Tetract-HIB

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Tetract-HIB uses

Tetract-HIB consists of Bordetella Pertussis, Diphtheria Toxoid, Haemophilus B conjugate Vaccine, Tetanus Toxoid Purified.

Haemophilus B conjugate Vaccine:


1 INDICATIONS AND USAGE

Tetract-HIB (Haemophilus B conjugate Vaccine)® is indicated for active immunization for the prevention of invasive disease caused by Haemophilus influenzae type b. Tetract-HIB (Haemophilus B conjugate Vaccine) is approved for use in children 6 weeks through 4 years of age (prior to fifth birthday).

The evaluation of effectiveness of Tetract-HIB (Haemophilus B conjugate Vaccine) was based on immune responses in children using serological endpoints that predict protection from invasive disease due to H. influenzae type b . These protective antibody levels have not been evaluated in clinical trials in which a booster dose of Tetract-HIB (Haemophilus B conjugate Vaccine) is compared to a booster dose of a US-licensed Tetract-HIB (Haemophilus B conjugate Vaccine) in children who previously received a primary series with a US-licensed Tetract-HIB (Haemophilus B conjugate Vaccine) .

Tetract-HIB (Haemophilus B conjugate Vaccine) is a vaccine indicated for active immunization for the prevention of invasive disease caused by Haemophilus influenzae type b. Tetract-HIB (Haemophilus B conjugate Vaccine) is approved for use in children 6 weeks through 4 years of age (prior to fifth birthday). (1)

No clinical data are available from controlled studies comparing booster immunization with Tetract-HIB (Haemophilus B conjugate Vaccine) and a US-licensed Tetract-HIB (Haemophilus B conjugate Vaccine). (1)

2 DOSAGE AND ADMINISTRATION

A 4-dose series given by intramuscular injection (2.3):

  • Primary series: One dose each at 2, 4, and 6 months of age. The first dose may be given as early as 6 weeks of age.
  • Booster: One dose at 15 through 18 months of age.

2.1 Reconstitution

Tetract-HIB (Haemophilus B conjugate Vaccine) is to be reconstituted only with the accompanying saline diluent. The reconstituted vaccine should be a clear and colorless solution. Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. If either of these conditions exists, the vaccine should not be administered.


Figure 1. Cleanse both vial stoppers. Withdraw 0.6 mL of saline diluent from accompanying vial.


Figure 2. Transfer 0.6 mL saline diluent into lyophilized vaccine vial.


Figure 3. Shake the vial well.


Figure 4. After reconstitution, withdraw 0.5 mL of reconstituted vaccine and administer intramuscularly.


Use a separate sterile needle and sterile syringe for each individual.

After reconstitution, administer Tetract-HIB (Haemophilus B conjugate Vaccine) immediately or store refrigerated between 2° and 8°C (36° and 46°F) and administer within 24 hours. If the vaccine is not administered immediately, shake the solution well again before administration.

Figure 1 Figure 2 Figure 3 Figure 4

2.2 Administration

For intramuscular use only.

Tetract-HIB is administered as a single dose (0.5 mL) by intramuscular injection into the anterolateral aspect of the thigh or deltoid.

Do not administer this product intravenously, intradermally, or subcutaneously.

2.3 Dose and Schedule

Tetract-HIB (Haemophilus B conjugate Vaccine) is administered as a 4-dose series (0.5-mL each dose) given by intramuscular injection. The series consists of a primary immunization course of 3 doses administered at 2, 4, and 6 months of age, followed by a booster dose administered at 15 through 18 months of age. The first dose may be given as early as 6 weeks of age.

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3 DOSAGE FORMS AND STRENGTHS

Tetract-HIB (Haemophilus B conjugate Vaccine) is a solution for injection supplied as a single-dose vial of lyophilized vaccine to be reconstituted with the accompanying vial of saline diluent. A single dose, after reconstitution, is 0.5 mL.

Solution for injection supplied as a vial of lyophilized vaccine to be reconstituted with the accompanying vial of saline diluent. A single dose, after reconstitution, is 0.5 mL. (3)

4 CONTRAINDICATIONS

Severe allergic reaction (e.g., anaphylaxis) after a previous dose of any H. influenzae type b- or tetanus toxoid-containing vaccine or any component of the vaccine is a contraindication to administration of Tetract-HIB (Haemophilus B conjugate Vaccine) .

Severe allergic reaction (e.g., anaphylaxis) after a previous dose of any H. influenzae type b- or tetanus toxoid-containing vaccine or any component of Tetract-HIB (Haemophilus B conjugate Vaccine). (4)

5 WARNINGS AND PRECAUTIONS

  • If Guillain-Barré syndrome has occurred within 6 weeks of receipt of a prior vaccine containing tetanus toxoid, the decision to give Tetract-HIB should be based on potential benefits and risks. (5.1)
  • Syncope (fainting) can occur in association with administration of injectable vaccines, including Tetract-HIB (Haemophilus B conjugate Vaccine). Procedures should be in place to avoid falling injury and to restore cerebral perfusion following syncope. (5.2)
  • Apnea following intramuscular vaccination has been observed in some infants born prematurely. Decisions about when to administer an intramuscular vaccine, including Tetract-HIB (Haemophilus B conjugate Vaccine), to infants born prematurely should be based on consideration of the individual infant’s medical status, and the potential benefits and possible risks of vaccination. (5.3)

5.1 Guillain-Barré Syndrome

If Guillain-Barré syndrome has occurred within 6 weeks of receipt of a prior vaccine containing tetanus toxoid, the decision to give any tetanus toxoid-containing vaccine, including Tetract-HIB (Haemophilus B conjugate Vaccine), should be based on careful consideration of the potential benefits and possible risks.

