Interchangeability of vaccines:

Primary doses:
It is ideal to finish the schedule of primary doses with the same brand. In case it is not known one can use any other vaccine. Studies have shown that the immune response is the same. PRP D is not used for primary doses. Some studies have used PRP OMP as 1^st dose to get maximum 1^st dose protection followed by 2nd & 3rd dose with either HbOC or PRPT to get maximum boosting titres. (22)

HbOC with adjuvant vaccine has different schedule as compared to other 4 vaccines. Hence it should not be interchanged for other vaccines. No such studies are even available.

Booster dose:
Again it is good practice to use same brand for booster as that used for primary doses. However all the 4 vaccines can be interchanged for booster. PRP D is licensed to use as booster (2.13). HbOC with adjuvant has different schedule & hence should not be interchanged with other vaccines.

Why do we need booster?


As seen before 98-99% achieved a titre of >0.15mcg/ml & 90% of them have >1.0mcg/ml level with GMT of 5-6 mcg/ml at the end of 3 doses. 90% maintain the level >0.15 mcg/ml till 15-18 months but the titre fall to 1.22 mcg/ml by that time. Hence a booster is given at 15-18 months which will lead to 100% achieve a titre >1.0 mcg/ml with GMT of 40-60 mcg/ml (17). This will protect the children for long time, certainly beyond 5 years of age.

Side effects:
Hib conjugate vaccines are one of the safest vaccines proved in many studies.

Local :
3-5% vaccinees develop local pain, 10% develop redness, 2-4 % develop swelling. These are mild in nature & lasts for 1-2 days. One can use paracetamol for pain (2,24).

Systemic :
10-15% develop fever which is mild, lasts for 1-2 days & responds to paracetamol. Other side effects include loss of appetite in 15-20%, restlessness in 15-20%, excessive crying in 20-22%, vomiting in 7-10% & diarrhoea in 10-15% of cases. Again these symptoms are mild and self limiting (2,24).

All the local & systemic side effects are more common with primary doses than booster dose.

Hib combination vaccines:
OPV/IPV, DPT, Hep B & Hib vaccines need to be given at about the same age of 6-8weeks onwards. To be meaningful, the schedule of all these vaccines has to be completed in time. This means giving these vaccines on the same day.

One can give more than 1 vaccine either separately using separate syringe at separate site or use combination vaccine containing more than 1 antigen in the same vaccine. Giving vaccines separately on same day will mean multiple pricks & use of multiple syringes. It is less acceptable by parents at times whereas combination vaccines means single prick for multiple antigen, use of only one syringe which will save on cost & also easy storage in fridge as one will need to keep less number of units. Combination vaccines also save on number of visits than when given on separate days.

Hib vaccine has been combined with DPT (quadrivalent), DPaT (quadrivalent), DPT/IPV (pentavalent), DPaT/IPV (pentavalent), DPT/HepB, DPT/IPV/HepB (hexavalent). The studies show similar immune response to all the components of vaccines than when given separately. Some studies have used Hib & these other vaccines given separately at different sites but on same day whereas others have mixed Hib vaccines with these vaccines. Some studies have shown interference with anti PRP titre & anti pertussis titres by mixing vaccines. Some have shown higher anti PRP, antidiphtheria & antitetanus titres by mixing the vaccines in same syringe due to priming effect of carrier protein. Hence one should not mix Hib with other vaccine in same syringe unless recommended by manufacturers based on studies.

IAP recommendation:
25 million babies are born in India every year. Each child will need 4 doses of Hib vaccine. So for universal immunization, India will need 100 million doses of Hib vaccine every year. At the current cost of RS 300/- per dose it will cost RS 30,000 million per year. This is an exorbitant cost especially when there are other priorities too in child health. Hence at present, govt. sponsored universal immunization programme appears a dream.

However Hib is a killer disease with high mortality & higher morbidity. Hence but for the cost of vaccine, it is a must vaccine for all children. Hence IAP recommends Hib vaccine as an optional vaccine to be promoted with high priority to affording patients, optional only because of high cost (25).

Also See Article On "HAEMOPHILUS INFLUENZAE B DISEASE"

References :

Shah Nitin, A Parthasarathy : Newer vaccines Your questions answered. Proceeding of the dialogue session on newer vaccines held at the annual conference of Indian Academy of Pediatric, Cochin 1998 pp 7 - 10


Wegner JD, Booy R, Heath P T et al: Epidemiological impact of conjugate vaccines on invasive disease caused by hemophilus influenza type B. In Newer Generation vaccines Eds: Levine MM, Woodrow GC, Kaper J B et al. Published by Marcel Dekker inc; 1999 pp 489 - 502


Kumar L, Ayyagari A: The etiology of lobar pneumonia and empyema thoracis in children. Indian Pediatrics 1984, 21: 133 - 38.


