Pediatrics Medical News about combined DTP-HBV-HIB vaccine

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Combined DTP-HBV-HIB vaccine versus separately administered DTP-HBV and HIB vaccines for primary prevention of diphtheria, tetanus, pertussis, hepatitis B and Haemophilus influenzae B (HIB)
Cochrane Reviews, 07/17/09

Bar–On ES et al. – Eighteen published randomized or quasi–randomized clinical trials, comparing vaccination with any combined DTP–HBV–HIB vaccine with or without three types of inactivated poliovirus (IPV) or concomitant oral polio vaccine (OPV) given in any dose, preparation or time schedule, compared with separate vaccines or placebo, administered to infants aged up to two years, were included. In two immunological responses the combined vaccine achieved lower responses than the separate vaccines for HIB and HBV. No significant differences in immunogenicity were found for pertussis, diphtheria, polio and tetanus. Serious adverse events were comparable. Minor adverse events were more common in children given the combined vaccine. Overall, the level of evidence provided by the studies was low, and the authors could not conclude that the immune responses elicited by the combined vaccine are equivalent to the separate injections. The combined vaccine did not result in a significant increase in the incidence of serious adverse events, but caused more minor reactions.

Exclusive Author Commentary
Edna S Bar-On, 07/22/09

Using data from eighteen studies involving 10,374 children, the review examined combined DTP-HBV-HIB vaccine and the separate DTP-HBV and HIB vaccines. Two of the trials took place in the US, others included studies were conducted in Mexico, Brazil, Panama, Venezuela, Dominican Republic, Costa Rica, Canada, South Africa, Philippines, Burma, Greece, Spain, Switzerland, Australia, Italy, Slovakia, France, Germany, Argentina, Nicaragua, Colombia, Turkey and Belgium. Despite the WHO recommendation to use the combined vaccine, our meta-analysis does not support this immunization practice. Still, the results of our review should be viewed with caution, mostly as an indication that high quality data are lacking. The choise about using combined or separate vaccines rests with the health care providors and policy makers taking in consideration the review limitations and the known benefits of a combined vaccine.

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