A cross sectional study by Stefan Flasche and coworkers document the serotype replacement of Streptococcus pneumoniae that has occurred in England since the introduction of PCV7 vaccination.
Objectives To compare the safety, reactogenicity, and immunogenicity of an adjuvanted split virion H1N1 vaccine and a non-adjuvanted whole virion vaccine used in the pandemic immunisation programme in the United Kingdom.
In conclusion, a single priming dose of either MCC-TT or MCC-CRM197 administered at 3 months of age can be used together with the Hib/MCC-TT booster in the second year of life.
The coadministration of the combined meningococcal serogroup C conjugate (MCC)/Haemophilus influenzae type b (Hib) vaccine with pneumococcal conjugate vaccine (PCV7) and measles, mumps, and rubella (MMR) vaccine at 12 months of age was investigated to assess the safety and immunogenicity of this regimen compared with separate administration of the conjugate vaccines. Children were randomized to receive MCC/Hib vaccine alone followed 1 month later by PCV7 with MMR vaccine or to receive all three vaccines concomitantly. Immunogenicity endpoints were MCC serum bactericidal antibody (SBA) titers of >8, Hib-polyribosylribitol phosphate (PRP) IgG antibody concentrations of >0.15 g/ml, PCV serotype-specific IgG concentrations of >0.35 g/ml, measles and mumps IgG concentrations of >120 arbitrary units (AU)/ml, and rubella IgG concentrations of >11 AU/ml. For safety assessment, the proportions of children with erythema, swelling, or tenderness at site of injection or fever or other systemic symptoms for 7 days after immunization were compared between regimens. No adverse consequences for either safety or immunogenicity were demonstrated when MCC/Hib vaccine was given concomitantly with PCV and MMR vaccine at 12 months of age or separately at 12 and 13 months of age. Any small differences in immunogenicity were largely in the direction of a higher response when all three vaccines were given concomitantly. For systemic symptoms, there was no evidence of an additive effect; rather, any differences between schedules showed benefit from the concomitant administration of all three vaccines, such as lower overall proportions with postvaccination fevers. The United Kingdom infant immunization schedule now recommends that these three vaccines may be offered at one visit at between 12 and 13 months of age.In September 2006, the combined meningococcal serogroup C (MCC) and Haemophilus influenzae type b (Hib) conjugate vaccine (Menitorix; GlaxoSmithKline [GSK]) was introduced in the United Kingdom as a booster dose given in the second year of life (2). At that time there were no data on the immunogenicity of the combined MCC/Hib vaccine when coadministered with measles, mumps, and rubella (MMR) vaccine and 7-valent pneumococcal conjugate vaccine (PCV7), both of which are also given early in the second year of life. Because of unpredictable immunological interactions when different polysaccharide conjugates are given concomitantly for primary immunization, it was recommended that the MCC/Hib vaccine should be given at 12 months, followed by PCV7 and MMR vaccine at 13 months (2).Following the launch of the new booster program, health professionals and parents began to ask whether, for convenience, all three vaccines could be given at the same visit. At the time, a study to evaluate the immunogenicity of reduced primary immunization schedules involving two doses of PCV7 given concomitantly with MCC vaccine was being conducted (6,14). Children in the study were subsequently recruited into a booster study and offered MCC/Hib vaccine at 1...
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