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Aloysia D’Cor N, Siddaiah P, Mohapatra S, Dhaded SM, I. V. P, Kar S, V. N. T, Muley P, Chhatwal J, Patnaik BN, Vidor E, Moureau A, Patel DM, Midde VJ, Jagga SR, Peesapati S, Noriega F. Safety and immunogenicity of a new formulation of a pentavalent DTwP-HepB-Hib vaccine in healthy Indian infants-A randomized study. PLoS One 2023; 18:e0284898. [PMID: 37582114 PMCID: PMC10426953 DOI: 10.1371/journal.pone.0284898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 04/11/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Pentavalent vaccines (DTP-HepB-Hib) have been introduced in many countries in their routine public immunization programmes to protect against diphtheria (D), tetanus (T), pertussis (P), hepatitis B (Hep B) and Hemophilus influenzae type b (Hib) diseases. This study compared the safety and immunogenicity of a new formulation of a whole-cell Bordetella pertussis (wP) based pentavalent vaccine (DTwP-HepB-Hib). The new formulation was developed using well-characterized hepatitis B and pertussis whole cell vaccine components. METHODS This was a phase III, observer-blind, randomized, non-inferiority, multi-center study conducted in India among 460 infants who were followed up for safety and immunogenicity for 28 days after administration of three doses of either investigational or licensed comparator formulations at 6-8, 10-12 and 14-16 weeks of age. RESULTS The investigational formulation of DTwP-HepB-Hib vaccine was non-inferior to the licensed formulation in terms of hepatitis B seroprotection rate (% of subjects with HepB antibodies ≥10mIU/mL were 99.1% versus 99.0%, respectively, corresponding to a difference of 0.1% (95% CI, -2.47 to 2.68)) and pertussis immune responses (adjusted geometric mean concentrations of antibodies for anti-PT were 76.7 EU/mL versus 63.3 EU/mL, with a ratio of aGMTs of 1.21 (95% CI, 0.89-1.64), and for anti-FIM were 1079 EU/mL versus 1129 EU/mL, with a ratio of aGMTs of 0.95 (95% CI, 0.73-1.24), respectively). The immune responses to other valences (D, T, and Hib) in the two formulations were also similar. The safety profile of both formulations was found to be similar and were well tolerated. CONCLUSIONS The investigational DTwP-HepB-Hib vaccine formulation was immunogenic and well-tolerated when administered as three dose primary series in infants. CLINICAL TRIAL REGISTRATION Clinical Trials Registry India number: CTRI/2018/12/016692.
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Affiliation(s)
| | - Prashanth Siddaiah
- Dept. of Pediatrics, Mysore Medical College and Research Institute, Mysore, India
| | - Satyajit Mohapatra
- Dept. of Pharmacology, SRM Medical College Hospital & Research Center, Chennai, India
| | - Sangappa Malappa Dhaded
- Dept. of Pediatrics, KLES Dr Prabhakar Kore Hospital & Medical Research Centre, Belagavi, India
| | - Padmavathi I. V.
- Dept. of Pediatrics, Government Victoria Hospital, Visakhapatnam, India
| | - Sonali Kar
- Dept. of Community Medicine, Kalinga Institute of Medical Sciences, Bhubaneswar, India
| | - Tripathi V. N.
