Infanrix-IPV+Hib

Combined diphtheria-tetanus-acellular pertussis, inactivated polio and Haemophilus influenzae type b vaccine.

After reconstitution, 1 dose (0.5 mL) contains: Diphtheria toxoid¹ not less than 30 International Units (IU) (25 Lf). Tetanus toxoid¹ not less than 40 International Units (IU) (10 Lf). Bordetella pertussis antigens: Pertussis toxoid (PT)¹ 25 micrograms; Filamentous haemagglutinin (FHA)¹ 25 micrograms; Pertactin (PRN)¹ 8 micrograms. Poliovirus (inactivated) (IPV): type 1 (Mahoney strain)² 40 D-antigen unit; type 2 (MEF-1 strain)² 8 D-antigen unit; type 3 (Saukett strain)² 32 D-antigen unit. Haemophilus influenzae type b polysaccharide (polyribosylribitol phosphate) (PRP) 10 micrograms. Conjugated to tetanus toxoid as carrier protein approximately 25 micrograms.
¹adsorbed on aluminium hydroxide, hydrated (Al(OH)₃) 0.5 milligrams Al³⁺.
²propagated in VERO cells.
The Infanrix-IPV component of the vaccine is a turbid white suspension. Upon storage, a white deposit and clear supernatant can be observed.
The Hib component of the vaccine is a white powder.
Excipients/Inactive Ingredients: Lactose, sodium chloride, Medium 199, water for injections.
Potassium chloride, disodium phosphate, monopotassium phosphate, polysorbate 80, glycine, formaldehyde, neomycin sulphate, polymyxin sulphate are present as residuals from the manufacturing process.

Pharmaco-therapeutic group: Bacterial and viral vaccines combined. ATC code: J07CA06.
Pharmacology: Pharmacodynamics: Results obtained in the clinical studies for each of the components are summarised in the tables as follows: (see Table 1 and Table 2.)


Click on icon to see table/diagram/image




Click on icon to see table/diagram/image


The effectiveness of the Hib component (when combined with DTPa, DTPa-IPV or DTPa-HBV-IPV) was investigated via an extensive post-marketing surveillance study conducted in Germany. Over a 4.5 year follow-up period, the effectiveness of DTPa+Hib or DTPa-IPV+Hib vaccines was 96.7% for a full primary series and 98.5% for a booster dose (irrespective of priming). Over a seven year follow-up period, the effectiveness of the Hib components of two hexavalent vaccines 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).
Clinical Studies: See Pharmacodynamics as previously mentioned.
Pharmacokinetics: Evaluation of pharmacokinetic properties is not required for vaccines.
Toxicology: Pre-clinical Safety Data: Non-clinical data reveal no special hazards for humans based on conventional studies of safety pharmacology, local tolerance and repeated dose toxicity.

Infanrix-IPV+Hib is indicated for active immunization in infants from the age of 2 months against diphtheria, tetanus, pertussis, poliomyelitis and Haemophilus influenzae type b.
Infanrix-IPV+Hib is also indicated as a booster dose for children who have previously been immunized with diphtheria, tetanus, pertussis (DTP), polio and Hib antigens.
Infanrix-IPV+Hib does not protect against diseases caused by other types of Haemophilus influenzae nor against meningitis caused by other organisms.

Posology: The primary vaccination schedule consists of three doses in the first 6 months of life and can start from the age of 2 months. An interval of at least 1 month should be respected between subsequent doses.
A booster dose is recommended in the second year of life, with an interval of at least 6 months after completion of primary vaccination schedule.
Method of administration: Infanrix-IPV+Hib is for deep intramuscular injection, in the anterolateral thigh.
It is preferable that each subsequent dose is given at alternate sites.
Infanrix-IPV+Hib should be administered with caution to subjects with thrombocytopenia or a bleeding disorder since bleeding may occur following an intramuscular administration to these subjects. Firm pressure should be applied to the injection site (without rubbing) for at least two minutes.

Some cases of overdose have been reported during post-marketing surveillance. Adverse events, when reported following overdosage, were similar to those observed after administration of the recommended dose of Infanrix-IPV+Hib.

