A comparative study of PENTA vaccine booster doses given at 12, 15, or 18 months of age

Comparing Haemophilus influenzae type b conjugate vaccine schedules: a systematic review and meta-analysis of vaccine trials

BACKGROUND

The optimal schedule and the need for a booster dose are unclear for Haemophilus influenzae type b (Hib) conjugate vaccines. We systematically reviewed relative effects of Hib vaccine schedules.

METHODS

We searched 21 databases to May 2010 or June 2012 and selected randomized controlled trials or quasi-randomized controlled trials that compared different Hib schedules (3 primary doses with no booster dose [3p+0], 3p+1 and 2p+1) or different intervals in primary schedules and between primary and booster schedules. Outcomes were clinical efficacy, nasopharyngeal carriage and immunological response. Results were combined in random-effects meta-analysis.

RESULTS

Twenty trials from 15 countries were included; 16 used vaccines conjugated to tetanus toxoid (polyribosylribitol phosphate conjugated to tetanus toxoid). No trials assessed clinical or carriage outcomes. Twenty trials examined immunological outcomes and found few relevant differences. Comparing polyribosylribitol phosphate conjugated to tetanus toxoid 3p+0 with 2p+0, there was no difference in seropositivity at the 1.0 μg/mL threshold by 6 months after the last primary dose (combined risk difference -0.02; 95% confidence interval: -0.10, 0.06). Only small differences were seen between schedules starting at different ages, with different intervals between primary doses, or with different intervals between primary and booster doses. Individuals receiving a booster were more likely to be seropositive than those at the same age who did not.

CONCLUSIONS

There is no clear evidence from trials that any 2p+1, 3p+0 or 3p+1 schedule of Hib conjugate vaccine is likely to provide better protection against Hib disease than other schedules. Until more data become available, scheduling is likely to be determined by epidemiological and programmatic considerations in individual settings.

Immunologic considerations for the timing of the booster dose of 7-valent pneumococcal conjugate vaccine in young children

BACKGROUND

The booster (fourth) dose of 7-valent pneumococcal conjugate vaccine (PCV7) is recommended to be given at 12-15 months but in Canada it better fits the national schedule at 18 months, prompting this comparison of the safety and immunogenicity of booster immunization at 15 or 18 months.

METHODS

Children who had completed a study of primary PCV7 immunization (with final serology at 7-8 months of age) were enrolled at 12 months, bled and randomly assigned to receive a PCV7 booster at age 15 or 18 months, with serologic testing before and 4 weeks afterward. Adverse events were documented for 3 days postbooster. Antibody concentrations were measured for the 7 pneumococcal serotypes and Haemophilus influenzae type b at 7-8, 12, 15 or 18 months and after boosting.

RESULTS

Three hundred thirty-one children were boosted, 167 at 15 months and 164 at 18 months. Pneumococcal geometric mean antibody concentrations declined by 15 months to 23.4% of peak geometric mean concentrations at age 7-8 months and to 19.8% by 18 months. Spontaneous increases in 1 or more antibody concentrations were noted in 195 subjects (61.7%), most commonly with types 6B and 19F. Antibody responses to PCV7 were similarly brisk at 15 and 18 months. Mild injection-site redness and swelling were significantly more frequent at 15 than 18 months but no other differences in reactogenicity were observed.

CONCLUSIONS

Residual antibody concentrations differed minimally between 15 and 18 months. Spontaneous antibody increases often occurred before boosting, possibly from colonization. PCV7 booster vaccination at 18 months appears to be safe and provides comparable immunogenicity to 15 months vaccination.

Acellular pertussis vaccines for adolescents

BACKGROUND

The epidemiology of pertussis is changing, with a clear increase in the number of cases diagnosed in adolescents and adults. This development has spurred studies and anticipated licensure of safer diphtheria, tetanus, acellular pertussis combined (Tdap) vaccines for this older population.

METHODS

Literature review.

RESULTS

Tdap vaccines are safe and immunogenic when administered to adolescents and adults. Correlates of immunity to pertussis after Tdap vaccination have not been established, but various combinations of antibody to pertussis antigens (pertussis toxin, filamentous hemagglutinin, pertactin, and fimbriae) provide protection. The importance of the number of antigens in Tdap vaccines for protection against mild pertussis disease is unclear. Pertussis vaccination establishes herd immunity after sufficient uptake within communities and countries. As experience with TdaP vaccines has accumulated, a 1-2% occurrence of large, local injection-site reactions with all TdaP vaccine products have been observed for booster doses in children 4-6 years of age. The frequency of large local reactions appears lower in adolescents and adults. The pathophysiologic mechanisms for the local reactions are not established, but a majority appears to be immunoglobulin E-mediated-reactive edema, and a minority appears to be immunoglobulin G-mediated Arthus-type reactions.

CONCLUSIONS

Tdap vaccines appear safe and immunogenic. The economic impact of pertussis provides a cost-benefit justification for widespread use of Tdap vaccine boosting in adolescents.

Acellular Pertussis Vaccine Safety and Efficacy in Children, Adolescents and Adults

This review offers a perspective on the acellular pertussis vaccine efficiency trials concluded in the 1990s and presents the main conclusions of a meta-analysis of 52 studies that assessed the safety and efficacy of the diphtheria-tetanus (DT)-whole cell pertussis (DTwP) and DT-acellular pertussis (DTaP) vaccines administered to children. A clear serological correlate of immunity to pertussis following DTaP vaccination was not identified despite an intensive analysis. It can be speculated that this may be because various combinations of antibody to agglutinogens (pertussis toxin, filamentous haemagglutinin, pertactin and fimbriae) provide protection, or because serum antibody levels and responses do not uniformly reflect mucosal IgA antibody levels.Long-term efficacy following DTaP vaccination is becoming characterised and cell-mediated immunity (T-cell memory) may have importance. DTaP vaccination appears to establish herd immunity after sufficient uptake within communities and countries. As experience with DTaP vaccine safety has accumulated, a 1-2% occurrence of large, local injection reactions with all products has been defined for booster doses. The pathophysiological mechanisms for the reactions are not established but a majority appear likely to be IgE-mediated reactive oedema and a minority to be IgG-mediated reactive Arthus-type reactions. DTwP and DTaP combinations with other vaccines have been studied and licensed; the most controversial combination products are the DTaP/Haemophilus influenzae type B polysaccharide conjugate vaccines. Pertussis epidemiology is changing with a clear increase in occurrence in adolescents and adults. This development has spurred studies and licensure of safer DTaP vaccines for this older population. The economic impact of pertussis and transmission from adults to vulnerable infants provides a cost-benefit justification for widespread use of DTaP vaccines in all age groups with routine boosting every 10 years.