5.2 Syncope

Syncope can occur in association with administration of injectable vaccines, including Tetract-HIB (Haemophilus B conjugate Vaccine). Syncope can be accompanied by transient neurological signs such as visual disturbance, paresthesia, and tonic-clonic limb movements. Procedures should be in place to avoid falling injury and to restore cerebral perfusion following syncope.

5.3 Apnea in Premature Infants

Apnea following intramuscular vaccination has been observed in some infants born prematurely. Decisions about when to administer an intramuscular vaccine, including Tetract-HIB (Haemophilus B conjugate Vaccine), to infants born prematurely should be based on consideration of the individual infant’s medical status, and the potential benefits and possible risks of vaccination.

5.4 Preventing and Managing Allergic Vaccine Reactions

Prior to administration, the healthcare provider should review the patient's immunization history for possible vaccine hypersensitivity. Epinephrine and other appropriate agents used for the control of immediate allergic reactions must be immediately available should an acute anaphylactic reaction occur.

5.5 Altered Immunocompetence

Safety and effectiveness of Tetract-HIB in immunosuppressed children have not been evaluated. If Tetract-HIB (Haemophilus B conjugate Vaccine) is administered to immunosuppressed children, including children receiving immunosuppressive therapy, the expected immune response may not be obtained.

5.6 Interference with Laboratory Tests

Urine antigen detection may not have a diagnostic value in suspected disease due to H. influenzae type b within 1 to 2 weeks after receipt of a H. influenzae type b-containing vaccine, including Tetract-HIB (Haemophilus B conjugate Vaccine).

5.7 Tetanus Immunization

Immunization with Tetract-HIB (Haemophilus B conjugate Vaccine) does not substitute for routine tetanus immunization.

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6 ADVERSE REACTIONS

Common solicited adverse events were pain and redness at the injection site, irritability, drowsiness, fever, loss of appetite, fussiness, and restlessness. (6.1)

To report SUSPECTED ADVERSE REACTIONS, contact GlaxoSmithKline at 1-888-825-5249 or VAERS at 1-800-822-7967 or www.vaers.hhs.gov.

6.1 Clinical Trials Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a vaccine cannot be directly compared with rates in the clinical trials of another vaccine, and may not reflect the rates observed in practice. There is the possibility that broad use of Tetract-HIB (Haemophilus B conjugate Vaccine) could reveal adverse reactions not observed in clinical trials.

Across clinical trials, common solicited adverse events (≥20%) were pain and redness at the injection site, irritability, drowsiness, fever, loss of appetite, fussiness, and restlessness.

Study 1: In a randomized, controlled clinical trial conducted in the US, children were vaccinated with Tetract-HIB (Haemophilus B conjugate Vaccine) (N = 2,963), a US-licensed monovalent Tetract-HIB (Haemophilus B conjugate Vaccine) (Control PRP-T) (Sanofi Pasteur SA) (N = 520), or a US-licensed combined Diphtheria and Tetanus Toxoids and Acellular Pertussis Adsorbed, Inactivated Poliovirus and Tetract-HIB (Haemophilus B conjugate Vaccine) (DTaP-IPV/Hib) (Sanofi Pasteur Ltd.) (N = 520) at 2, 4, and 6 months of age. Tetract-HIB (Haemophilus B conjugate Vaccine) and Control PRP-T (Sanofi Pasteur SA) were administered concomitantly with PEDIARIX® (DTaP-HBV-IPV) [Diphtheria and Tetanus Toxoids and Acellular Pertussis Adsorbed, Hepatitis B (Recombinant) and Inactivated Poliovirus Vaccine] and Pneumococcal 13-valent Conjugate Vaccine (PCV13) (Wyeth Pharmaceuticals Inc.) with Doses 1, 2, and 3 and ROTARIX® [Rotavirus Vaccine, Live, Oral] with Doses 1 and 2. DTaP-IPV/Hib was administered concomitantly with PCV13 and ENGERIX-B® [Hepatitis B Vaccine (Recombinant)] with Doses 1, 2, and 3 and ROTARIX with Doses 1 and 2. If a birth dose of hepatitis B vaccine was received, ENGERIX-B was given with Doses 1 and 3. In the total population, 51.2% were male; 61% were white, 8% were Asian, 9% were black, and 22% were other racial/ethnic groups.

In 7 additional clinical studies, 1,008 children received Tetract-HIB (Haemophilus B conjugate Vaccine) as a booster dose following primary vaccination with either Tetract-HIB (Haemophilus B conjugate Vaccine) (N = 530), Tetract-HIB (Haemophilus B conjugate Vaccine) (Control PRP-T) (Sanofi Pasteur SA) (N = 235), Tetract-HIB (Haemophilus B conjugate Vaccine) (Merck & Co., Inc.) (N = 26), or Tetract-HIB (Haemophilus B conjugate Vaccine) (Wyeth Pharmaceuticals Inc.) (no longer licensed in the US, N = 217). None of the studies included a comparator group that received a booster dose with a US-licensed Tetract-HIB (Haemophilus B conjugate Vaccine). Studies were conducted in Europe, Canada, and Latin America. Across these studies, the mean age of subjects at the time of booster vaccination with Tetract-HIB (Haemophilus B conjugate Vaccine) ranged from 16 to 19 months. At the time of vaccination, 172 (17.1%) subjects were 11 to 14 months of age, 642 (63.7%) subjects were 15 to 18 months of age, and 194 (19.2%) subjects were 19 to 25 months of age. Approximately half of the subjects were male. Among subjects for whom information on race/ethnicity was available, nearly all subjects were white.

