Nairobi (F.W.), Nairobi - all in Kenya
Christian Bottomley From the Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine (K.E.G., C.B., P.G.S., J.A.G.S.), and the Great Ormond Street Institute of Child Health, University College London (S.R., L.T.-Y., D.G.), London, and the Centre for Tropical Medicine and Global Health, University of Oxford, Oxford (J.A.B.) - all in the United Kingdom; and the KEMRI-Wellcome Trust Research Programme, Kilifi (K.E.G., R.L., M.K., M.M., L.M., J.A.B., M.H., A.K., J.S., M.O., E.G., D.M., J.A.G.S.), the Department of Paediatrics, Coast General Teaching and Referral Hospital, Mombasa (B.S.), and Immunization, UNICEF (C.T.), and the School of Medicine, University of Nairobi (F.W.), Nairobi - all in Kenya
Mary Kaniu From the Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine (K.E.G., C.B., P.G.S., J.A.G.S.), and the Great Ormond Street Institute of Child Health, University College London (S.R., L.T.-Y., D.G.), London, and the Centre for Tropical Medicine and Global Health, University of Oxford, Oxford (J.A.B.) - all in the United Kingdom; and the KEMRI-Wellcome Trust Research Programme, Kilifi (K.E.G., R.L., M.K., M.M., L.M., J.A.B., M.H., A.K., J.S., M.O., E.G., D.M., J.A.G.S.), the Department of Paediatrics, Coast General Teaching and Referral Hospital, Mombasa (B.S.), and Immunization, UNICEF (C.T.), and the School of Medicine, University of Nairobi (F.W.), Nairobi - all in Kenya
Badaud Suaad From the Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine (K.E.G., C.B., P.G.S., J.A.G.S.), and the Great Ormond Street Institute of Child Health, University College London (S.R., L.T.-Y., D.G.), London, and the Centre for Tropical Medicine and Global Health, University of Oxford, Oxford (J.A.B.) - all in the United Kingdom; and the KEMRI-Wellcome Trust Research Programme, Kilifi (K.E.G., R.L., M.K., M.M., L.M., J.A.B., M.H., A.K., J.S., M.O., E.G., D.M., J.A.G.S.), the Department of Paediatrics, Coast General Teaching and Referral Hospital, Mombasa (B.S.), and Immunization, UNICEF (C.T.), and the School of Medicine, University of Nairobi (F.W.), Nairobi - all in Kenya
Mary Mutahi From the Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine (K.E.G., C.B., P.G.S., J.A.G.S.), and the Great Ormond Street Institute of Child Health, University College London (S.R., L.T.-Y., D.G.), London, and the Centre for Tropical Medicine and Global Health, University of Oxford, Oxford (J.A.B.) - all in the United Kingdom; and the KEMRI-Wellcome Trust Research Programme, Kilifi (K.E.G., R.L., M.K., M.M., L.M., J.A.B., M.H., A.K., J.S., M.O., E.G., D.M., J.A.G.S.), the Department of Paediatrics, Coast General Teaching and Referral Hospital, Mombasa (B.S.), and Immunization, UNICEF (C.T.), and the School of Medicine, University of Nairobi (F.W.), Nairobi - all in Kenya
Laura Mwalekwa From the Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine (K.E.G., C.B., P.G.S., J.A.G.S.), and the Great Ormond Street Institute of Child Health, University College London (S.R., L.T.-Y., D.G.), London, and the Centre for Tropical Medicine and Global Health, University of Oxford, Oxford (J.A.B.) - all in the United Kingdom; and the KEMRI-Wellcome Trust Research Programme, Kilifi (K.E.G., R.L., M.K., M.M., L.M., J.A.B., M.H., A.K., J.S., M.O., E.G., D.M., J.A.G.S.), the Department of Paediatrics, Coast General Teaching and Referral Hospital, Mombasa (B.S.), and Immunization, UNICEF (C.T.), and the School of Medicine, University of Nairobi (F.W.), Nairobi - all in Kenya
Sarah Ragab From the Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine (K.E.G., C.B., P.G.S., J.A.G.S.), and the Great Ormond Street Institute of Child Health, University College London (S.R., L.T.-Y., D.G.), London, and the Centre for Tropical Medicine and Global Health, University of Oxford, Oxford (J.A.B.) - all in the United Kingdom; and the KEMRI-Wellcome Trust Research Programme, Kilifi (K.E.G., R.L., M.K., M.M., L.M., J.A.B., M.H., A.K., J.S., M.O., E.G., D.M., J.A.G.S.), the Department of Paediatrics, Coast General Teaching and Referral Hospital, Mombasa (B.S.), and Immunization, UNICEF (C.T.), and the School of Medicine, University of Nairobi (F.W.), Nairobi - all in Kenya
