[Relationship between pharmaceutical industry and public health in vaccination]. / Il rapporto tra industria farmaceutica e Sanità Pubblica nell'ambito della vaccinazione.

Vaccines play the main role in primary prevention in Public Health as they allow the control of many infectious diseases progression, reducing complications, morbidity and mortality. Pharmaceutical industry has spread worldwide the production and distribution of vaccines; moreover, research and new technological approaches inside industry make possible new formulations and preparations with an increasing safety. In spite of these positive aspects, lack of confidence in the utility of vaccination as well as in the real role of the pharmaceutical industry has grown in importance in recent decades. Aim of the study was to analyze these issues, with regards to cost and timing of vaccine production, and complex vaccine planning, related to efficacy, safety and tolerability assessment. Relationship between pharmaceutical industry and Public Health was finally considered; in particular, the role of Public Health as mediator between the pharmaceutical industry and the general population.

Evaluation of the immunogenicity and reactogenicity of a DTPa-HBV-IPV Combination vaccine co-administered with a Hib conjugate vaccine either as a single injection of a hexavalent combination or as two separate injections at 3, 5 and 11 months of age.

A combined DTPa-HBV-IPV/Hib vaccine containing diphtheria (D), tetanus (T), acellular pertussis (Pa), hepatitis B (HBV) and types 1, 2 and 3 inactivated polioviruses (IPV) extemporaneously mixed with a conjugated Haemophilus influenzae type b (Hib) vaccine (Group 1) was compared to the DTPa-HBV-IPV and Hib vaccines (Group 2) administered separately at 3, 5 and 11 months of age (n = 440). A microneutralization assay was used to detect antibodies against the 3 polio virus types (cut-off 1:8 dil), RIA for anti-HBs antibodies (cut-off 10 mIU/ml) and ELISA for antibodies against all other vaccine antigens (cut-off: 0.1 IU/ml for anti-tetanus and anti-diphtheria antibodies; 5 El.U/ml for antibodies against each of the 3 acellular pertussis antigens and 0.15 microg/ml for anti-PRP antibodies). Similar immune responses were observed in both groups 1 month after dose 2 as well as after dose 3. Six months after dose 2 however, the proportion of subjects maintaining an anti-tetanus antibody concentration > or = 0.1 IU/ml was lower in Group 2 and a slight group difference in favour of Group 1 was also observed for anti-PRP, anti-diphtheria and anti-polio type 1 antibody persistence prior to the third dose. The overall incidence of local and general solicited symptoms was similar in both groups. One subject discontinued study vaccination following an SAE considered to be related to vaccination. The DTPa-HBV-IPV/Hib combined vaccine is immunogenic and well tolerated when administered according to a 3, 5 and 11 month vaccination schedule and can therefore be considered as a feasible alternative to the separate administration of the pentavalent DTPa-HBV-IPV and the monovalent Hib vaccines.