In these 7 studies, Tetract-HIB (Haemophilus B conjugate Vaccine) was administered concomitantly with non-US formulations (containing 2.5 mg 2-phenoxyethanol per dose as preservative) of one of the following US-licensed vaccines: INFANRIX® (DTaP) [Diphtheria and Tetanus Toxoids and Acellular Pertussis Vaccine Adsorbed], KINRIX® (DTaP-IPV) [Diphtheria and Tetanus Toxoids and Acellular Pertussis Adsorbed and Inactivated Poliovirus Vaccine], or PEDIARIX (DTaP-HBV-IPV). In the studies, DTaP-IPV and DTaP-HBV-IPV were administered in dosing regimens not approved in the US. Some subjects received DTaP-HBV (GlaxoSmithKline Biologicals, not licensed in US) concomitantly with Tetract-HIB (Haemophilus B conjugate Vaccine).

Solicited Adverse Events

The reported frequencies of solicited local and general adverse events from Study 1 are presented in Table 1.

Table 1. Percentage of Children with Solicited Local and General Adverse Events within 4 Days of Primary Series Vaccinationa (at 2, 4, and 6 Months of Age) with Tetract-HIB (Haemophilus B conjugate Vaccine)b, Control PRP-Tb, or DTaP-IPV/Hibc, Total Vaccinated Cohortd


Adverse Events


Tetract-HIB (Haemophilus B conjugate Vaccine)

%


Control PRP-T

%


DTaP-IPV/Hib

%


Dose


Dose


Dose


1


2


3


1


2


3


1


2


3


Locale


N


2,828


2,668


2,553


498


481


463


492


469


443


Pain


49.4


45.1


42.8


57.2


53.2


48.2


58.1


50.1


48.5


Pain, grade 3f


3.9


2.7


1.9


9.0


5.4


3.5


8.9


3.2


2.7


Redness


18.7


25.4


29.4


23.5


32.0


29.6


25.6


30.7


37.0


Redness, >20 mm


0.9


0.7


0.7


2.2


1.0


0.2


2.0


2.1


2.3


Swelling


13.0


15.4


18.7


18.5


21.8


19.7


19.5


23.7


23.7


Swelling, >20 mm


1.5


1.0


0.8


4.2


2.7


0.6


3.9


1.9


2.0


General


N


2,830


2,669


2,553


499


480


463


492


469


443


Irritability


68.9


70.4


67.1


76.4


71.0


67.2


73.0


66.7


69.3


Irritability, grade 3g


4.1


6.4


4.8


8.4


7.7


5.2


6.1


4.5


3.2


Drowsiness


59.9


54.1


49.3


65.7


55.6


49.5


60.6


51.8


49.7


Drowsiness, grade 3h


2.4


2.8


2.2


3.8


2.1


1.3


3.9


2.6


2.7


Loss of appetite


28.7


28.3


27.6


33.3


31.5


27.2


33.5


24.3


24.2


Loss of appetite, grade 3i


0.7


1.6


1.5


2.0


1.0


0.4


0.6


0.4


0.5


Fever


13.7


19.2


18.7


16.4


18.8


16.2


11.6


10.9


17.8


Fever, grade 3j


0.3


0.6


0.7


0.4


0.4


0.9


0.0


0.0


0.5

  • N = All subjects for whom safety data were available.
  • a Within 4 days of vaccination defined as day of vaccination and the next 3 days.
  • b Each dose (Doses 1, 2, and 3) of Tetract-HIB (Haemophilus B conjugate Vaccine) or Control PRP-T (Sanofi Pasteur SA) was concomitantly administered with PEDIARIX (DTaP-HBV-IPV) and PCV13. Doses 1 and 2 were concomitantly administered with ROTARIX.
  • c Each dose (Doses 1, 2, and 3) of DTaP-IPV/Hib was concomitantly administered with PCV13 and ENGERIX-B with Doses 1, 2, and 3 and ROTARIX with Doses 1 and 2. If a birth dose of hepatitis B vaccine was received, ENGERIX-B was given with Doses 1 and 3.
  • d Study 1: NCT01000974.
  • e Local reactions at the injection site for Tetract-HIB (Haemophilus B conjugate Vaccine), Control PRP-T, or DTaP-IPV/Hib.
  • f Grade 3 pain defined as cried when limb was moved/spontaneously painful.
  • g Grade 3 irritability defined as crying that could not be comforted/prevented normal activity.
  • h Grade 3 drowsiness defined as prevented normal daily activity.
  • i Grade 3 loss of appetite defined as did not eat at all.
  • j Fever defined as ≥100.4°F (≥38.0°C) rectally; Grade 3 fever defined as >103.1°F (>39.5°C) rectally.