Infanrix-IPV+Hib should not be administered to subjects with known hypersensitivity to any component of the vaccine, or to subjects having shown signs of hypersensitivity after previous administration of diphtheria, tetanus, pertussis, inactivated polio or Hib vaccines.
Infanrix-IPV+Hib is contraindicated if the child has experienced an encephalopathy of unknown aetiology, occurring within 7 days following previous vaccination with pertussis containing vaccine.

It is good clinical practice that vaccination should be preceded by a review of the medical history (especially with regard to previous vaccination and the possible occurrence of undesirable events) and a clinical examination.
As with other vaccines, the administration of Infanrix-IPV+Hib should be postponed in subjects suffering from acute severe febrile illness. The presence of a minor infection, however, is not a contraindication.
Infanrix-IPV+Hib should be administered with caution to subjects with thrombocytopenia or a bleeding disorder since bleeding may occur following an intramuscular administration to these subjects.
Infanrix-IPV+Hib contains traces of neomycin and polymyxin and the vaccine should be used with caution in patients with known hypersensitivity to either of these antibiotics.
As with all injectable vaccines, appropriate medical treatment and supervision should always be readily available in case of a rare anaphylactic event following the administration of the vaccine.
Syncope (fainting) can occur following, or even before, any vaccination as a psychogenic response to the needle injection. It is important that procedures are in place to avoid injury from faints.
The use of Infanrix-IPV+Hib is not recommended in adults, adolescents or children above 5 years of age.
As with all diphtheria, tetanus, and pertussis vaccines, the vaccine should be administered by deep intramuscular injection to the anterolateral thigh. It is preferable that each subsequent dose is given at alternate sites.
The expected immunological response may not be obtained after vaccination of immunosuppressed patients, e.g. patients on immunosuppressive therapy.
If any of the following events occur in a temporal relationship to the receipt of a DTP-containing vaccine, the decision to give subsequent doses of vaccine containing the pertussis component should be carefully considered. These events include: temperature of ≥40.0°C (rectal) within 48 hours, not due to another identifiable cause; collapse or shock-like state (hypotonic-hyporesponsive episode) within 48 hours of vaccination; persistent, inconsolable crying lasting ≥3 hours, occurring within 48 hours of vaccination; convulsions with or without fever, occurring within 3 days of vaccination.
However, as these events are not associated with permanent sequelae, there may be circumstances, such as a high incidence of pertussis, where the potential benefits outweigh possible risks.
In children with progressive neurological disorders, including infantile spasms, uncontrolled epilepsy or progressive encephalopathy, it is better to defer pertussis (Pa or Pw) immunization until the condition is corrected or stable. However, the decision to give pertussis vaccine must be made on an individual basis after careful consideration of the risks and benefits.
A history of febrile convulsions, a family history of convulsions, a family history of Sudden Infant Death Syndrome (SIDS) or a family history of an adverse event following DTP, IPV and/or Hib vaccination do not constitute contraindications.
Human Immunodeficiency Virus (HIV) infection is not considered as a contraindication.
Excretion of capsular polysaccharide antigen in the urine has been described following receipt of Hib vaccines, and therefore antigen detection may not have a diagnostic value in suspected Hib disease within 1-2 weeks of vaccination.
Infanrix-IPV+Hib should under no circumstances be administered intravenously.
The potential risk of apnoea and the need for respiratory monitoring for 48-72h should be considered when administering the primary immunization series to very premature infants (born ≤28 weeks of gestation) and particularly for those with a previous history of respiratory immaturity. As the benefit of vaccination is high in this group of infants, vaccination should not be withheld or delayed.
Effects on Ability to Drive and Use Machines: Not relevant.

As Infanrix-IPV+Hib is not intended for use in adults, information on the safety of the vaccine when used during pregnancy or lactation is not available.

