In the UK, the current acellular-pertussis-containing 5-in-1 combination vaccine (DTaP5/Hib/IPV Pediacel™) has been extremely effective at maintaining control of the diseases it is aiming to prevent. NeisVac-C™) may enhance immune responses to the Hib component of combination vaccines. On the other hand, MenC vaccines that use tetanus as their carrier protein (e.g. Vaccines that use a diphtheria mutant toxin (CRM197) as their primary carrier protein, for example, have been shown to interfere with the immune response to the Hib component of combination vaccines in a dose-dependent manner, even when the vaccines are administered on different limbs. Interactions can also occur between vaccines that are given during the same visit (Dagan et al., 2008, Borrow et al, 2011). Similarly, the immunogenicity of the Hib component of combination vaccines containing acellular pertussis (DTaP-Hib) is significantly lower when compared to those containing whole cell pertussis (DTwP-Hib) (Bar-On et al., 2009). Administration of Hib conjugate vaccine as part of a diphtheria-tetanus-pertussis (DTP-Hib) combination results in much lower Hib antibody concentrations compared to the Hib conjugate vaccine administered separately (Eskola et al., 1996 Schmitt et al., 1998 Schmitt et al., 2000). ![]() The development and manufacture of combination vaccines, however, is complex because of possible interactions between different antigens, carrier proteins and adjuvants used in such vaccines. ![]() Combination vaccines reduce the number of injections administered to infants and, therefore, minimise the number of visits to general practitioners while, at the same time, improving compliance, parental satisfaction and the cost-effectiveness of vaccination programmes. From 01 July 2013, infants will also receive an oral rotavirus vaccine at 2 and 3 months of age. They also receive vaccines against Neisseria meningitidis serogroup C (MenC) at 3 months and against 13 pneumococcal serotypes (PCV13) at 2-4 months. Infants in the United Kingdom are routinely immunised against diphtheria, tetanus, pertussis (whooping cough), polio and Haemophilus influenzae type b (Hib) as a single 5-in-1 (DTaP5-IPV-Hib) combination vaccine given as a 2-3-4 month schedule. Meningococcal Disease Pneumococcal Disease Haemophilus Influenzae Serotype b Disease Diphtheria, Tetanus and Pertussis Hepatitis bīiological: Menjugate Biological: Menitorix Biological: NeisVac-C Menitorix protects against both Hib and MenC, so babies in the group receiving MenitorixTM will have an extra dose of Hib which is also included in Infanrix-Hexa but might have a lower antibody response to MenC compared to the other two MenC vaccines, although all infants should be well-protected after their 12-month booster vaccinations, which also contain Menitorix. Studies have already shown that one dose of Neis-Vac or Menjugate given to babies at 3 months provides similar protection against MenC infection as two doses given at 3 and 4 months. In order to check whether there are differences in protection, babies taking part will randomly receive one of 3 MenC-containing vaccines: NeisVacC, Menjugate or Menitorix. There are currently several licensed MenC vaccines that can be given to babies. All other vaccines given will be the same as in the routine schedule but will include one MenC vaccine instead of 2 doses because the UK infant immunisation schedule is soon going to change so that all babies will receive only one MenC vaccine at 3 months of age. Babies taking part in this study will receive Infanrix-Hexa instead of Pediacel. Many other countries already use Infanrix-Hexa and this study is being undertaken to help decide whether the UK can do the same. Children with hepatitis B infection may not have symptoms for many years but may go on to develop liver failure, cirrhosis and cancer. Hepatitis B virus infects the liver and usually affects adults, but children can be infected through close contact with carriers of the virus. This study aims to offer infants a 6-in-1 vaccine (Infanrix-Hexa)that also helps protect against hepatitis B alongside the other routine vaccinations in the UK infant immunisation schedule and assess their immune responses to the different vaccines. Infants also routinely receive a meningococcal group C vaccine (MenC) at 3 and 4 months and a 13-valent pneumococcal vaccine (Prevenar13) at 2 and 4 months of age. ![]() In the UK, infants currently receive a 5-in-1 vaccine (Pediacel) at 2, 3 and 4 months of age, which protects against diphtheria, tetanus, pertussis (whooping cough), polio and Haemophilus influenzae type b (Hib).
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