In an open-label, multicenter study conducted in Germany (Study 2), 371 children received a booster dose of Tetract-HIB (Haemophilus B conjugate Vaccine) administered concomitantly with DTaP-HBV-IPV. The mean age at the time of vaccination was 16 months. Subjects in this study had previously received a primary series with either Tetract-HIB (Haemophilus B conjugate Vaccine) (N = 92), Control PRP-T (Sanofi Pasteur SA) (N = 96), or Tetract-HIB (Haemophilus B conjugate Vaccine) (Wyeth Pharmaceuticals Inc.) (no longer licensed in the US) (N = 183). All subjects previously received 3 doses of DTaP-HBV-IPV. The reported frequencies of solicited local and general adverse events are presented in Table 2.


Adverse Events


%

Any


%

Grade 3


Locald


Redness


24.5


2.4e


Pain


20.5


1.1f


Swelling


14.8


2.2e


General


Feverg


34.8


3.8


Fussiness


25.9


0.8h


Loss of appetite


22.9


0.8i


Restlessness


21.8


0.5i


Sleepiness


19.9


1.1i


Diarrhea


14.6


0.8i


Vomiting


4.9


0.5i

  • N = All subjects for whom safety data were available.
  • a Within 4 days of vaccination defined as day of vaccination and the next 3 days.
  • b In this study, 92 subjects previously received 3 doses of Tetract-HIB (Haemophilus B conjugate Vaccine), 96 subjects previously received 3 doses of a Control PRP-T (Sanofi Pasteur SA), and 183 subjects previously received 3 doses of a Tetract-HIB (Haemophilus B conjugate Vaccine) that is no longer licensed in the US.
  • c In this study, DTaP-HBV-IPV was given to subjects who previously received 3 doses of DTaP-HBV-IPV. In the US, PEDIARIX is approved for use as a 3-dose primary series; use as a fourth consecutive dose is not approved in the US.
  • d Local reactions at the injection site for Tetract-HIB (Haemophilus B conjugate Vaccine).
  • e Grade 3 redness or swelling defined as >20 mm.
  • f Grade 3 pain defined as causing crying when limb moved.
  • g Fever defined as ≥100.4°F (≥38.0°C) rectally or ≥99.5°F (≥37.5°C) axillary, oral, or tympanic; Grade 3 fever defined as >103.1°F (>39.5°C) rectally or >102.2°F (>39.0°C) axillary, oral, or tympanic.
  • h Grade 3 fussiness defined as persistent crying and could not be comforted.
  • i Grade 3 for these symptoms defined as preventing normal daily activity.

Serious Adverse Events

In Study 1, one of 2,963 subjects who received Tetract-HIB (Haemophilus B conjugate Vaccine) and coadministered vaccines given at 2, 4, and 6 months of age experienced a SAE which was in temporal association with vaccination and had no alternative plausible causes (convulsion on Day 14 after Dose 1).

In the 7 additional studies, two of 1,008 subjects reported a serious adverse event that occurred in the 31-day period following booster immunization with Tetract-HIB (Haemophilus B conjugate Vaccine). One subject developed bilateral pneumonia 9 days post-vaccination and one subject experienced asthenia following accidental drug ingestion 18 days post-vaccination.

6.2 Postmarketing Experience

In addition to reports in clinical trials, worldwide voluntary reports of adverse events received for Tetract-HIB (Haemophilus B conjugate Vaccine) since market introduction (1996) of this vaccine are listed below. This list includes serious events and/or events which have a plausible causal connection to Tetract-HIB (Haemophilus B conjugate Vaccine). Because these events are reported voluntarily from a population of uncertain size, it is not possible to reliably estimate their frequency or establish a causal relationship to vaccination.

General Disorders and Administration Site Conditions

Extensive swelling of the vaccinated limb, injection site induration.

Immune System Disorders

Allergic reactions (including anaphylactic and anaphylactoid reactions), angioedema.

Nervous System Disorders

Convulsions (with or without fever), hypotonic-hyporesponsive episode (i.e., sudden onset of hypotonia, hyporesponsiveness, and pallor or cyanosis), somnolence, syncope, or vasovagal responses to injection.

Respiratory, Thoracic, and Mediastinal Disorders

Apnea .

Skin and Subcutaneous Tissue Disorders

Rash, urticaria.

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7 DRUG INTERACTIONS

Do not mix Tetract-HIB with any other vaccine in the same syringe or vial. (7.2)

7.1 Interference with Laboratory Tests

Haemophilus b capsular polysaccharide derived from Haemophilus b Conjugate Vaccines has been detected in the urine of some vaccinees.1 Urine antigen detection may not have a diagnostic value in suspected disease due to H. influenzae type b within 1 to 2 weeks after receipt of a H. influenzae type b-containing vaccine, including Tetract-HIB (Haemophilus B conjugate Vaccine) .

7.2 Concomitant Vaccine Administration

In Study 1, Tetract-HIB was administered concomitantly with PEDIARIX (DTaP-HBV-IPV), PCV13, and ROTARIX .

In the 7 additional studies, a booster dose of Tetract-HIB (Haemophilus B conjugate Vaccine) was administered concomitantly with 1 of the following vaccines: DTaP, DTaP-IPV, DTaP-HBV-IPV, or DTaP-HBV (GlaxoSmithKline Biologicals, not licensed in the US). The formulations of DTaP, DTaP-IPV, and DTaP-HBV-IPV were non-US formulations (containing 2.5 mg 2-phenoxyethanol per dose as preservative) of the following US-licensed vaccines: INFANRIX, KINRIX, and PEDIARIX, respectively. In these studies, DTaP-IPV and DTaP-HBV-IPV were administered in dosing regimens that are not approved in the US.