Louise Twi-Yeboah From the Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine (K.E.G., C.B., P.G.S., J.A.G.S.), and the Great Ormond Street Institute of Child Health, University College London (S.R., L.T.-Y., D.G.), London, and the Centre for Tropical Medicine and Global Health, University of Oxford, Oxford (J.A.B.) - all in the United Kingdom; and the KEMRI-Wellcome Trust Research Programme, Kilifi (K.E.G., R.L., M.K., M.M., L.M., J.A.B., M.H., A.K., J.S., M.O., E.G., D.M., J.A.G.S.), the Department of Paediatrics, Coast General Teaching and Referral Hospital, Mombasa (B.S.), and Immunization, UNICEF (C.T.), and the School of Medicine, University of Nairobi (F.W.), Nairobi - all in Kenya
James A Berkley From the Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine (K.E.G., C.B., P.G.S., J.A.G.S.), and the Great Ormond Street Institute of Child Health, University College London (S.R., L.T.-Y., D.G.), London, and the Centre for Tropical Medicine and Global Health, University of Oxford, Oxford (J.A.B.) - all in the United Kingdom; and the KEMRI-Wellcome Trust Research Programme, Kilifi (K.E.G., R.L., M.K., M.M., L.M., J.A.B., M.H., A.K., J.S., M.O., E.G., D.M., J.A.G.S.), the Department of Paediatrics, Coast General Teaching and Referral Hospital, Mombasa (B.S.), and Immunization, UNICEF (C.T.), and the School of Medicine, University of Nairobi (F.W.), Nairobi - all in Kenya
Mainga Hamaluba From the Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine (K.E.G., C.B., P.G.S., J.A.G.S.), and the Great Ormond Street Institute of Child Health, University College London (S.R., L.T.-Y., D.G.), London, and the Centre for Tropical Medicine and Global Health, University of Oxford, Oxford (J.A.B.) - all in the United Kingdom; and the KEMRI-Wellcome Trust Research Programme, Kilifi (K.E.G., R.L., M.K., M.M., L.M., J.A.B., M.H., A.K., J.S., M.O., E.G., D.M., J.A.G.S.), the Department of Paediatrics, Coast General Teaching and Referral Hospital, Mombasa (B.S.), and Immunization, UNICEF (C.T.), and the School of Medicine, University of Nairobi (F.W.), Nairobi - all in Kenya
Angela Karani From the Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine (K.E.G., C.B., P.G.S., J.A.G.S.), and the Great Ormond Street Institute of Child Health, University College London (S.R., L.T.-Y., D.G.), London, and the Centre for Tropical Medicine and Global Health, University of Oxford, Oxford (J.A.B.) - all in the United Kingdom; and the KEMRI-Wellcome Trust Research Programme, Kilifi (K.E.G., R.L., M.K., M.M., L.M., J.A.B., M.H., A.K., J.S., M.O., E.G., D.M., J.A.G.S.), the Department of Paediatrics, Coast General Teaching and Referral Hospital, Mombasa (B.S.), and Immunization, UNICEF (C.T.), and the School of Medicine, University of Nairobi (F.W.), Nairobi - all in Kenya
Jimmy Shangala From the Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine (K.E.G., C.B., P.G.S., J.A.G.S.), and the Great Ormond Street Institute of Child Health, University College London (S.R., L.T.-Y., D.G.), London, and the Centre for Tropical Medicine and Global Health, University of Oxford, Oxford (J.A.B.) - all in the United Kingdom; and the KEMRI-Wellcome Trust Research Programme, Kilifi (K.E.G., R.L., M.K., M.M., L.M., J.A.B., M.H., A.K., J.S., M.O., E.G., D.M., J.A.G.S.), the Department of Paediatrics, Coast General Teaching and Referral Hospital, Mombasa (B.S.), and Immunization, UNICEF (C.T.), and the School of Medicine, University of Nairobi (F.W.), Nairobi - all in Kenya
Mark Otiende From the Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine (K.E.G., C.B., P.G.S., J.A.G.S.), and the Great Ormond Street Institute of Child Health, University College London (S.R., L.T.-Y., D.G.), London, and the Centre for Tropical Medicine and Global Health, University of Oxford, Oxford (J.A.B.) - all in the United Kingdom; and the KEMRI-Wellcome Trust Research Programme, Kilifi (K.E.G., R.L., M.K., M.M., L.M., J.A.B., M.H., A.K., J.S., M.O., E.G., D.M., J.A.G.S.), the Department of Paediatrics, Coast General Teaching and Referral Hospital, Mombasa (B.S.), and Immunization, UNICEF (C.T.), and the School of Medicine, University of Nairobi (F.W.), Nairobi - all in Kenya
Elizabeth Gardiner From the Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine (K.E.G., C.B., P.G.S., J.A.G.S.), and the Great Ormond Street Institute of Child Health, University College London (S.R., L.T.-Y., D.G.), London, and the Centre for Tropical Medicine and Global Health, University of Oxford, Oxford (J.A.B.) - all in the United Kingdom; and the KEMRI-Wellcome Trust Research Programme, Kilifi (K.E.G., R.L., M.K., M.M., L.M., J.A.B., M.H., A.K., J.S., M.O., E.G., D.M., J.A.G.S.), the Department of Paediatrics, Coast General Teaching and Referral Hospital, Mombasa (B.S.), and Immunization, UNICEF (C.T.), and the School of Medicine, University of Nairobi (F.W.), Nairobi - all in Kenya
