RESUMEN
BACKGROUND AND OBJECTIVE: In view of the possible introduction of diphtheria-tetanus-acellular pertussis-inactivated poliovirus-Haemophilus influenzae type b (DTaP-IPV-Hib, eg Pediacel) vaccine in the UK, a study of the immunogenicity of Pediacel when given with one of two different meningococcal group C conjugate (MCC) vaccines at 2, 3 and 4 months of age was conducted. METHODS: Randomised controlled study in 241 infants. RESULTS: Post vaccination, the proportion of infants with anti-polyribosylribitol phosphate (PRP) levels > or =0.15 microg/ml was 93.2% (95% confidence interval (CI) 86.6 to 96.7) in the Pediacel group compared with 100% (95% CI 96.4 to 100) in the diphtheria-tetanus-whole-cell pertussis-Haemophilus influenzae type b (DTwP-Hib) group. The anti-PRP response was lower in infants receiving either Pediacel or DTwP-Hib when these vaccines were given concomitantly with meningococcal group C conjugate with diphtheria-derived protein CRM(197) as conjugate protein (MCC-CRM) compared with meningococcal group C conjugate with tetanus toxoid as conjugate protein (MCC-TT). For group C meningococcus, the proportion of infants with serum bactericidal antibody (SBA) titre > or =1:8 in the Pediacel group was 99.0% compared with 100% in the DTwP-Hib group. The MCC SBA geometric mean titre (GMT) was lower in those receiving Pediacel with MCC-TT than in those receiving DTwP-Hib with MCC-TT, although all titres were well above the protective threshold. The MCC SBA GMT was similar in those receiving Pediacel and DTwP-Hib and MCC-CRM. Responses to all other vaccine components were equivalent in the two groups. CONCLUSIONS: Pediacel is immunogenic when given at 2, 3 and 4 months of age. Coadministration of MCC vaccine can influence the Hib response, and the MCC response to a tetanus conjugate can be influenced by the nature of the coadministered DTP-Hib vaccine.
Asunto(s)
Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/inmunología , Vacunas contra Haemophilus/inmunología , Vacunas contra la Influenza/inmunología , Vacunas Meningococicas/inmunología , Vacuna Antipolio de Virus Inactivados/inmunología , Vacuna contra Difteria, Tétanos y Tos Ferina , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/administración & dosificación , Relación Dosis-Respuesta Inmunológica , Vacunas contra Haemophilus/administración & dosificación , Humanos , Lactante , Vacunas contra la Influenza/administración & dosificación , Vacunas Meningococicas/administración & dosificación , Vacuna Antipolio de Virus Inactivados/administración & dosificación , Vacunas Conjugadas/administración & dosificación , Vacunas Conjugadas/inmunologíaRESUMEN
In the first UK study to examine feasibility and acceptability of universal adolescent hepatitis B vaccination, the costs associated with the administration and uptake (80.2 and 89.3% for three doses and at least two doses, respectively), of a three-dose regimen in pupils in Glasgow schools (2001/2002) were measured. These data were used to estimate the economic outlay for the delivery of a routine, ongoing three-dose and two-dose hepatitis B vaccine programme in schools. Vaccine, accounting for almost 70% of the overall costs, was the largest cost item for both the pilot and routine programmes, using either regimen. However, the ongoing, two-dose regimen was the cheapest option in this analysis, irrespective of vaccine price. Cost data from this study may be useful for other countries wishing to implement a similar programme.