If Tetract-HIB (Haemophilus B conjugate Vaccine) is administered concomitantly with other injectable vaccines, they should be given with separate syringes and at different injection sites. Tetract-HIB (Haemophilus B conjugate Vaccine) should not be mixed with any other vaccine in the same syringe or vial.

7.3 Immunosuppressive Therapies

Immunosuppressive therapies, including irradiation, antimetabolites, alkylating agents, cytotoxic drugs, and corticosteroids (used in greater than physiologic doses), may reduce the immune response to Tetract-HIB (Haemophilus B conjugate Vaccine).

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8 USE IN SPECIFIC POPULATIONS

8.1 Pregnancy

Pregnancy Category C

Animal reproduction studies have not been conducted with Tetract-HIB. It is also not known whether Tetract-HIB (Haemophilus B conjugate Vaccine) can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity.

8.4 Pediatric Use

Safety and effectiveness of Tetract-HIB (Haemophilus B conjugate Vaccine) in children younger than 6 weeks of age and in children 5 to 16 years of age have not been established.

11 DESCRIPTION

Tetract-HIB (Haemophilus B conjugate Vaccine) [Haemophilus b Conjugate Vaccine (Tetanus Toxoid Conjugate)] is a solution for intramuscular injection, supplied as a sterile, lyophilized powder which is reconstituted at the time of use with the accompanying saline diluent. Tetract-HIB (Haemophilus B conjugate Vaccine) contains Haemophilus b capsular polysaccharide (polyribosyl-ribitol-phosphate [PRP]), a high molecular weight polymer prepared from the Haemophilus influenzae type b strain 20,752 grown in a synthetic medium that undergoes heat inactivation and purification. The tetanus toxin, prepared from Clostridium tetani grown in a semi-synthetic medium, is detoxified with formaldehyde and purified. The capsular polysaccharide is covalently bound to the tetanus toxoid. After purification, the conjugate is lyophilized in the presence of lactose as a stabilizer. The diluent for Tetract-HIB (Haemophilus B conjugate Vaccine) is a sterile saline solution (0.9% sodium chloride) supplied in vials.

After reconstitution, each 0.5-mL dose is formulated to contain 10 mcg of purified capsular polysaccharide conjugated to approximately 25 mcg of tetanus toxoid, 12.6 mg of lactose, and ≤0.5 mcg of residual formaldehyde.

Tetract-HIB (Haemophilus B conjugate Vaccine) does not contain a preservative.

The lyophilized vaccine and saline diluent vial stoppers are not made with natural rubber latex.

12 CLINICAL PHARMACOLOGY

12.1 Mechanism of Action

Haemophilus influenzae is a gram-negative coccobacillus. Most strains of H. influenzae that cause invasive disease are type b. H. influenzae type b can cause invasive disease such as sepsis and meningitis.

Specific levels of antibodies to polyribosyl-ribitol-phosphate (anti-PRP) have been shown to correlate with protection against invasive disease due to H. influenzae type b. Based on data from passive antibody studies2 and a clinical efficacy study with unconjugated Haemophilus b polysaccharide vaccine3, an anti-PRP concentration of 0.15 mcg/mL has been accepted as a minimal protective level. Data from an efficacy study with unconjugated Haemophilus b polysaccharide vaccine indicate that an anti-PRP concentration of ≥1.0 mcg/mL predicts protection through at least a 1-year period.4,5 These antibody levels have been used to evaluate the effectiveness of Haemophilus b Conjugate Vaccines, including Tetract-HIB (Haemophilus B conjugate Vaccine).

13 NONCLINICAL TOXICOLOGY

13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility

Tetract-HIB (Haemophilus B conjugate Vaccine) has not been evaluated for carcinogenic or mutagenic potential, or for impairment of fertility.

14 CLINICAL STUDIES

14.1 Immunological Evaluation

Primary Series Vaccination

The immunogenicity of Tetract-HIB (Haemophilus B conjugate Vaccine) was evaluated in a randomized, controlled trial (Study 1). Tetract-HIB (Haemophilus B conjugate Vaccine) or control vaccines were administered concomitantly with US-licensed vaccines .

Anti-PRP GMCs and seroprotection rates 1 month following Dose 3 of Tetract-HIB (Haemophilus B conjugate Vaccine), Control PRP-T (Sanofi Pasteur SA), or DTaP-IPV/Hib are presented in Table 3.