Daisy Mugo From the Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine (K.E.G., C.B., P.G.S., J.A.G.S.), and the Great Ormond Street Institute of Child Health, University College London (S.R., L.T.-Y., D.G.), London, and the Centre for Tropical Medicine and Global Health, University of Oxford, Oxford (J.A.B.) - all in the United Kingdom; and the KEMRI-Wellcome Trust Research Programme, Kilifi (K.E.G., R.L., M.K., M.M., L.M., J.A.B., M.H., A.K., J.S., M.O., E.G., D.M., J.A.G.S.), the Department of Paediatrics, Coast General Teaching and Referral Hospital, Mombasa (B.S.), and Immunization, UNICEF (C.T.), and the School of Medicine, University of Nairobi (F.W.), Nairobi - all in Kenya
Peter G Smith From the Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine (K.E.G., C.B., P.G.S., J.A.G.S.), and the Great Ormond Street Institute of Child Health, University College London (S.R., L.T.-Y., D.G.), London, and the Centre for Tropical Medicine and Global Health, University of Oxford, Oxford (J.A.B.) - all in the United Kingdom; and the KEMRI-Wellcome Trust Research Programme, Kilifi (K.E.G., R.L., M.K., M.M., L.M., J.A.B., M.H., A.K., J.S., M.O., E.G., D.M., J.A.G.S.), the Department of Paediatrics, Coast General Teaching and Referral Hospital, Mombasa (B.S.), and Immunization, UNICEF (C.T.), and the School of Medicine, University of Nairobi (F.W.), Nairobi - all in Kenya
Collins Tabu From the Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine (K.E.G., C.B., P.G.S., J.A.G.S.), and the Great Ormond Street Institute of Child Health, University College London (S.R., L.T.-Y., D.G.), London, and the Centre for Tropical Medicine and Global Health, University of Oxford, Oxford (J.A.B.) - all in the United Kingdom; and the KEMRI-Wellcome Trust Research Programme, Kilifi (K.E.G., R.L., M.K., M.M., L.M., J.A.B., M.H., A.K., J.S., M.O., E.G., D.M., J.A.G.S.), the Department of Paediatrics, Coast General Teaching and Referral Hospital, Mombasa (B.S.), and Immunization, UNICEF (C.T.), and the School of Medicine, University of Nairobi (F.W.), Nairobi - all in Kenya
Fred Were From the Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine (K.E.G., C.B., P.G.S., J.A.G.S.), and the Great Ormond Street Institute of Child Health, University College London (S.R., L.T.-Y., D.G.), London, and the Centre for Tropical Medicine and Global Health, University of Oxford, Oxford (J.A.B.) - all in the United Kingdom; and the KEMRI-Wellcome Trust Research Programme, Kilifi (K.E.G., R.L., M.K., M.M., L.M., J.A.B., M.H., A.K., J.S., M.O., E.G., D.M., J.A.G.S.), the Department of Paediatrics, Coast General Teaching and Referral Hospital, Mombasa (B.S.), and Immunization, UNICEF (C.T.), and the School of Medicine, University of Nairobi (F.W.), Nairobi - all in Kenya
David Goldblatt From the Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine (K.E.G., C.B., P.G.S., J.A.G.S.), and the Great Ormond Street Institute of Child Health, University College London (S.R., L.T.-Y., D.G.), London, and the Centre for Tropical Medicine and Global Health, University of Oxford, Oxford (J.A.B.) - all in the United Kingdom; and the KEMRI-Wellcome Trust Research Programme, Kilifi (K.E.G., R.L., M.K., M.M., L.M., J.A.B., M.H., A.K., J.S., M.O., E.G., D.M., J.A.G.S.), the Department of Paediatrics, Coast General Teaching and Referral Hospital, Mombasa (B.S.), and Immunization, UNICEF (C.T.), and the School of Medicine, University of Nairobi (F.W.), Nairobi - all in Kenya
J Anthony G Scott From the Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine (K.E.G., C.B., P.G.S., J.A.G.S.), and the Great Ormond Street Institute of Child Health, University College London (S.R., L.T.-Y., D.G.), London, and the Centre for Tropical Medicine and Global Health, University of Oxford, Oxford (J.A.B.) - all in the United Kingdom; and the KEMRI-Wellcome Trust Research Programme, Kilifi (K.E.G., R.L., M.K., M.M., L.M., J.A.B., M.H., A.K., J.S., M.O., E.G., D.M., J.A.G.S.), the Department of Paediatrics, Coast General Teaching and Referral Hospital, Mombasa (B.S.), and Immunization, UNICEF (C.T.), and the School of Medicine, University of Nairobi (F.W.), Nairobi - all in Kenya