Clinical Trial Data: The safety profile presented as follows is based on data from more than 3500 subjects.
As has been observed for DTPa and DTPa-containing combinations, an increase in local reactogenicity and fever was reported after booster vaccination with Infanrix-IPV+Hib with respect to the primary course.
Adverse reactions reported are listed according to the following frequency: Very common: ≥1/10; Common: ≥1/100 to <1/10; Uncommon: ≥1/1,000 to <1/100; Rare: ≥1/10,000 to <1/1,000; Very rare: <1/10,000.
Infections and infestations: Uncommon: upper respiratory tract infection.
Blood and lymphatic system disorders: Uncommon: lymphadenopathy.
Metabolism and nutrition disorders: Very common: appetite lost.
Psychiatric disorders: Very common: irritability, crying abnormal, restlessness.
Nervous system disorders: Very common: somnolence.
Respiratory, thoracic and mediastinal disorders: Uncommon: cough, bronchitis, rhinorrhoea.
Gastrointestinal disorders: Common: diarrhoea, vomiting.
Skin and subcutaneous tissue disorders: Uncommon: rash, urticaria.
Rare: pruritus, dermatitis.
General disorders and administration site conditions: Very common: injection site reactions such as pain and redness, local swelling at the injection site (≤50 mm), fever (≥38.0°C).
Common: injection site reactions including induration, local swelling at the injection site (>50 mm)¹.
Uncommon: fever² >39.5°C, fatigue, diffuse swelling of the injected limb, sometimes involving the adjacent joint¹.
Post Marketing Data: Blood and lymphatic system disorders: Thrombocytopenia⁴.
Immune system disorders: Allergic reactions (including anaphylactic³ and anaphylactoid reactions).
Nervous system disorders: Convulsions (with or without fever), collapse or shock-like state (hypotonic-hyporesponsiveness episode).
Respiratory, thoracic and mediastinal disorders: Apnoea³ [see Precautions for apnoea in very premature infants (≤28 weeks of gestation)].
Skin and subcutaneous tissue disorders: Angioneurotic oedema³.
General disorders and administration site conditions: Swelling of the entire injected limb¹, injection site vesicles³.
¹Children primed with acellular pertussis vaccines are more likely to experience swelling reactions after booster administration in comparison with children primed with whole cell vaccines. These reactions resolve over an average of 4 days.
²Common with booster vaccination.
³Reported with GSK's DTPa containing vaccines.
⁴Reported with D and T vaccines.

As it is current practice in paediatric vaccination to co-administer different vaccines during the same session, Infanrix-IPV+Hib can be administered concomitantly with hepatitis B vaccine.
Reconstituted Infanrix-IPV+Hib and a different injectable vaccine should be administered at different injection sites.
As with other vaccines it may be expected that, in patients receiving immunosuppressive therapy or patients with immunodeficiency, an adequate response may not be achieved.

Instructions for Use/Handling: The Hib powder, the Infanrix-IPV suspension and the reconstituted vaccine should be inspected visually for any foreign particulate matter and/or variation of physical aspect prior to administration. In the event of either being observed, discard the vaccine.
Since a white sediment may form during storage, the Infanrix-IPV suspension should be shaken before reconstitution.
The vaccine must be reconstituted by adding the entire contents of the supplied container of the Infanrix-IPV component to the vial containing the Hib powder. Only the components of the vaccine should be mixed together and not with other vaccines or other batches of components. After the addition of the Infanrix-IPV suspension to the Hib powder, the mixture should be well shaken.
The reconstituted Infanrix-IPV+Hib vaccine presents as a slightly more cloudy suspension than the liquid Infanrix-IPV component alone. This is normal and does not impair the performance of the vaccine. In the event of other variations being observed, discard the vaccines.
Remove and discard the first needle and replace it with the second needle. Administer the vaccine.
After reconstitution, the vaccine should be injected immediately.
Withdraw the entire contents of the vial.
Any unused product or waste material should be disposed of in accordance with local requirements.
Incompatibilities: Reconstituted Infanrix-IPV+Hib should not be mixed with other vaccines in the same syringe.

The Hib component and the Infanrix-IPV component should be stored at between +2°C to +8°C.
The Infanrix-IPV component should not be frozen. Discard if it has been frozen.

Vaccines, Antisera & Immunologicals

J07CA06 - diphtheria-haemophilus influenzae B-pertussis-poliomyelitis-tetanus ; Belongs to the class of combined bacterial and viral vaccines.

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