title: Two or three primary dose regime for Haemophilus influenzae type b conjugate vaccine: meta-analysis of randomized controlled trials.
abstract: Haemophilus influenzae type b (Hib) is an important cause of meningitis and pneumonia in children. Despite the availability of Hib conjugate vaccine, many countries are still to implement it in their immunization schedule. Before introducing the vaccine in routine immunization programs, it is important to know not only the cumulative efficacy but also the efficacy of each vaccine dose. The primary objective of this review is to find whether two primary dose schedule of Hib vaccine is equally efficacious as the standard three primary dose schedule. A highly sensitive online search was run using the terms 'Haemophilus Vaccines' or 'Haemophilus influenzae type b' and 'conjugate vaccine', and Medline (Ovid), PubMed, Embase, CENTRAL and Scopus were explored for prospective randomized controlled studies. Data were extracted in a predesigned proforma and analyzed using RevMan software. Nine randomized studies were included in the analysis. Pooled vaccine efficacy using a fixed effects model against confirmed invasive Hib disease following the 3, 2 and 1 primary dose schedule were 82% [95% confidence interval (CI) 73-87], 79% (95% CI 54-90) and 65% (95% CI 23-84), respectively, and the overall efficacy was 80% (95% CI 72-85). To conclude, we found that Hib conjugate vaccine is highly efficacious and that the two dose regime is as good as the three dose regime. [The protocol was registered with PROSPERO (CRD42013004490)].
authors.affiliation: ICMR Advanced Center for Evidence Based Child Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
authors.forename: Kiran K
authors.initials: KK
authors.lastname: Thumburu
authors.affiliation: Professor, Department of Pediatrics, Advanced Pediatric Centre, PGIMER, Chandigarh-160012, India.
authors.forename: Meenu
authors.initials: M
authors.lastname: Singh
authors.affiliation: Department of Pediatrics, All India Institute of Medical sciences, Bhubaneswar, India.
authors.forename: Rashmi Ranjan
authors.initials: RR
authors.lastname: Das
authors.affiliation: ICMR Advanced Center for Evidence Based Child Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
authors.forename: Nishant
authors.initials: N
authors.lastname: Jaiswal
authors.affiliation: ICMR Advanced Center for Evidence Based Child Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
authors.forename: Amit
authors.initials: A
authors.lastname: Agarwal
authors.affiliation: Department of Ophthalmology, Wayne State University, Detroit, MI, USA.
authors.forename: Ajay
authors.initials: A
authors.lastname: Kumar
authors.affiliation: University Business School, Punjab University, Chandigarh, India.
authors.forename: Harpreet
authors.initials: H
authors.lastname: Kaur
keywords: Haemophilus influenzae type b vaccine; efficacy; evidence; meta-analysis