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Dalvi S, Kulkarni PS, Phadke MA, More SS, Lalwani SK, Jain D, Manglani M, Garg BS, Doibale MK, Deshmukh CT. A comparative clinical study to assess safety and reactogenicity of a DTwP-HepB+Hib vaccine. Hum Vaccin Immunother 2016;11:901-7. [PMID: 25933183 DOI: 10.1080/21645515.2015.1010953] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 10/23/2022] Open

Dewé W, Durand C, Marion S, Oostvogels L, Devaster JM, Fourneau M. A multi-criteria decision making approach to identify a vaccine formulation. J Biopharm Stat 2015;26:352-64. [PMID: 25616785 DOI: 10.1080/10543406.2015.1008517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 10/24/2022]

Combination vaccines. Vaccines (Basel) 2013. [DOI: 10.1016/b978-1-4557-0090-5.00015-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] Open

Aspinall S, Traynor D, Bedford P, Hartmann K. Lot-to-lot consistency study of the fully liquid pentavalent DTwP-HepB-Hib vaccine Quinvaxem (®) demonstrating clinical equivalence, suitability of the vaccine as a booster and concomitant administration with measles vaccine. Hum Vaccin Immunother 2012;8:1109-18. [PMID: 22854660 DOI: 10.4161/hv.21095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 11/19/2022] Open

Bar-On ES, Goldberg E, Hellmann S, Leibovici L. Combined DTP-HBV-HIB vaccine versus separately administered DTP-HBV and HIB vaccines for primary prevention of diphtheria, tetanus, pertussis, hepatitis B and Haemophilus influenzae B (HIB). Cochrane Database Syst Rev 2012;2012:CD005530. [PMID: 22513932 PMCID: PMC11440342 DOI: 10.1002/14651858.cd005530.pub3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Indexed: 11/10/2022]

Abstract

BACKGROUND

Advantages to combining childhood vaccines include reducing the number of visits, injections and patient discomfort, increasing compliance and optimising prevention. The World Health Organization (WHO) recommends that routine infant immunisation programmes include a vaccination against Haemophilus influenzae (H. influenzae) type B (HIB) in the combined diphtheria-tetanus-pertussis (DTP)-hepatitis B virus (HBV) vaccination. The effectiveness and safety of the combined vaccine should be carefully and systematically assessed to ensure its acceptability by the community.

OBJECTIVES

To compare the effectiveness of combined DTP-HBV-HIB vaccines versus combined DTP-HBV and separate HIB vaccinations.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 4), which contains the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE (January 1966 to week 1, November 2011), EMBASE (January 1990 to November 2011) and www.clinicaltrials.gov (up to April 2011).