Table 3. Anti-PRP GMCs and Seroprotection Rates 1 Month following 3 Doses of Tetract-HIB (Haemophilus B conjugate Vaccine), Control PRP-Ta, or DTaP-IPV/Hibb Administered at 2, 4, and 6 Months of Age, ATP Cohort for Immunogenicityc


Vaccine


N


Anti-PRP GMC

(mcg/mL)

(95% CI)


% Anti-PRP

≥0.15 mcg/mL

(95% CI)


% Anti-PRP

≥1.0 mcg/mL

(95% CI)


Tetract-HIB (Haemophilus B conjugate Vaccine)


1,590


5.19

(4.77, 5.66)


96.6

(95.6, 97.4)


81.2

(79.2, 83.1)


Control PRP-T


274


6.74

(5.59, 8.13)


96.7d

(93.9, 98.5)


89.8e

(85.6, 93.1)


DTaP-IPV/Hib


253


3.64

(2.89, 4.58)


92.5f

(88.5, 95.4)


78.3f

(72.7, 83.2)

  • a US-licensed monovalent Tetract-HIB (Haemophilus B conjugate Vaccine) (Control PRP-T) (Sanofi Pasteur SA).
  • b US-licensed DTaP-IPV/Hib Vaccine (Sanofi Pasteur Ltd.).
  • c Study 1: NCT01000974.
  • d HIBERIX was non-inferior to Control PRP-T for percent of subjects achieving anti-PRP ≥0.15 mcg/mL [lower limit of 95% CI on difference of Tetract-HIB (Haemophilus B conjugate Vaccine) minus Control PRP-T ≥ predefined limit of -5%].
  • e The non-inferiority criterion was not met (lower limit of 95% CI for the difference in the percentages of subjects with anti-PRP ≥1.0 mcg/mL between two groups [HIBERIX minus Control PRP-T] was -12.28%, which was lower than the predefined limit of -10%).
  • f Analyses of anti-PRP immune responses following DTaP-IPV/Hib vaccination were exploratory.

Booster Vaccination (Dose 4)

In 6 clinical studies, the immune response to Tetract-HIB (Haemophilus B conjugate Vaccine) administered as a booster dose was evaluated in a total of 415 children 12 to 23 months of age. At the time of vaccination, 30 children were 12 to 14 months of age, 316 children were 15 to 18 months of age, and 69 children were 19 to 23 months of age. Among subjects, 43% to 60% were male. Among subjects for whom information on race/ethnicity was available, nearly all subjects were white. None of the studies included a comparator group that received a booster dose with a US-licensed Tetract-HIB (Haemophilus B conjugate Vaccine). Characteristics of 3 of these studies are presented in Table 4.

Table 4. Characteristics of 3 Open-Label Booster Immunization Studies of Tetract-HIB (Haemophilus B conjugate Vaccine)


Study


Country


Per-Protocol Immunogenicity Cohort

N


Priming History


Booster Vaccination with Tetract-HIB (Haemophilus B conjugate Vaccine)


Age at Vaccination (months)


Concomitantly Administered Vaccinea


3


Canada


42


DTaP-HBV-IPVb + Tetract-HIB (Haemophilus B conjugate Vaccine)c

at 2, 4, and 6 months of age


16-18


DTaP-HBV-IPVb


4


Canada


64


DTaP-IPVd + Tetract-HIB (Haemophilus B conjugate Vaccine)

at 2, 4, and 6 months of age


16-19


DTaP-IPVd


5


Germany


108


DTaP-HBVe + Tetract-HIB (Haemophilus B conjugate Vaccine)

at 3, 4, and 5 months of age


16-23


DTaP-HBVe

  • a Administered at a separate site.
  • b Non-US formulation equivalent to PEDIARIX with the exception of containing 2.5 mg 2-phenoxyethanol per dose as preservative. In the US, PEDIARIX is approved for use as a 3-dose primary series; use as a fourth consecutive dose is not approved in the US.
  • c US-licensed Tetract-HIB (Haemophilus B conjugate Vaccine) (Control PRP-T) (Sanofi Pasteur SA).
  • d Non-US formulation equivalent to KINRIX with the exception of containing 2.5 mg 2-phenoxyethanol per dose as preservative. In the US, KINRIX is approved for use as the fifth dose of DTaP and the fourth dose of IPV in children 4 to 6 years of age previously primed with approved dosing regimens of INFANRIX and/or PEDIARIX. The DTaP-IPV dosing regimen is not approved in the US.
  • e Manufactured by GlaxoSmithKline Biologicals (not licensed in the US).

Antibodies to PRP were measured in sera obtained immediately prior to and 1 month after booster vaccination with Tetract-HIB (Haemophilus B conjugate Vaccine). Geometric mean concentrations and anti-PRP seroprotection rates are presented in Table 5.

Table 5. Anti-PRP GMCs and Seroprotection Rates prior to and 1 Month following a Booster Dose of Tetract-HIB (Haemophilus B conjugate Vaccine), Per-protocol Immunogenicity Cohort


Study


N


Anti-PRP GMC

(mcg/mL)