- Dept. of Pediatrics, Prakhar Hospital Pvt. Ltd., Kanpur, India
| | - Prasad Muley
- Dept. of Pediatrics, SBKS Medical College, Vadodara, India
| | - Jugesh Chhatwal
- Dept. of Pediatrics, Christian Medical College & Hospital, Ludhiana, India
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Lot-to-lot consistency of a hexavalent DTwP-IPV-HB-PRP∼T vaccine and non-inferiority to separate DTwP-HB-PRP∼T and IPV antigen-matching vaccines at 6–8, 10–12, and 14–16 weeks of age co-administered with oral rotavirus vaccine in healthy infants in India: A multi-center, randomized, controlled study. Vaccine X 2022; 12:100216. [PMID: 36164460 PMCID: PMC9508377 DOI: 10.1016/j.jvacx.2022.100216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 09/05/2022] [Accepted: 09/06/2022] [Indexed: 11/24/2022] Open
Abstract
Background Combination vaccines reduce the number of pediatric injections but must be as safe, immunogenic, and effective as each of the individual vaccines given separately. Additionally, consistency in manufacturing lots is essential for WHO prequalification. This study aimed to establish the lot-to-lot consistency of a fully liquid, hexavalent diphtheria (D)-tetanus (T)-whole-cell pertussis (wP)-inactivated poliovirus (IPV)-hepatitis B (HB)-Haemophilus influenzae b (PRP-T) (DTwP-IPV-HB-PRP∼T) vaccine and to demonstrate non-inferiority to licensed DTwP-HB-PRP∼T and IPV vaccines. Methods A Phase III, randomized, active-controlled, and open-label study was conducted at multiple centers across India. Healthy infants who had received a birth dose of oral poliovirus vaccine and hepatitis B vaccine received one of three lots of DTwP-IPV-HB-PRP∼T or separate DTwP-HB-PRP∼T and IPV vaccines at 6–8, 10–12, and 14–16 weeks of age. Oral rotavirus vaccine was co-administered at 6–8 weeks of age and 10–12/14–16 weeks of age. DTwP-IPV-HB-PRP∼T lot-to-lot consistency and non-inferiority (pooled DTwP-IPV-HB-PRP∼T) versus DTwP-HB-PRP∼T and IPV post-third dose were assessed using seroprotection rates (anti-D, anti-T, anti-HBs, anti-PRP, anti-polio 1, 2, 3) and adjusted geometric mean concentrations (anti-PT, anti-FIM). Safety was assessed by parental reports. Results Lot-to-lot consistency was demonstrated for DTwP-IPV-HB-PRP∼T and non-inferiority versus DTwP-HB-PRP∼T and IPV was confirmed with 95% CIs for seroprotection rate differences and adjusted geometric mean concentration ratios within pre-defined clinical margins. Pooled seroprotection rate was ≥ 99.7% for anti-D ≥ 0.01 IU/mL, anti-T ≥ 0.01 IU/mL, anti-HBs ≥ 10 mIU/mL, anti-PRP ≥ 0.15 µg/mL, and anti-polio 1, 2, and 3 ≥ 8 (1/dil) and vaccine response rate was 83.9% for anti-PT and 97.7% for anti-FIM. There were no safety concerns. Conclusions Immunogenicity of three lots of the fully liquid DTwP-IPV-HB-PRP∼T vaccine was consistent and non-inferior to licensed comparators following vaccination at 6–8, 10–12, and 14–16 weeks of age. There were no safety concerns and no evidence of any effect of co-administration with rotavirus vaccine.
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Sharma H, Lalwani S, Parekh S, Pujari P, Shewale S, Palkar S, Hanumante N, Gokhale S, Ks J, Kumar R, Sharma I, Gairola S. A phase I, open label, clinical study to assess the safety and immunogenicity of indigenously developed liquid (DTwP-HepB-IPV-Hib) hexavalent combination vaccine in healthy toddlers aged 16-24 months. Hum Vaccin Immunother 2022; 18:2146435. [PMID: 36412272 DOI: 10.1080/21645515.2022.2146435] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This first in human study was designed as an open label clinical trial to assess the safety and immunogenicity of SIIPL DTwP-HepB-IPV-Hib (Hexavalent) combination vaccine in healthy toddlers, aged 16-24 months. A total of 24 healthy toddlers were administered a 0.5 ml single dose of SIIPL DTwP-HepB-IPV-Hib vaccine intramuscularly, and followed for 28 days for safety outcomes viz. immediate, solicited, unsolicited and serious adverse events. Blood samples were collected immediately prior to and 28 days after vaccination to assess the immunogenicity. Twenty four completed the study in compliance with the study protocol. None of the participants experienced any immediate or any serious adverse event. In terms of the frequency and intensity, the adverse events were comparable to DTwP-based combination vaccines. The vaccine elicited a strong booster response as demonstrated by a large increase in antibodies against all vaccine antigens. One month post booster vaccination seroprotection for diphtheria, tetanus, Hepatitis B, Haemophilus influenzae type b and polio virus type 1 and 3 was 100%. The percentage sero-response for pertussis was 75%. Four-fold increase in antibody concentration for pertussis was achieved in 87.5% subjects. Indigenously developed DTwP-HepB-IPV-Hib vaccine by Serum Institute of India Pvt. Ltd. was found to be safe, well tolerated and showed a robust immune response in toddlers. It was concluded that this vaccine should be assessed in the next phases of clinical development in the target population.Clinical Trial Registration - CTRI/2018/10/015875.
