Economisation of vaccination against Haemophilus influenzae type b: A randomised trial of immunogenicity of fractional-dose and two-dose regimens

Rosanna Lagos, Maria Teresa Valenzuela, Orin S. Levine, Genevieve A. Losonsky, Alvaro Erazo, Steven S. Wasserman, Myron Levine

Resultado de la investigación: Contribución a una revistaArtículorevisión exhaustiva

52 Citas (Scopus)

Resumen

Background. The cost of Haemophilus influenzae type b (Hib) conjugate vaccines has limited their use in non-industrialised countries. To identify more economical vaccination schedules, we carried out a randomised trial of the immunogenicity of alternative regimens to the standard three-dose series. Methods. 627 Chilean infants were randomly allocated to one of four regimens with either Hib polysaccharide-tetanus toxoid conjugate vaccine (PRP-T) or Hib oligosaccharide-diphtheria mutant toxoid conjugate vaccine (PRP-CRM197), for a total of eight groups. All infants receive diphtheria-tetanus-pertussis (DTP) vaccine at ages 2, 4, and 6 months. The regimens included three full doses, three fractional doses consisting of one half or one third of the full dose, and a regimen of two full doses (at age 4 and 6 months). The primary outcome was the proportion of infants with serum anti-polyribosylribitol phosphate (PRP, the type b capsular polysaccharide) concentrations of 0.15 μg/mL or more at age 8 months. Findings. 93% (95% CI 85-98) of infants vaccinated with three full doses of PRP-T or PRP-CRM197 (95% CI 84-98) achieved anti-PRP concentrations of 0.15 μg/mL or more at age 8 months, compared with 91% (83-96) to 100% (95-100) of infants immunised with any fractional-dose regimen. Of the infants vaccinated with two doses of PRP-T or PRP-CRM197, 99% (93-100) and 87% (77-93) developed anti-PRP concentrations of 0.15 μg/mL or more, respectively. Interpretation. 91% (83-96) to 100% (95-100) of infants immunised with one-half or one-third of a full dose of Hib conjugate developed protective antibody concentrations. Carrier priming with DTP may make two-dose schedules an option in some places. These alternative regimens could bring the cost of Hib vaccines within reach of countries that currently cannot afford them.
Idioma originalInglés estadounidense
Páginas (desde-hasta)1472-1476
Número de páginas5
PublicaciónLancet
Volumen351
N.º9114
DOI
EstadoPublicada - 16 may 1998
Publicado de forma externa

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