title: One arm or two? Concurrent administration of meningococcal C conjugate and hepatitis B vaccines in pre-teens.
abstract: BACKGROUND
  The purpose of this study was to: (a) compare rates of local reactions from meningococcal C conjugate (Neis Vac-C) and hepatitis B vaccines (Recombivax HB), and (b) compare local reactions when both injections were given in one arm versus one in each arm.
  
  
  METHODS
  Schools were randomized to have grade six students receive both vaccines in one arm (One Arm Group), or one vaccine in each arm (Two Arm Group; MCC always given in left arm). Structured telephone interviews of parents were conducted, and respondents were asked about local and systemic reactions, interference with school or other activities, need for medical attention, and lost parental work time.
  
  
  RESULTS
  The Two Arm Group reported significantly more local redness >46 mm (6.5% vs. 0.5%, p < 0.001), moderate to severe tenderness (28% vs. 18%, p < 0.05), and drowsiness (14% vs. 7%, p < 0.05). When adjusted for sex, ethnicity, and town of residence, report of any tenderness was associated with town of residence only; moderate or severe tenderness was independently associated with the Two Arm Group (OR 1.4, 95% CI 1.1-1.85). There were no statistically significant differences between groups for interference with school attendance or other activities, need for medical attention, or lost parental work time. Among participants of the Two Arm Group (188 students), there was more redness (6% vs. 2%, p < 0.05) and tenderness (54% vs. 32%, p < 0.001) experienced with Neis Vac-C than with Recombivax HB, respectively.
  
  
  CONCLUSIONS
  Injecting two vaccines in one arm did not cause more local reaction than one injection in each arm and remains an option for those who prefer it for logistical reasons, If vaccinating in two arms, Neis Vac-C should preferentially be given in the nondominant arm.
authors.affiliation: British Columbia Centre for Disease Control, Vancouver, BC. Karen.pielak@bccdc.ca
authors.forename: Karen L
authors.initials: KL
authors.lastname: Pielak
authors.forename: Cheryl C
authors.initials: CC
authors.lastname: McIntyre
authors.forename: Valencia P
authors.initials: VP
authors.lastname: Remple
authors.forename: Jane A
authors.initials: JA
authors.lastname: Buxton
authors.forename: Danuta M
authors.initials: DM
authors.lastname: Skowronski
mesh_terms: D000293:Adolescent; D002648:Child; D006306:Health Surveys; D006509:Hepatitis B / Q000517:prevention & control*; D017325:Hepatitis B Vaccines / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D017589:Immunization Programs; D022401:Meningococcal Vaccines / Q000008:administration & dosage* / Q000009:adverse effects; D011637:Public Health Nursing; D011795:Surveys and Questionnaires; D013997:Time Factors
chemical_list: D017325:Hepatitis B Vaccines; D022401:Meningococcal Vaccines; C410218:serogroup C meningococcal conjugate vaccine