Asunto(s)
Servicios de Salud del Adolescente/economía , Vacunas contra Hepatitis B/administración & dosificación , Vacunas contra Hepatitis B/economía , Hepatitis B/prevención & control , Programas de Inmunización/economía , Esquemas de Inmunización , Adolescente , Servicios de Salud del Adolescente/estadística & datos numéricos , Servicios de Salud Comunitaria/economía , Servicios de Salud Comunitaria/estadística & datos numéricos , Análisis Costo-Beneficio , Estudios de Factibilidad , Política de Salud , Humanos , Programas de Inmunización/organización & administración , Programas de Inmunización/estadística & datos numéricos , Evaluación de Programas y Proyectos de Salud , Servicios de Salud Escolar/economía , Servicios de Salud Escolar/organización & administración , Servicios de Salud Escolar/estadística & datos numéricosRESUMEN
The UK is currently considering the introduction of universal hepatitis B vaccination. This study of determinants of vaccine uptake among school based adolescents shows that living in areas of high deprivation, commonly associated with injecting drug risk behaviours, was the most important factor, with statistically significant lower odds of receiving three doses. This was less pronounced for receipt of two doses. Thus, there are implications for future policy; if universal vaccination is approved, a licensed two dose schedule would be most appropriate in this setting.
Asunto(s)
Conducta del Adolescente , Vacunas contra Hepatitis B/administración & dosificación , Hepatitis B/prevención & control , Aceptación de la Atención de Salud/estadística & datos numéricos , Vacunación/estadística & datos numéricos , Adolescente , Femenino , Humanos , Esquemas de Inmunización , Modelos Logísticos , Masculino , Pobreza , Factores de Riesgo , EscociaRESUMEN
This open, randomised controlled trial studied the immunogenicity and reactogenicity of two combined low-dose diphtheria, tetanus and acellular pertussis vaccines (Td5aP-IPV, REPEVAX, Aventis Pasteur MSD; and Td5aP, COVAXIS, Aventis Pasteur MSD + OPV, GlaxoSmithKline) in comparison with a standard dose diphtheria pre-school booster vaccine (DT2aP-IPV, TETRAVAC, Aventis Pasteur MSD) in a population of 3.5-5-year-old children administered concomitantly with measles, mumps and rubella vaccine (M-M-R II, Aventis Pasteur MSD). A linked sub-study aimed to evaluate the immunogenicity and reactogenicity of Td5aP-IPV in a population of younger children, aged 3-3.5 years. This study demonstrated non-inferiority of seroprotection rates for diphtheria and tetanus for the study vaccines and comparable immunogenicity for pertussis and polio components of the vaccines. Reactogenicity was similar for all three vaccines. The study vaccines containing low-dose diphtheria antigen (Td5aP-IPV and Td5aP + OPV) are immunogenic and have acceptable reactogenicity for use as a pre-school booster vaccine administered concomitantly with MMR.
Asunto(s)
Vacuna contra Difteria, Tétanos y Tos Ferina/inmunología , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/inmunología , Vacunas contra Poliovirus/inmunología , Antitoxinas/análisis , Antitoxinas/biosíntesis , Preescolar , Difteria/inmunología , Difteria/prevención & control , Vacuna contra Difteria, Tétanos y Tos Ferina/administración & dosificación , Vacuna contra Difteria, Tétanos y Tos Ferina/efectos adversos , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/administración & dosificación , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/efectos adversos , Relación Dosis-Respuesta Inmunológica , Femenino , Humanos , Inmunización Secundaria , Masculino , Cooperación del Paciente , Vacunas contra Poliovirus/administración & dosificación , Vacunas contra Poliovirus/efectos adversos , Tamaño de la Muestra , Tétanos/inmunología , Tétanos/prevención & control , Reino Unido/epidemiología , Vacunas Combinadas/administración & dosificación , Vacunas Combinadas/efectos adversos , Vacunas Combinadas/inmunologíaRESUMEN
The feasibility of introducing universal hepatitis B immunisation was assessed by offering the vaccine to all 11-12 year old pupils in Greater Glasgow (approximately 10,800). Consent was received from 92% of the school roll, and 91.3%, 89.2% and 80.3% received at least 1, at least 2, and 3 doses respectively. The findings of this study constitute key evidence for the ongoing debate in the UK on hepatitis B vaccination.