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Affiliation(s)
- Hitt Sharma
- Department of Clinical Research and Pharmacovigilance, Serum Institute of India Pvt. Ltd, Pune, India
| | - Sanjay Lalwani
- Department of Pediatrics, Bharati Vidyapeeth (Deemed to be University) Medical college & Hospital, Pune, India
| | - Sameer Parekh
- Department of Clinical Research and Pharmacovigilance, Serum Institute of India Pvt. Ltd, Pune, India
| | - Pramod Pujari
- Department of Clinical Research and Pharmacovigilance, Serum Institute of India Pvt. Ltd, Pune, India
| | - Sunil Shewale
- Department of Clinical Research and Pharmacovigilance, Serum Institute of India Pvt. Ltd, Pune, India
| | - Sonali Palkar
- Department of Pediatrics, Bharati Vidyapeeth (Deemed to be University) Medical college & Hospital, Pune, India
| | - Neeta Hanumante
- Department of Pediatrics, Bharati Vidyapeeth (Deemed to be University) Medical college & Hospital, Pune, India
| | - Shilpa Gokhale
- Department of Pediatrics, Bharati Vidyapeeth (Deemed to be University) Medical college & Hospital, Pune, India
| | - Jaganathan Ks
- Department of Production, Serum Institute of India Pvt. Ltd., Pune, India
| | - Rakesh Kumar
- Department of Production, Serum Institute of India Pvt. Ltd., Pune, India
| | - Inderjit Sharma
- Department of Production, Serum Institute of India Pvt. Ltd., Pune, India
| | - Sunil Gairola
- Department of Quality Control, Serum Institute of India Pvt. Ltd., Pune, India
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Mangarule S, Palkar S, Mitra M, Ravi M, Dubey A, Moureau A, Jayanth M, Patel D, Ravinuthala S, Jagga S, Patnaik B, Jordanov E, Noriega F. Safety and immunogenicity of a hexavalent DTwP-IPV-HB-PRP∼T vaccine versus separate DTwP-HB-PRP∼T and IPV vaccines in healthy infants in India. Vaccine X 2022; 10:100137. [PMID: 35462885 PMCID: PMC9019696 DOI: 10.1016/j.jvacx.2021.100137] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/11/2021] [Accepted: 12/21/2021] [Indexed: 11/24/2022] Open
Abstract
Background Multivalent vaccines containing whole-cell pertussis (wP) antigens combined with established diphtheria (D), tetanus (T), hepatitis B (HB), Haemophilus influenzae type b (Hib), and inactivated poliomyelitis (IPV) antigens allow the provision of a high-quality, affordable DTwP-IPV-HB-PRP∼T vaccine. Methods Phase I/II, randomized, active-controlled, open-label study in healthy toddlers (Cohort I) and infants (Cohort II). Toddlers in Cohort I who had completed primary series D, T, P, HB, Hib, and polio vaccination received a booster dose of DTwP-IPV-HB-PRP∼T (N = 30) or DTwP-HB-PRP∼T + IPV (N = 15) vaccines at 15–18 months of age. After satisfactory review of safety data in Cohort I, infants in Cohort II received DTwP-IPV-HB-PRP∼T (N = 100) or DTwP-HB-PRP∼T + IPV (N = 50) at 6–8, 10–12, and 14–16 weeks of age. All infants in Cohort II had received previous oral polio and HB vaccines per country recommendations. Results Booster and primary series vaccinations were well tolerated with no clinically significant differences between vaccine groups. Most adverse events were mild and resolved spontaneously; there were no vaccine-related serious adverse events and no deaths. In both vaccine groups, anti-D, anti-T, anti-HB, anti-Hib, and anti-polio 1, 2, and 3 seroprotection was 100% post-booster and post-primary series. For the pertussis antigens, booster response rate was > 86% in both groups. For the primary series, vaccine response rate was slightly higher for DTwP-IPV-HB-PRP∼T than DTwP-HB-PRP∼T + IPV for anti-PT (80.2% and 70.8%) and anti-FHA (81.3% and 68.8%), slightly lower for anti-PRN (72.5% and 81.3%), and similar in each group for anti-FIM (95.6% and 97.9%). Conclusions This study demonstrated a good safety and immunogenicity profile of the hexavalent DTwP-IPV-HB-PRP∼T vaccine for infant primary series vaccination at 6–8, 10–12, and 14–16 weeks of age and booster vaccination at 15–18 months of age and supported progression to the next development phase.