% Anti-PRP

≥0.15 mcg/mL


% Anti-PRP

≥1.0 mcg/mL


Pre-


Post-


Pre-


Post-


Pre-


Post-


3a


42


0.46


59.07


76.2


100


35.7


97.6


4b


63-64


0.25


47.78


71.4


100


12.7


100


5c


108


0.59


96.12


77.8


100


32.4


100

  • GMC = Geometric mean antibody concentration.
  • N = Number of children for whom serological results were available for the pre- and post-dose immunological evaluations.
  • Studies 3, 4, and 5 correspond to Studies 3, 4, and 5, respectively in Table 4.
  • a Canadian study in children 16 to 18 months of age who previously received 3 doses of DTaP-HBV-IPV and Tetract-HIB (Haemophilus B conjugate Vaccine) (Control PRP-T) (Sanofi Pasteur SA). The booster dose of Tetract-HIB (Haemophilus B conjugate Vaccine) was coadministered with DTaP-HBV-IPV (a fourth consecutive dose of PEDIARIX is not approved in the US). In this study, pre-vaccination sera may have been obtained up to 1 week prior to booster vaccination with Tetract-HIB (Haemophilus B conjugate Vaccine).
  • b Canadian study in children 16 to 19 months of age who previously received 3 doses of DTaP-IPV and Tetract-HIB (Haemophilus B conjugate Vaccine). The booster dose of Tetract-HIB (Haemophilus B conjugate Vaccine) was coadministered with DTaP-IPV. The DTaP-IPV dosing regimen is not approved in the US.
  • c German study in children 16 to 23 months of age who previously received 3 doses of DTaP-HBV (GlaxoSmithKline Biologicals, not licensed in the US) and Tetract-HIB (Haemophilus B conjugate Vaccine). The booster dose of Tetract-HIB (Haemophilus B conjugate Vaccine) was coadministered with DTaP-HBV.

14.2 Concomitant Vaccine Administration

Primary Series Vaccination (Doses 1, 2, and 3)

In US Study 1, subjects who received Tetract-HIB (Haemophilus B conjugate Vaccine) concomitantly with PEDIARIX (DTaP-HBV-IPV) and PCV13 at 2, 4, and 6 months of age had no evidence for reduced antibody responses relative to the response in control subjects administered Control PRP-T (Sanofi Pasteur SA) concomitantly with PEDIARIX (DTaP-HBV-IPV) and PCV13, to pertussis antigens (GMC to pertussis toxin, filamentous hemagglutinin, and pertactin), diphtheria toxoid (antibody levels ≥0.1 IU/mL), tetanus toxoid (antibody levels ≥0.1 IU/mL), poliovirus types 1, 2, and 3 (antibody levels ≥1:8 to each virus), PCV13 (antibody levels ≥0.2 mcg/mL and GMC to each serotype), or hepatitis B (anti-hepatitis B surface antigen ≥10 mIU/mL). The immune responses to PEDIARIX (DTaP-HBV-IPV) and PCV13 were evaluated 1 month following Dose 3. Subjects in both groups received ROTARIX at 2 and 4 months of age.

Booster Vaccination (Dose 4)

In 7 additional studies, a booster dose of Tetract-HIB (Haemophilus B conjugate Vaccine) was administered concomitantly with non-US formulations of INFANRIX, KINRIX, and PEDIARIX. Non-US formulations of KINRIX and PEDIARIX were administered in dosing regimens not approved in the US.

Sufficient data are not available to confirm lack of interference in immune responses to vaccines administered concomitantly with a booster dose of Tetract-HIB (Haemophilus B conjugate Vaccine).

15 REFERENCES

  • Rothstein EP, Madore DV, Girone JAC, et al. Comparison of antigenuria after immunization with three Haemophilus influenzae type b conjugate vaccines. Pediatr Infect Dis J 1991;10:311-314.
  • Robbins JB, Parke JC, Schneerson R, et al. Quantitative measurement of “natural” and immunization-induced Haemophilus influenzae type b capsular polysaccharide antibodies. Pediatr Res 1973;7:103-110.
  • Peltola H, Käythy H, Sivonen A, et al. Haemophilus influenzae type b capsular polysaccharide vaccine in children: A double-blind field study of 100,000 vaccinees 3 months to 5 years of age in Finland. Pediatrics 1977;60:730-737.
  • Käythy H, Peltola H, Karanko V, et al. The protective level of serum antibodies to the capsular polysaccharide of Haemophilus influenzae type b. J Infect Dis 1983;147:1100.
  • Anderson P. The protective level of serum antibodies to the capsular polysaccharide of Haemophilus influenzae type b. J Infect Dis 1984;149:1034.

16 HOW SUPPLIED/STORAGE AND HANDLING

Tetract-HIB is available in single-dose vials of lyophilized vaccine, accompanied by vials containing 0.85 mL of saline diluent (packaged without syringes or needles).

Supplied as package of 10 doses (NDC 58160-818-11):

NDC 58160-816-01 Vial of lyophilized vaccine in Package of 10: NDC 58160-816-05

NDC 58160-817-01 Vial of saline diluent in Package of 10: NDC 58160-817-05

16.1 Storage before Reconstitution

Lyophilized vaccine vials: Store refrigerated between 2° and 8°C (36° and 46°F). Protect vials from light.

Diluent: Store refrigerated or at controlled room temperature between 2° and 25°C (36° and 77°F). Do not freeze. Discard if the diluent has been frozen.

16.2 Storage after Reconstitution

Administer within 24 hours of reconstitution. After reconstitution, store refrigerated between 2° and 8°C (36° and 46°F). Discard the reconstituted vaccine if not used within 24 hours. Do not freeze. Discard if the vaccine has been frozen.

17 PATIENT COUNSELING INFORMATION

  • Inform parents or guardians of the potential benefits and risks of immunization with Tetract-HIB (Haemophilus B conjugate Vaccine).
  • Inform parents or guardians about the potential for adverse reactions that have been temporally associated with administration of Tetract-HIB (Haemophilus B conjugate Vaccine) or other vaccines containing similar components.
  • Give parents or guardians the Vaccine Information Statements, which are required by the National Childhood Vaccine Injury Act of 1986 to be given prior to immunization. These materials are available free of charge at the Centers for Disease Control and Prevention (CDC) website (www.cdc.gov/vaccines).