SELECTION CRITERIA

Randomised controlled trials (RCTs) or quasi-RCTs comparing vaccination with any combined DTP-HBV-HIB vaccine, with or without three types of inactivated polio virus (IPV) or concomitant oral polio vaccine (OPV) in any dose, preparation or time schedule, compared with separate vaccines or placebo, administered to infants up to two years old.

DATA COLLECTION AND ANALYSIS

Two review authors independently inspected references identified by the searches and evaluated them against the inclusion criteria, extracted data and assessed the methodological quality of included trials.

MAIN RESULTS

Data for the primary outcome (prevention of disease) were lacking. We performed a meta-analysis to pool the results of 20 studies with 5874 participants in an immunogenicity analysis and 5232 participants in the reactogenicity analysis. There were no data on clinical outcomes for the primary outcome (prevention of disease) and all studies used immunogenicity and reactogenicity (adverse events). The number of vaccine doses differed significantly between the studies. Heterogeneous interventions, study location, healthcare environment and combining research across disparate geographical locations, may have lead to bias. The risk of bias was unclear across most of the included studies. Comparisons found little heterogeneity. In two immunological responses the combined vaccine achieved lower responses than the separate vaccines for HIB and tetanus. No significant differences in immunogenicity were found for pertussis, diphtheria, polio and hepatitis B. Serious adverse events were comparable with mainly hospitalisation and acute bronchiolitis cases. Minor adverse events such as pain and redness were more common in children given the combined vaccine. Overall, the direction shown by the results is in favour of the DTPw (diptheria-tetanus-whole cell pertussis)-HBV-HIB vaccine rather than the DTPa (diptheria-tetanus-acellular pertussis)-HBV-HIB vaccine when compared to the separate vaccines (size of effect: risk ratio (RR) 1.43; 95% confidence interval (CI) 0.98 to 2.10, for 5269 participants).

AUTHORS' CONCLUSIONS

We could not conclude that the immune responses elicited by the combined vaccine were different from or equivalent to the separate vaccines. There was significantly less immunological response for HIB and tetanus and more local reactions in the combined injections. However, these differences rely mostly on one study each. Studies did not use an intention-to-treat (ITT) analysis and we were uncertain about the risk of bias in many of the studies. These results are therefore inconclusive. Studies addressing clinical end points whenever possible, using correct methodology and a large enough sample size should be conducted.

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Dicko A, Odusanya OO, Diallo AI, Santara G, Barry A, Dolo A, Diallo A, Kuyinu YA, Kehinde OA, François N, Borys D, Yarzabal JP, Moreira M, Schuerman L. Primary vaccination with the 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) in infants in Mali and Nigeria: a randomized controlled trial. BMC Public Health 2011;11:882. [PMID: 22112189 PMCID: PMC3267728 DOI: 10.1186/1471-2458-11-882] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 07/20/2011] [Accepted: 11/23/2011] [Indexed: 12/04/2022] Open

Gentile A, Umido V, Czerniuk P, Nacul J, Seigelchifer M, Hilbert AK, Yela U, Herzog C, Aeberhard U, Spyr C. Immunogenicity and reactogenicity of a combined fully liquid DTPw–HepB–Hib pentavalent vaccine in healthy infants: no clinically relevant impact of a birth dose of hepatitis B vaccine. Int J Infect Dis 2011;15:e24-9. [PMID: 21093342 DOI: 10.1016/j.ijid.2010.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 01/07/2010] [Revised: 09/02/2010] [Accepted: 09/06/2010] [Indexed: 10/18/2022] Open

Espinoza F, Tregnaghi M, Gentile A, Abarca K, Casellas J, Collard A, Lefevre I, Jacquet JM. Primary and booster vaccination in Latin American children with a DTPw-HBV/Hib combination: a randomized controlled trial. BMC Infect Dis 2010;10:297. [PMID: 20950456 PMCID: PMC2967556 DOI: 10.1186/1471-2334-10-297] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 02/25/2010] [Accepted: 10/15/2010] [Indexed: 11/10/2022] Open

Abstract

BACKGROUND

Diphtheria-tetanus-whole-cell pertussis (DTPw)-based combination vaccines are an attractive option to rapidly achieve high coverage and protection against other important pathogens, such as hepatitis B virus (HBV) and Haemophilus influenzae type B (Hib). To ensure adequate antigen supply, GlaxoSmithKline Biologicals has introduced a new DTPw antigen source and developed a new DTPw-HBV/Hib combination vaccine containing a reduced amount of Hib polyribosylribitol phosphate (PRP). This study was undertaken to compare the immunogenicity and reactogenicity of this new DTPw-HBV/Hib vaccine with a licensed DTPw-HBV/Hib vaccine (Tritanrix™-HBV/Hib).

