title: Diminution of the anti-polyribosylribitol phosphate response to a combined diphtheria-tetanus-acellular pertussis/Haemophilus influenzae type b vaccine by concurrent inactivated poliovirus vaccination.
abstract: 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%.
  
  
  CONCLUSIONS
  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.
authors.affiliation: University of Maryland School of Medicine, Baltimore, USA. mrennels@som.umaryland.edu
authors.forename: M B
authors.initials: MB
authors.lastname: Rennels
authors.forename: J A
authors.initials: JA
authors.lastname: Englund
authors.forename: D I
authors.initials: DI
authors.lastname: Bernstein
authors.forename: G A
authors.initials: GA
authors.lastname: Losonsky
authors.forename: E L
authors.initials: EL
authors.lastname: Anderson
authors.forename: M E
authors.initials: ME
authors.lastname: Pichichero
authors.forename: F M
authors.initials: FM
authors.lastname: Munoz
authors.forename: M C
authors.initials: MC
authors.lastname: Wolff
mesh_terms: D018829:Adhesins, Bacterial / Q000276:immunology; D000907:Antibodies, Bacterial / Q000097:blood; D000914:Antibodies, Viral / Q000097:blood; D000917:Antibody Formation / Q000187:drug effects / Q000276:immunology; D016667:Bacterial Capsules; D004167:Diphtheria Toxin / Q000276:immunology; D015721:Diphtheria-Tetanus-Pertussis Vaccine / Q000008:administration & dosage* / Q000009:adverse effects / Q000276:immunology; D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines; D004306:Dose-Response Relationship, Immunologic; D004334:Drug Administration Schedule; D005260:Female; D018073:Haemophilus Vaccines / Q000008:administration & dosage* / Q000009:adverse effects / Q000276:immunology; D006388:Hemagglutinins / Q000276:immunology; D006801:Humans; D007108:Immune Tolerance / Q000187:drug effects / Q000276:immunology; D007223:Infant; D008297:Male; D011054:Poliovirus Vaccine, Inactivated / Q000008:administration & dosage* / Q000009:adverse effects / Q000276:immunology; D011134:Polysaccharides / Q000276:immunology*; D011135:Polysaccharides, Bacterial / Q000008:administration & dosage* / Q000009:adverse effects / Q000276:immunology; D012698:Serologic Tests; D015164:Vaccines, Inactivated / Q000008:administration & dosage* / Q000276:immunology; D010566:Virulence Factors, Bordetella / Q000276:immunology
chemical_list: D018829:Adhesins, Bacterial; D000907:Antibodies, Bacterial; D000914:Antibodies, Viral; D004167:Diphtheria Toxin; D015721:Diphtheria-Tetanus-Pertussis Vaccine; D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines; D018073:Haemophilus Vaccines; C044237:Haemophilus influenzae type b polysaccharide vaccine; D006388:Hemagglutinins; D011054:Poliovirus Vaccine, Inactivated; D011134:Polysaccharides; D011135:Polysaccharides, Bacterial; D015164:Vaccines, Inactivated; D010566:Virulence Factors, Bordetella; C065273:filamentous hemagglutinin adhesin, Bordetella pertussis; C008984:polyribitol phosphate