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Affiliation(s)
- S. Mangarule
- Sanofi Healthcare India Private Ltd (SHIPL), Hyderabad, India
- Corresponding author at: Sanofi Healthcare India Private Ltd (SHIPL), Vasantha Chambers, 5-10-173 Fateh Maidan Road, Hyderabad, 500004 Telangana, India.
| | - S. Palkar
- Bharati Vidyapeeth Deemed University Medical College, Pune, India
| | - M. Mitra
- Institute of Child Health, Kolkata, India
| | - M.D. Ravi
- JSS Academy of Higher Education and Research, JSS Medical College and Hospital, Mysore, India
| | - A.P. Dubey
- Maulana Azad Medical College, New Delhi, India
| | | | - M.V. Jayanth
- Sanofi Healthcare India Private Ltd (SHIPL), Hyderabad, India
| | | | - S. Ravinuthala
- Sanofi Healthcare India Private Ltd (SHIPL), Hyderabad, India
| | - S.R. Jagga
- Sanofi Healthcare India Private Ltd (SHIPL), Hyderabad, India
| | - B.N. Patnaik
- Sanofi Healthcare India Private Ltd (SHIPL), Hyderabad, India
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Tabatabaei SR, Karimi A, Zahraei SM, Esteghamati A, Azimi L, Shirvani F, Mohammadi S, Rajabnejad M, Shamshiri A, Faghihian R, Faghihian E. Immunogenicity and Safety of Three WHO Prequalified (DTwP -HB-Hib) Pentavalent Combination Vaccines Administered As Per Iranian National Immunization Plan in Iranian Infants: A Randomized, Phase III Study. Indian Pediatr 2022. [DOI: 10.1007/s13312-021-2393-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kulkarni-Munje A, Malshe N, Palkar S, Amlekar A, Lalwani S, Mishra AC, Arankalle V. Immune Response of Indian Preterm Infants to Pentavalent Vaccine Varies With Component Antigens and Gestational Age. Front Immunol 2021; 12:592731. [PMID: 33968011 PMCID: PMC8102823 DOI: 10.3389/fimmu.2021.592731] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 03/31/2021] [Indexed: 11/28/2022] Open
Abstract
Childhood vaccination plays critical role in protecting infants from several dreaded diseases. Of the global 15 million preterm (PT) infants with compromised immune system born annually, India contributes to >3.5 million. Generation of adequate vaccine-induced immune response needs to be ensured of their protection. Immune response of Indian PT (n = 113) and full-term (FT, n = 80) infants to pentavalent vaccine administered as per the national recommendation was studied. Antibody titers against component antigens of pentavalent vaccine, immune cells profiling (T and B cells, monocytes and dendritic cells) and plasma cytokines were determined pre- and post-vaccination. Additionally, cell-mediated recall immune responses to pentavalent antigens were evaluated after short time antigenic exposure to infant PBMCs. Irrespective of gestational age (GA), all the infants developed adequate antibody response against tetanus, diphtheria, and protective but lower antibody levels for Haemophilus influenzae type-b and hepatitis B in preterm infants. Lower (~74%) protective antibody response to pertussis was independent of gestational age. PT-infants exhibited lower frequencies of CD4 T cells/dendritic cells/monocytes, increased plasma IL-10 levels and lower proliferation of central and effector memory T cells than in term-infants. Proliferative central memory response of FT-infants without anti-pertussis antibodies suggests protection from subsequent infection. Responder/non-responder PT-infants lacked immunological memory and could be infected with Bordetella. For hepatitis B, the recall response was gestational age-dependent and antibody status-independent. Humoral/cellular immune responses of PT-infants were dependent on the type of the immunogen. Preterm infants born before 32 weeks of gestation may need an extra dose of pentavalent vaccine for long lived robust immune response.