METHODS

This was a randomized, partially-blind, multicenter study in three countries in Latin America (Argentina, Chile and Nicaragua). Healthy children received either the new DTPw-HBV/Hib vaccine (1 of 3 lots; n = 439; double-blind) or Tritanrix™-HBV/Hib (n = 146; single-blind) co-administered with oral poliovirus vaccine (OPV) at 2, 4 and 6 months, with a booster dose at 18-24 months.

RESULTS

One month after the end of the 3-dose primary vaccination course, the new DTPw-HBV/Hib vaccine was non-inferior to Tritanrix™-HBV/Hib in terms of seroprotection/vaccine response rates for all component antigens; ≥97.3% and ≥93.9% of subjects in the two groups, respectively, had seroprotective levels of antibodies against diphtheria, tetanus, hepatitis B and Hib and a vaccine response to the pertussis component. Persistence of antibodies against all vaccine antigens was comparable between groups, with marked increases in all antibody concentrations after booster administration in both groups. Both vaccines were generally well-tolerated as primary and booster doses.

CONCLUSIONS

Results confirm the suitability of this new DTPw-HBV/Hib vaccine comprising antigens from a new source and a reduced PRP content for inclusion into routine childhood vaccination programs.

TRIAL REGISTRATION

http://www.clinicaltrials.gov NCT00332566.

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Chatterjee S, Rego SJ, D'Souza F, Bhatia BD, Collard A, Datta SK, Jacquet JM. The immunogenicity and safety of a reduced PRP-content DTPw-HBV/Hib vaccine when administered according to the accelerated EPI schedule. BMC Infect Dis 2010;10:298. [PMID: 20950457 PMCID: PMC2973939 DOI: 10.1186/1471-2334-10-298] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 03/19/2010] [Accepted: 10/15/2010] [Indexed: 11/17/2022] Open

Abstract

Background

Combination vaccines improve coverage, compliance and effectively introduce new antigens to mass vaccination programmes. This was a phase III, observer-blind, randomized study of GSK Biologicals diphtheria-tetanus-whole cell pertussis vaccine combined with hepatitis B and Haemophilus influenzae type b vaccines, containing a reduced amount of polyribosyl-ribitol-phosphate (PRP) and a DTPw component manufactured at a different site (DTPw-HBV/Hib_2.5[Kft]). The primary aim of this study was to demonstrate that DTPw-HBV/Hib_2.5[Kft] was not inferior to the licensed DTPw-HBV/Hib (Tritanrix(tm)-HepB/Hiberix(tm)) vaccine or the DTPw-HBV/Hib_2.5vaccine, also containing a reduced amount of PRP, with respect to the immune response to the PRP antigen, when administered to healthy infants, according to the Expanded Programme for Immunization (EPI) schedule at 6, 10 and 14 weeks of age.

Methods

299 healthy infants were randomised to receive either DTPw-HBV/Hib_2.5[Kft] DTPw-HBV/Hib_2.5or DTPw-HBV/Hib according to the 6-10-14 week EPI schedule. Blood samples were analysed prior to the first dose of study vaccine and one month after the third vaccine dose for the analysis of immune responses. Solicited local and general symptoms such as pain, redness and swelling at the injection site and drowsiness and fever, unsolicited symptoms (defined as any additional adverse event) and serious adverse events (SAEs) were recorded up to 20 weeks of age.

Results

One month after the third vaccine dose, 100% of subjects receiving DTPw-HBV/Hib_2.5[Kft] or DTPw-HBV/Hib and 98.8% of subjects receiving DTPw-HBV/Hib_2.5vaccine had seroprotective levels of anti-PRP antibodies (defined as anti-PRP antibody concentration ≥0.15 μg/ml). Seroprotective antibody concentrations were attained in over 98.9% of subjects for diphtheria, tetanus and hepatitis B. The vaccine response rate to pertussis antigen was at least 97.8% in each group. Overall, the DTPw-HBV/Hib_2.5[Kft] vaccine was well tolerated in healthy infants; no SAEs were reported in any group.

