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Combination Vaccines Partners in Prevention Coalition of Dodge County and City of Watertown Spring 2014 Betsy Peterson, MD.

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Presentation on theme: "Combination Vaccines Partners in Prevention Coalition of Dodge County and City of Watertown Spring 2014 Betsy Peterson, MD."— Presentation transcript:

1 Combination Vaccines Partners in Prevention Coalition of Dodge County and City of Watertown Spring 2014 Betsy Peterson, MD

2 Objectives Identify common combination vaccines used in practice Understand indications and contraindications to combinations Understand differences in schedules when patients have had combination vaccines


4 Combination Vaccines





9 Infant Vaccines 2mo, 4mo, 6mo: –DTaP = Diphtheria, Tetanus, Pertussis (no available individual vaccines) –IPV = Polio –Hep B = Hepatitis B –HiB-OMP (Pedvax HiB, 3 doses) OR HiB-PRPT (ActHib, 4 doses) = Hemophilus influenza, Type B –Prevnar 13 = Pneumococcus, 13 serotypes –RV5 = Rotateq (5 serotypes, 3 doses) OR RV1 = Rotarix (1 serotype, 2 doses)

10 DTaP Daptacel – Sanofi, 6wk to <7yr Infanrix – GSK, 6wk to <7yr Pediarix – also includes IPV, Hep B; GSK, 6wk to <7yr Pentacel – also includes IPV, HiB; Sanofi, 6wk to <7yr Kinrix – also includes IPV; GSK, 4yr to <7yr

11 Tdap Boostrix – GSK, single dose*, 10yr “and older” Adacel – Sanofi, single dose*, 10yr to 64yr **off-label used for 7-10yr if previously undervaccinated; off label for use with each pregnancy**

12 Pediarix – - Hep B - DTaP - IPV Given at – - 2mo - 4mo - 6mo ** Baby will get 4 doses of Hep B, which is acceptable. MUST have 16 weeks between dose 1 and 3 (or 4) AND be At Least 24 weeks old for dose 3 (or 4). **Dose 3 of 4 is marked “invalid”

13 Pentacel – - DTaP - HiB - IPV Given at – - 2mo - 4mo - 6mo - 15mo *** Baby will get the 4 th dose of IPV (polio) at 15mo, But still needs a dose after 4 th birthday. ***

14 HiB options Pedvax Hib (Merck) – 3 doses at 2mo, 4mo, 12- 15mo ActHib (Sanofi) – 4 doses at 2mo, 4mo, 6mo, 12- 15mo Pentacel (Sanofi) – 4 doses at 2mo, 4mo, 6mo, 12- 15mo Hiberix (GSK) – 12-15mo booster dose only ComVax (Merck) – includes Hep B, 3 doses at 2mo, 4mo, 12-15mo

15 An aside about buying groups… Vaccines are expensive Buying groups allow offices or companies to save significant money by agreeing to purchase certain types of vaccines Examples – –GSK “when available” (Pediarix, Rotarix, Havrix, Kinrix, Boostrix), choose a Hib brand. –Merck/Sanofi “when available” (Pentacel, Rotateq, ActHib OR PedvaxHib, Adacel, Vaqta)

16 Sample Pediarix schedule Birth – Hep B 2mo – Pediarix (DTaP-Hep B-IPV), Prevnar 13, Hib-OMP, Rotarix 4mo – Pediarix, Prevnar 13, Hib-OMP, Rotarix 6mo – Pediarix, Prevnar 13 15mo – Infanrix (DTaP), Hib-OMP

17 Sample Pentacel schedule Birth – Hep B 2mo – Pentacel (DTaP-HiB-IPV), Prevnar 13, Hep B, Rotateq 4mo – Pentacel, Prevnar 13, Rotateq 6mo – Pentacel, Prevnar 13, Hep B, Rotateq 15mo - Pentacel

18 But what about…? Shortages Kids who move/transfer to a different clinic Occasionally clinics will have certain combo vaccines for private vs. VFC When your office is changing from one combo to another

19 Kindergarten age Due for – –DTaP (#5) – Infanrix, Daptacel, or Kinrix (DTaP-IPV) –IPV (#4) – IPOL or Kinrix –MMR (#2) – MMRII or Proquad –Varicella (#2) – Varivax or Proquad

20 MMR and Varicella – Separate** or as Proquad DTaP and IPV – Separate or as Kinrix ***MMR and Varicella (and FluMist) can be given – On the same day, or separated by 28 days (4wk)


22 ComVax HiB plus Hep B – Merck, 3 doses 2mo, 4mo, 12-15mo Less common with Pediarix and Pentacel, but may appear on historical records Discontinued production, off VFC 4/1/14, private “early 2015”

23 TwinRix Hep A and Hep B – GSK, 3 doses For 18 years and older Given as 0, 1 and 6mo doses For adults who have not completed either Hep A or Hep B series

24 Why Combo vaccines? Less pokes! If no combo vaccines were used (when available) – –DTaP 5 doses - MMR 2 doses –Polio 4 doses - Varicella 2 doses –HiB 3-4 doses - Hep A 2 doses –Hep B 3 doses - Influenza 6 doses* –Prevnar 4 doses 28-32 injections by age 5!

25 Why Combo vaccines? At 2, 4, 6mo – 2-3 injections vs. 5 each visit (plus one for flu at 6mo) At kindergarten – 2-3 instead of 4! 20-24 injections (vs. 28-32) by age 5

26 Why not Combo vaccines? Immunization administration fees have classically been “per injection” –More pokes = more money Now <19yr has administration codes for “per component, with counseling” –Pediarix = 5 components, DTaP = 3 components, HiB = 1 component, etc.

27 What about safety? Immunizations are very closely regulated and monitored for safety –ProQuad has an advisory of slightly increased risk of febrile seizures when given at 12-23mo compared to MMR and Varicella given separately on the same day at 12-23mo. No difference seen with the booster dose. 1 additional febrile seizure at 5-12 days after vaccination Per 2500 infants vaccinated; 7-8/10,000 vs. 3-4/10,000

28 Historical/Future Combos TriHibit – DTaP and HiB-PRP – Sanofi, discontinued 2011 (Pentacel) Hexaxim – DTaP-IPV-Hep B-HiB – Sanofi, approved for WHO use outside US and Europe (no reconstitution required)


30 A note about errors… Double check – the components, age (<7?), minimum intervals, right patient, route of admin (IM/SQ), dilution liquid, storage, lot numbers Computers are good, but not perfect – if it doesn’t match up or gives an error message, ASK!

31 Pentacel Pentacel – one vial is DTaP-polio, 2 nd vial is Hib – NEED BOTH! Missing component needs to be repeated - wrong diluent (repeat both) vs. only gave liquid

32 ProQuad MMR-V contains varicella, so needs to be in the freezer – pay attention to what the shipping container says! MMR and varicella and ProQuad are given sub-Q, not IM

33 Kinrix Approved for 4-<7 years Dose does NOT need to be repeated if given outside of this range, counts as valid, but higher risk of side effects.

34 Questions?

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