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Affiliation(s)
- Archana Kulkarni-Munje
- Department of Communicable Diseases, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed To Be University) University, Pune, India
| | - Nandini Malshe
- Department of Paediatrics, Bharati Vidyapeeth (Deemed To Be University) University Medical College, Pune, India
| | - Sonali Palkar
- Department of Paediatrics, Bharati Vidyapeeth (Deemed To Be University) University Medical College, Pune, India
| | - Aniket Amlekar
- Department of Communicable Diseases, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed To Be University) University, Pune, India
| | - Sanjay Lalwani
- Department of Paediatrics, Bharati Vidyapeeth (Deemed To Be University) University Medical College, Pune, India
| | - Akhilesh Chandra Mishra
- Department of Communicable Diseases, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed To Be University) University, Pune, India
| | - Vidya Arankalle
- Department of Communicable Diseases, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed To Be University) University, Pune, India
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Ekrami Noghabi M, Saffar MJ, Rezai S, Saffar H, Saffar H, Hosseinzadeh F, Nadi Ghara A, Rezai MS. Immunogenicity and Complications of the Pentavalent Vaccine in Iranian Children. Front Pediatr 2021; 9:716779. [PMID: 34660483 PMCID: PMC8518599 DOI: 10.3389/fped.2021.716779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 09/03/2021] [Indexed: 12/03/2022] Open
Abstract
Objective: Vaccination is one of the most convenient and safe preventive care measures available for children. The Pentavalent vaccine which protects against five major infections including diphtheria, tetanus, pertussis, hepatitis B(HepB) and Haemophilus influenzae type b(Hib) was added to the Iranian national immunization program in November 2014. This study aimed to determine the Pentavalent vaccine adverse events and immunogenicity in an Iranian children population in Sari, northern Iran. Method: In this descriptive-analytical study, children who were vaccinated with three doses of the Pentavalent vaccine were studied. Two venous blood samples were obtained before the first dose and 4 weeks following the last booster dose. Possible local and systemic complications of the vaccine were recorded until 7 days following vaccination. Antibody titers were measured by quantitative ELISA kits and geometric mean titer(GMT) was calculated for each vaccine component before and after 3 doses of vaccine. Statistical analysis was performed by SPSS 20.0 software and Chi-square and Fisher's exact tests were used for analysis. Results: Immunogenicity of the Pentavalent vaccine for tetanus was 100%(GMT:2.52 Eu/mL, 95%CI: 2.22-2.88), Hib 98.7%(GMT:2.44 Eu/mL, 95%CI: 2.06-2.89), HepB 98.7%(GMT:153.54 Eu/mL, 95%CI: 133.73-176.29), diphtheria 93.1%(GMT:0.43 Eu/mL, 95%CI:0.37-0.51) and pertussis were 63.7% (GMT:19.44 Eu/mL, 95%CI:16.42-23.03). The most common systemic complication after vaccination was fever. Also, one infant cried for more than 3 hours after the second dose. Other serious side effects were not observed. Conclusion: The Pentavalent vaccine used in Iran can cause adequate antibody response against diphtheria, tetanus, pertussis, Hib and hepatitis B in most cases with minimal side effects. The immunogenicity of this vaccine is significantly lower for pertussis. In this study, no severe complication leading to contraindication to subsequent injections was reported. So, the present policy in replacing triple DTP vaccine with Pentavalent vaccine should be continued in Iran.