John T J, Cherian T, Raghupathy P: Hemophilus influenza disease in children in India : a hospital perspective. The paediatric infectious disease journal 1998, 17(9) : 5169 - 71.


Booy R, Hodgson SR, Slack SPE et al: Invasive Hemophilus influenza type b disease in the Oxford region (1985 - 91). Archives of disease in childhood. 1993, 69 : 225 - 28.


Bijlwer H : World wide epidemiology of hemophilus influenzae meningitis; industrialised versus non industrialised countries. Vaccine 1991, 9: 55 - 9


1. Singh R, Thomas S, Chellam K et al : Occurrence of multiple antimicrobial resistance among Hemophilus influenzae type b is causing meningitis Indian J Med Res 1992, 95 : 230 - 33
   
   
2. Invasive Hemophilus influenza disease in India : a preliminary report of prospective multihospital surveillance IBIS. Pediatr. Infect Dis J 1998, 17: 3172 - 75
   
   
3. Barbour ML, Mayon- White -RT, Coles C et al :The impact of conjugate vaccine on carriage of Hemophilus influenzae type b. The Journal of Infectious Disease: 1995, 171 : 93 - 8.
   
   
4. Ayyagiri A, Sharma P, Chakrabarti A et al: Isolation and detection of hemophilus influenzae from patients of respiratory tract infections and their antibiotic susceptibility pattern in Chandigarh. Indian J Chest Dis & All Sci 1985, 27 : 230 - 35
   
   
5. Bahl R, Mishra S, Sharma D et al : A bacteriological study on hospitalised children with pneumonia. Ann Trop Pediatr 1995, 15 : 173 - 77.
   
   
6. Ayyagiri A, Kaut P, Sachdeva S et al: Meningitis due to beta lactamase producing type 'b' hemophilus influenzae resistant to chloramphenicol in India - a care report. Indian J Pediatr 1984, 51: 615 - 17
   
   
7. Singh N, Ayyagiri A, Marmaha RK: Multiple resistant Hemophilus Influenzae 'b' meningitis. Indian Pediatr 1990, 27 : 502 - 04
   
   
8. Agarwal V, Jaivi D, Patnaik A et al: Characterisation of invasive Hemophilus influenza isolated in Nagpur, Central India. Indian J med Res. 1996, 103: 296 - 98
   
   
9. Hib disease & its prevention. A newer perspective product monogram on Varem Hib printed by Chiron vaccines & Hoechst Marrion Roussel Limited, 1999.
   
   
10. Decker MD, Edwards KN, Bradley R et al: Comparative trial in infants of four conjugate hemophilus influenzae type b vaccines. The journal of Pediatrics 1992, 120:184-89
    
    
11. Fritzell B: Polysaccharide vaccine against hemophilus influenzae b conjugated to tetanus protein. Immunol Med 1991, 8:176-83.
    
    
12. Capeding M.R.Z. : Immunogenecity of hemophilus influenzae conjugate vaccines in developing countries. JAMA 1994 s:156-58
    
    
13. Peltola H, Kilpi T, Anttila M: Rapid disappearance of Hemophilus influenza type b meningitis after routine childhood immunisation with conjugate vaccines. Lancet 1992, 340:592-94
    
    
14. Booy R, Hodgson S, Carpenter L et al: Efficacy of hemophilus influenza type b conjugate vaccine - PRPT. Lancet 1994; 344:362-66
    
    
15. Clements D: Cost of treatment and prevention of hemophilus influenza type b disease. Pharmacoeconomics 1994, 6(5) : 442-52
    
    
16. Greenberg DP, Liberman JM, Marcy SM et al: Enhanced antibody responses in infants given different sequences of heterogeneous hemophilus influenza type b conjugate vaccines. The journal of Pediatrics 1995, 126 : 206-11
    
    
17. Decker MD, Edwards KM, Bradley R et al: Responses of children to booster immunisation with their primary conjugate hemophilus influenzae type b vaccine or with polyribosyl ribitol phosphate conjugated with diphtheria toxoid. The Journal of Pediatrics 1993 122:410-13
    
    
18. Schmitt HJ, Zepp F, Miischenborn S et al: Immunogenecity and reactogenicity of a hemophilus influenza type b tetanus conjugate vaccine when administered separately or mixed with concomitant diphtheria-tetanus-toxoid and acellular pertussis vaccine for primary and for booster immunisation. Eur. J Pediatr 1998, 157: 208-14.
    
    

Last created on 23-02-2001
Last updated on 14-05-2007