Diminution of the anti-polyribosylribitol phosphate response to a combined diphtheria-tetanus-acellular pertussis/Haemophilus influenzae type b vaccine by concurrent inactivated poliovirus vaccination.

Publication Type
Journal Article
Year of Publication
Rennels, M B; Englund, J A; Bernstein, D I; Losonsky, G A; Anderson, E L; Pichichero, M E; Munoz, F M; Wolff, M C
Pediatr Infect Dis J
Date Published
2000 May
Adhesins, Bacterial; Antibodies, Bacterial; Antibodies, Viral; Antibody Formation; Bacterial Capsules; Diphtheria Toxin; Diphtheria-Tetanus-acellular Pertussis Vaccines; Diphtheria-Tetanus-Pertussis Vaccine; Dose-Response Relationship, Immunologic; Drug Administration Schedule; Female; Haemophilus Vaccines; Hemagglutinins; Humans; Immune Tolerance; Infant; Male; Poliovirus Vaccine, Inactivated; Polysaccharides; Polysaccharides, Bacterial; Serologic Tests; Vaccines, Inactivated; Virulence Factors, Bordetella

BACKGROUND: Prelicensure studies of Haemophilus influenzae type b vaccines (Hib) and diphtheria-tetanus-acellular pertussis vaccines (DTaP) were evaluated with concurrent oral poliovirus vaccine (OPV). However, inactivated poliovirus vaccine (IPV) is now recommended. A trial was conducted in which infants received a DTaP and Hib vaccine, separately (+) or combined (/), with either all OPV, all IPV or sequential IPV-OPV for the primary series of vaccinations.

METHODS: In this protocol 567 infants were equally randomized to receive one of the following: Reference Arm A, DTaP + Hib + OPV; Treatment Arm B, DTaP/Hib + OPV; Treatment Arm C, DTaP/Hib + IPV at 2 and 4 months and OPV at 6 months; or Treatment Arm D, DTaP/Hib + IPV. antibodies against all administered antigens were measured at 7 months of age. Children with an antibody response to Hib (anti-polyribosylribitol phosphate (anti-PRP) <0.15 microg/ml had an antibody titer repeated after the toddler booster immunization.

RESULTS: A significant diminution in the anti-PRP response was observed at 7 months of age in children given two or three doses of IPV concurrently with DTaP/Hib, compared with the groups given OPV. The geometric mean concentration of anti-PRP, percentage of children with > or = 0.15 microg/ml and percentage of children with > or = 1.0 microg/ ml, respectively, were: A, 4.4, 98%, 81%; B, 3.2, 94%, 78%; C, 1.3, 86%, 58% and D, 1.2, 84%, 53%.

CONCLUSION: In this trial concurrent IPV appeared to interfere with the anti-PRP response to DTaP/Hib vaccine, suggesting that introduction of new vaccines may require evaluation of immune responses to all concurrently administered vaccines.