Infanrix Hexa

Infanrix Hexa Mechanism of Action

Manufacturer:

GlaxoSmithKline

Distributor:

Zuellig
Full Prescribing Info
Action
Pharmaco-therapeutic group: Bacterial and viral vaccines combined. ATC code: J07CA09.
Pharmacology: Pharmacodynamics: Immunogenicity: The immunogenicity of Infanrix hexa has been evaluated in clinical studies from 6 weeks of age. The vaccine was assessed in 2-dose and 3-dose priming schedules, including the schedule for the Expanded Program on Immunisation, and as a booster dose. The results of these clinical studies are summarised in the tables as follows.
After a 3-dose primary vaccination schedule, at least 95.7% of infants had developed seroprotective or seropositive antibody levels against each of the vaccine antigens. After booster vaccination (post-dose 4), at least 98.4% of children had developed seroprotective or seropositive antibody levels against each of the vaccine antigens. (See Table 1.)

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After a 2-dose primary vaccination schedule, at least 84.3% of infants had developed seroprotective or seropositive antibody levels against each of the vaccine antigens. After a complete vaccination according to a 2-dose primary and booster schedule with Infanrix hexa, at least 97.9% of the subjects had developed seroprotective or seropositive antibody levels against each of the vaccine antigens.
According to different studies, immune response to the PRP antigen of Infanrix hexa after 2 doses given at 2 and 4 months of age will vary if co-administered with a tetanus toxoid conjugate vaccine. Infanrix hexa will confer an anti-PRP immune response (cut-off ≥ 0.15μg/ml) in at least 84% of the infants. This rises to 88% in case of concomitant use of pneumococcal vaccine containing tetanus toxoid as carrier and to 98% when Infanrix hexa is co-administered with a TT conjugated meningococcal vaccine (see Interactions). (See Table 2.)

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Serological correlates of protection have been established for diphtheria, tetanus, polio, Hepatitis B and Hib. For pertussis there is no serological correlate of protection. However, as the immune response to pertussis antigens following Infanrix hexa administration is equivalent to that of Infanrix, the protective efficacy of the two vaccines is expected to be equivalent.
Efficacy in protecting against pertussis: The clinical protection of the pertussis component of Infanrix, against WHO-defined typical pertussis (≥ 21 days of paroxysmal cough) was demonstrated after 3-dose primary immunisation in the studies tabulated as follows: (See Table 3.)

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Persistence of the immune response: The persistence of the immune response to a 3-dose primary (at 2-3-4, 3-4-5 or 2-4-6 months of age) and booster (in the second year of life) schedule with Infanrix hexa was evaluated in children 4-8 years of age. Protective immunity against the three poliovirus types and PRP was observed in at least 91.0% of children and against diphtheria and tetanus in at least 64.7% of children. At least 25.4% (anti-PT), 97.5% (anti-FHA) and 87.0% (anti-PRN) of children were seropositive against the pertussis components. (See Table 4.)

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With regards to hepatitis B, protective immunity (≥10 mIU/ml) following a 3-dose primary and booster schedule with Infanrix hexa has been shown to persist in ≥ 85% of subjects 4-5 years of age and in ≥72% of subjects 7-8 years of age. Additionally, following a 2-dose primary and booster schedule, protective immunity against hepatitis B persisted in ≥ 48% of subjects 11-12 years of age.
Hepatitis B immunological memory was confirmed in children 4 to 12 years of age. These children had received Infanrix hexa as primary and booster vaccination in infancy, and when an additional dose of monovalent HBV vaccine was administered, protective immunity was induced in at least 96.8% of subjects.
Immunogenicity in preterm infants: The immunogenicity of Infanrix hexa was evaluated across three studies including approximately 300 preterm infants (born after a gestation period of 24 to 36 weeks) following a 3-dose primary vaccination course at 2, 4 and 6 months of age. The immunogenicity of a booster dose at 18 to 24 months of age was evaluated in approximately 200 preterm infants.
One month after primary vaccination at least 98.7% of subjects were seroprotected against diphtheria, tetanus and poliovirus types 1 and 2; at least 90.9% had seroprotective antibody levels against the hepatitis B, PRP and poliovirus type 3 antigens; and all subjects were seropositive for antibodies against FHA and PRN while 94.9% were seropositive for anti-PT antibodies.
One month after the booster dose at least 98.4% of subjects had seroprotective or seropositive antibody levels against each of the antigens except against PT (at least 96.8%) and hepatitis B (at least 88.7%). The response to the booster dose in terms of fold increases in antibody concentrations (15- to 235-fold), indicate that preterm infants were adequately primed for all the antigens of Infanrix hexa.
In a follow-up study conducted in 74 children, approximately 2.5 to 3 years after the booster dose, 85.3% of the children were still seroprotected against hepatitis B and at least 95.7% were seroprotected against the three poliovirus types and PRP.
Post marketing experience: Results of long term follow-up in Sweden demonstrate that acellular pertussis vaccines are efficacious in infants when administered according to the 3 and 5 months primary vaccination schedule, with a booster dose administered at approximately 12 months. However, data indicate that protection against pertussis may be waning at 7-8 years of age with this 3-5-12 month's schedule. This suggests that a second booster dose of pertussis vaccine is warranted in children aged 5-7 years who have previously been vaccinated following this particular schedule.
The effectiveness of the Hib component of Infanrix hexa was investigated via an extensive post-marketing surveillance study conducted in Germany. Over a seven year follow-up period, the effectiveness of the Hib components of two hexavalent vaccines, of which one was Infanrix Hexa, was 89.6% for a full primary series and 100% for a full primary series plus booster dose (irrespective of the Hib vaccine used for priming).
Results of ongoing routine national surveillance in Italy demonstrate that Infanrix hexa is effective in controlling Hib disease in infants when the vaccine is administered according to the 3 and 5 months primary vaccination schedule, with a booster dose administered at approximately 11 months. Over a six year period starting in 2006, where Infanrix hexa was the principal Hib-containing vaccine in use with vaccination coverage exceeding 95%, Hib invasive disease continued to be well controlled, with four confirmed Hib cases reported in Italian children aged less than 5 years through passive surveillance.
Pharmacokinetics: Evaluation of pharmacokinetic properties is not required for vaccines.
Toxicology: Preclinical safety data: Non-clinical data reveal no special hazard for humans based on conventional studies of safety, specific toxicity, repeated dose toxicity and compatibility of ingredients.
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