Conclusions

The DTPw-HBV/Hib_2.5[Kft] vaccine was immunogenic and well-tolerated when administered according to the EPI schedule to Indian infants.

Trial registration

http://www.clinicaltrials.gov NCT00473668

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Bar-On ES, Goldberg E, Fraser A, Vidal L, Hellmann S, Leibovici L. Combined DTP-HBV-HIB vaccine versus separately administered DTP-HBV and HIB vaccines for primary prevention of diphtheria, tetanus, pertussis, hepatitis B and Haemophilus influenzae B (HIB). Cochrane Database Syst Rev 2009:CD005530. [PMID: 19588375 DOI: 10.1002/14651858.cd005530.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Indexed: 11/10/2022]

Abstract

BACKGROUND

Advantages to combining childhood vaccines include reducing the number of visits, injections and patient discomfort, increasing compliance, and optimizing prevention. The World Health Organization recommends that routine infant immunization programs include a vaccination against Haemophilus influenza type B (HIB) in the combined diphtheria, tetanus, pertussis (DTP)-hepatitis B (HBV) vaccination. The effectiveness and safety of the combined vaccine should be carefully and systematically assessed to ensure their acceptability by the community.

OBJECTIVES

To compare the effectiveness of combined DTP-HBV-HIB vaccine with DTP-HBV and HIB vaccinations.

SEARCH STRATEGY

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, issue 1) which contains the Acute Respiratory Infection Group's Specialized Register; MEDLINE (January 1966 to March 2009) and EMBASE (January 1990 to March 2009).

SELECTION CRITERIA

Randomized or quasi-randomized controlled trials comparing vaccination with any combined DTP-HBV-HIB vaccine, with or without three types of inactivated poliovirus (IPV) or concomitant oral polio vaccine (OPV) in any dose, preparation or time schedule, compared with separate vaccines or placebo, administered to infants aged up to two years.

DATA COLLECTION AND ANALYSIS

MAIN RESULTS

Meta-analysis was performed to pool the results of 18 studies. There were no data on clinical outcomes for the primary outcome and all studies used immunogenicity and reactogenicity (adverse events). In two immunological responses the combined vaccine achieved lower responses than the separate vaccines for HIB and HBV. Comparison found little heterogeneity. No significant differences in immunogenicity were found for pertussis, diphtheria, polio and tetanus. Serious adverse events were comparable. Minor adverse events were more common in children given the combined vaccine.

AUTHORS' CONCLUSIONS

We could not conclude that the immune responses elicited by the combined vaccine were different from, or equivalent to, the separate vaccines. Data for the primary outcome (prevention of disease) were lacking. There was significantly less immunological response for HIB and HBV, and more local reactions in the combined injections. However, these differences rely mostly on one study each. Studies did not use an intention-to-treat analysis and we were uncertain about the risk of bias in many of the studies. These results are therefore inconclusive. Studies addressing clinical end-points whenever possible, using correct methodology and a large enough sample size should be conducted.

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Prymula R, Plisek S. Clinical experience with DTPw-HBV and DTPw-HBV/Hib combination vaccines. Expert Opin Biol Ther 2008;8:503-13. [PMID: 18352853 DOI: 10.1517/14712598.8.4.503] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 11/05/2022]

Kerdpanich A, Warachit B, Kosuwon P, Gatchalian SR, Watanaveeradej V, Borkird T, Kosalaraksa P, Han HH, Hutagalung Y, Boutriau D, Dobbelaere K. Primary vaccination with a new heptavalent DTPw–HBV/Hib–Neisseria meningitidis serogroups A and C combined vaccine is well tolerated. Int J Infect Dis 2008;12:88-97. [PMID: 17716936 DOI: 10.1016/j.ijid.2007.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 02/06/2007] [Accepted: 06/12/2007] [Indexed: 11/17/2022] Open

Combination vaccines. Vaccines (Basel) 2008. [DOI: 10.1016/b978-1-4160-3611-1.50042-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] Open

Denoël PA, Goldblatt D, de Vleeschauwer I, Jacquet JM, Pichichero ME, Poolman JT. Quality of the Haemophilus influenzae type b (Hib) antibody response induced by diphtheria-tetanus-acellular pertussis/Hib combination vaccines. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2007;14:1362-9. [PMID: 17699836 PMCID: PMC2168112 DOI: 10.1128/cvi.00154-07] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Academic Contribution Register] [Indexed: 11/20/2022]