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Affiliation(s)
- Mina Ekrami Noghabi
- Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad Jafar Saffar
- Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Shaghayegh Rezai
- Department of Microbiology and Virology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hana Saffar
- Anatomical and Clinical Pathology, Department of Pathology, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hiva Saffar
- Anatomical and Clinical Pathology, Department of Pathology, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Hosseinzadeh
- Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Aliasghar Nadi Ghara
- Health Science Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad Sadegh Rezai
- Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
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Gunardi H, Rusmil K, Fadlyana E, Soedjatmiko, Dhamayanti M, Sekartini R, Tarigan R, Satari HI, Medise BE, Sari RM, Bachtiar NS, Kartasasmita CB, Hadinegoro SRS. DTwP-HB-Hib: antibody persistence after a primary series, immune response and safety after a booster dose in children 18-24 months old. BMC Pediatr 2018; 18:177. [PMID: 29804542 PMCID: PMC5971417 DOI: 10.1186/s12887-018-1143-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 05/03/2018] [Indexed: 11/24/2022] Open
Abstract
Background The new combination of DTwP-HB-Hib vaccines has been developed in Indonesia following World Health Organization (WHO) recommendation and integrated into national immunization program. The aims of the study were to measure 1) antibody persistence 12–18 months after a primary series, 2) immune response and safety after a booster dose of DTwP-HB-Hib. Methods This was a multi-center, open-labeled, prospective, interventional study. Subjects who had received complete primary dose of DTwP-HB-Hib vaccine from the previous phase III trial were recruited in this trial. Subjects were given one dose of DTwP-HB-Hib (Pentabio®) booster at age 18–24 months old. Diphtheria, tetanus, pertussis, hepatitis B, Hemophilus influenza type B antibodies were measured before and after booster to determine antibody persistence and immune response. Vaccine adverse events were assessed immediately and monitored until 28 days after the booster recorded with parent’s diary cards. Results There were 396 subjects who completed the study. Increased proportion of seroprotected subjects from pre-booster to post-booster were noted in all vaccine antigens: 74.5 to 99.7% for diphtheria; 100 to 100% for tetanus; 40.4 to 95.5% for pertussis; 90.2 to 99.5% for hepatitis B; and 97.7 to 100% for Hib. Common systemic adverse events (AEs) were irritability (23.7–25%) and fever (39.9–45.2%). Local AEs such as redness, swelling, and induration were significantly less common in the thigh group (7.7, 11.3, and 7.1%) than in the deltoid group (28.9, 30.7, and 25%) (P < 0.001). Most AEs were mild and resolved spontaneously within three-day follow-up period. Conclusions Booster of DTwP-HB-Hib vaccine at age 18–24 months is required to achieve and maintain optimal protective antibody. The vaccine is safe and immunogenic to be used for booster vaccination. Trial registration NCT02095314 (retrospectively registered, March 24, 2014).
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Affiliation(s)
- Hartono Gunardi
- Department of Child Health, Faculty of Medicine, Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jl. Diponegoro No 71, Jakarta, 10430, Indonesia.
| | - Kusnandi Rusmil
- Department of Child Health, Faculty of Medicine, Padjadjaran University/Dr. Hasan Sadikin Hospital, Jl. Pasteur No 38, Bandung, 40161, Indonesia
| | - Eddy Fadlyana
- Department of Child Health, Faculty of Medicine, Padjadjaran University/Dr. Hasan Sadikin Hospital, Jl. Pasteur No 38, Bandung, 40161, Indonesia
| | - Soedjatmiko
- Department of Child Health, Faculty of Medicine, Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jl. Diponegoro No 71, Jakarta, 10430, Indonesia
| | - Meita Dhamayanti
- Department of Child Health, Faculty of Medicine, Padjadjaran University/Dr. Hasan Sadikin Hospital, Jl. Pasteur No 38, Bandung, 40161, Indonesia
| | - Rini Sekartini
- Department of Child Health, Faculty of Medicine, Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jl. Diponegoro No 71, Jakarta, 10430, Indonesia
| | - Rodman Tarigan
- Department of Child Health, Faculty of Medicine, Padjadjaran University/Dr. Hasan Sadikin Hospital, Jl. Pasteur No 38, Bandung, 40161, Indonesia
| | - Hindra Irawan Satari