ENGERIX-B, Tetract-HIB (Haemophilus B conjugate Vaccine), INFANRIX, KINRIX, PEDIARIX, and ROTARIX are registered trademarks of the GSK group of companies.

Manufactured by GlaxoSmithKline Biologicals

Rixensart, Belgium, US License 1617, and

Distributed by GlaxoSmithKline

Research Triangle Park, NC 27709

©2016 the GSK group of companies. All rights reserved.

HRX:6PI

Tetanus Toxoid Purified:


This medication is given to provide protection (immunity) against tetanus (lockjaw) in adults and children 7 years or older. Vaccination is the best way to protect against this life-threatening disease. Vaccines work by causing the body to produce its own protection (antibodies). Tetanus vaccine is usually first given to infants with 2 other vaccines for diphtheria and whooping cough (pertussis) in a series of 3 injections. This medication is usually used as a "booster" vaccine after this first series. Closely follow the vaccination schedule provided by the doctor. Booster injections may be needed at the time of injury in older children and adults if it has been 5-10 years since the last tetanus vaccine was received. Booster injections should also be given every 10 years even if no injury has occurred. This injection or an injection with tetanus/diphtheria or tetanus/diphtheria/pertussis may be used for the booster.

Tetract-HIB pharmaceutical active ingredients containing related brand and generic drugs:

Active ingredient is the part of the drug or medicine which is biologically active. This portion of the drug is responsible for the main action of the drug which is intended to cure or reduce the symptom or disease. The other portions of the drug which are inactive are called excipients; there role is to act as vehicle or binder. In contrast to active ingredient, the inactive ingredient's role is not significant in the cure or treatment of the disease. There can be one or more active ingredients in a drug.


Tetract-HIB available forms, composition, doses:

Form of the medicine is the form in which the medicine is marketed in the market, for example, a medicine X can be in the form of capsule or the form of chewable tablet or the form of tablet. Sometimes same medicine can be available as injection form. Each medicine cannot be in all forms but can be marketed in 1, 2, or 3 forms which the pharmaceutical company decided based on various background research results.
Composition is the list of ingredients which combinedly form a medicine. Both active ingredients and inactive ingredients form the composition. The active ingredient gives the desired therapeutic effect whereas the inactive ingredient helps in making the medicine stable.
Doses are various strengths of the medicine like 10mg, 20mg, 30mg and so on. Each medicine comes in various doses which is decided by the manufacturer, that is, pharmaceutical company. The dose is decided on the severity of the symptom or disease.


Tetract-HIB destination | category:

Destination is defined as the organism to which the drug or medicine is targeted. For most of the drugs what we discuss, human is the drug destination.
Drug category can be defined as major classification of the drug. For example, an antihistaminic or an antipyretic or anti anginal or pain killer, anti-inflammatory or so.


Tetract-HIB Anatomical Therapeutic Chemical codes:

A medicine is classified depending on the organ or system it acts [Anatomical], based on what result it gives on what disease, symptom [Therapeutical], based on chemical composition [Chemical]. It is called as ATC code. The code is based on Active ingredients of the medicine. A medicine can have different codes as sometimes it acts on different organs for different indications. Same way, different brands with same active ingredients and same indications can have same ATC code.


Tetract-HIB pharmaceutical companies:

Pharmaceutical companies are drug manufacturing companies that help in complete development of the drug from the background research to formation, clinical trials, release of the drug into the market and marketing of the drug.
Researchers are the persons who are responsible for the scientific research and is responsible for all the background clinical trials that resulted in the development of the drug.


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References

  1. Dailymed."HIBERIX (HAEMOPHILUS B CONJUGATE VACCINE (TETANUS TOXOID CONJUGATE)) INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION HIBERIX (HAEMOPHILUS B CONJUGATE VACC". https://dailymed.nlm.nih.gov/dailym... (accessed August 28, 2018).
  2. "Tetanus toxoid". https://pubchem.ncbi.nlm.nih.gov/su... (accessed August 28, 2018).
  3. "Clostridium tetani toxoid antigen (formaldehyde inactivated) - DrugBank". http://www.drugbank.ca/drugs/DB1058... (accessed August 28, 2018).

Frequently asked Questions

Can i drive or operate heavy machine after consuming Tetract-HIB?

Depending on the reaction of the Tetract-HIB after taken, if you are feeling dizziness, drowsiness or any weakness as a reaction on your body, Then consider Tetract-HIB not safe to drive or operate heavy machine after consumption. Meaning that, do not drive or operate heavy duty machines after taking the capsule if the capsule has a strange reaction on your body like dizziness, drowsiness. As prescribed by a pharmacist, it is dangerous to take alcohol while taking medicines as it exposed patients to drowsiness and health risk. Please take note of such effect most especially when taking Primosa capsule. It's advisable to consult your doctor on time for a proper recommendation and medical consultations.

Is Tetract-HIB addictive or habit forming?

Medicines are not designed with the mind of creating an addiction or abuse on the health of the users. Addictive Medicine is categorically called Controlled substances by the government. For instance, Schedule H or X in India and schedule II-V in the US are controlled substances.

Please consult the medicine instruction manual on how to use and ensure it is not a controlled substance.In conclusion, self medication is a killer to your health. Consult your doctor for a proper prescription, recommendation, and guidiance.

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The information was verified by Dr. Rachana Salvi, MD Pharmacology

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