- Department of Child Health, Faculty of Medicine, Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jl. Diponegoro No 71, Jakarta, 10430, Indonesia
| | - Bernie Endyarni Medise
- Department of Child Health, Faculty of Medicine, Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jl. Diponegoro No 71, Jakarta, 10430, Indonesia
| | - Rini Mulia Sari
- PT Bio Farma, Jl. Pasteur No 28, Bandung, Jawa Barat, Indonesia
| | | | - Cissy B Kartasasmita
- Department of Child Health, Faculty of Medicine, Padjadjaran University/Dr. Hasan Sadikin Hospital, Jl. Pasteur No 38, Bandung, 40161, Indonesia
| | - Sri Rezeki S Hadinegoro
- Department of Child Health, Faculty of Medicine, Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jl. Diponegoro No 71, Jakarta, 10430, Indonesia
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Sil A, Ravi MD, Patnaik BN, Dhingra MS, Dupuy M, Gandhi DJ, Dhaded SM, Dubey AP, Kundu R, Lalwani SK, Chhatwal J, Mathew LG, Gupta M, Sharma SD, Bavdekar SB, Rout SP, Jayanth MV, D'Cor NA, Mangarule SA, Ravinuthala S, Reddy E J. Effect of prophylactic or therapeutic administration of paracetamol on immune response to DTwP-HepB-Hib combination vaccine in Indian infants. Vaccine 2017; 35:2999-3006. [PMID: 28449972 DOI: 10.1016/j.vaccine.2017.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 03/04/2017] [Accepted: 03/06/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Vaccination is considered as the most cost effective method for preventing infectious diseases. Low grade fever is a known adverse effect of vaccination. In India, it is a common clinical practice to prescribe paracetamol either prophylactically or therapeutically to manage fever. Some studies have shown that paracetamol interferes with antibody responses following immunization. This manuscript reports the outcome of a post hoc analysis of data from a clinical trial of a pentavalent vaccine in Indian infants where paracetamol was not used or was used either as prophylaxis or for treatment of fever. METHODS Pre and post vaccine antibody levels against Diphtheria, Tetanus, Pertussis, Hepatitis B, Haemophilus influenzae type B were assessed in no paracetamol and paracetamol groups. The paracetamol group was further divided into prophylactic and treatment groups. RESULTS Similar rates of seroprotection/seroresponse for anti-D, anti-T, anti-wP, anti-PT, anti-HBs and anti-PRP were observed in all the groups. There was no clear tendency for difference in percentage seroprotection/seroresponse and geometric mean (GM) titers in any of the groups. CONCLUSION The study found no evidence that paracetamol usage either as prophylactic or for treatment impact immunological responses to DTwP-HepB-Hib combination vaccine. [Clinical trial registry of India (study registration number CTRI/2012/08/002872)].
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Affiliation(s)
- Arijit Sil
- Shantha Biotechnics Private Limited - A Sanofi Company, Hyderabad, India.
| | | | - Badri N Patnaik
- Shantha Biotechnics Private Limited - A Sanofi Company, Hyderabad, India
| | | | | | - Dulari J Gandhi
- Dept. of Pediatrics, SBKS MI & RC, Sumandeep Vidyapeeth, Vadodara, India
| | - Sangappa M Dhaded
- Dept. of Pediatrics, KLE University's, Jawaharlal Nehru Medical College, Belagavi, India
| | - Anand P Dubey
- Dept. of Pediatrics, Maulana Azad Medical College, Delhi, India
| | - Ritabrata Kundu
- Dept. of Pediatrics, Institute of Child Health, Kolkata, India
| | - Sanjay K Lalwani
- Dept. of Pediatrics, Bharati Vidyapeeth Deemed University Medical College, Pune, India
| | - Jugesh Chhatwal
- Dept. of Pediatrics, Christian Medical College, Ludhiana, India
| | - Leni G Mathew
- Dept. of Pediatrics, Christian Medical College, Vellore, India
| | - Madhu Gupta
- Dept. of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Shiv D Sharma
- Dept. of Pediatrics, Sawai Man Singh Medical College, Jaipur, India
| | - Sandeep B Bavdekar
- Dept. of Pediatrics, Topiwala National Medical College and BYL Nair Ch. Hospital, Mumbai, India
| | - Soumya P Rout
- Shantha Biotechnics Private Limited - A Sanofi Company, Hyderabad, India
| | - Midde V Jayanth
- Shantha Biotechnics Private Limited - A Sanofi Company, Hyderabad, India
| | - Naveena A D'Cor
- Shantha Biotechnics Private Limited - A Sanofi Company, Hyderabad, India
| | | | - Suresh Ravinuthala
- Shantha Biotechnics Private Limited - A Sanofi Company, Hyderabad, India
| | - Jagadeesh Reddy E
- Shantha Biotechnics Private Limited - A Sanofi Company, Hyderabad, India
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