Manual 18140483

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ISSN 0382-232X
Rapport hebdomadaire des
maladies au Canada
Canada Diseases
Weekly Report
Date of publication: 28 September 1991
Contenu du present numero:
Contained In this Issue:
Announcement
.
.
.
.
Date de publication: 28 septembre 1991
Vol. 17-39
.
NACI - Statement on Haemophilus lnfluenzae Type B Conjugate
Vaccines for Use in Infants and Children . . . . . .
209
Annonce . . . . . . • . . . .
209
210
CCNI - Declaration au sujet des vaccins conjugues contra Haemophi/us influenzae
de type b chez les nourrissons et les enfants . . . . . • . . • . . .
210
Announcement
An nonce
Changes to the
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a
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I Se::cnd a°"
.LI
I"'!""
Mal Ro!IJ!raloo No. 6670
Health and Welfare
Canada
a
I
Santa et
Canada
Bien-~tre
social
209
Canada
National Advisory Committee on Immunization (NACI)
Comlte consultatlf national de l'lmmunlsauon (CCNI)
STATEMENT ON HAEMOPHILUS INFLUENZAE TYPE B
CONJUGATE VACCINES FOR USE IN
INFANTS AND CHILDREN
On 30August,1991, 2 new Haemophilus influenzae type b
DECLARATION AU SUJET DES VACCINS CONJUGUES CONTRE
HAEMOPHILUS INFLUENZAE DE TYPE B CHEZ LES
NOURRISSONS ET LES ENFANTS
conjugate vaccines (one from Merck Frosst and the other from
Lederle-Praxis) were licensed for use in Canada in infants 2
months and older. The recommendations are in general agreement
with those published by the US Immunization Practices Advisory
Committee (ACIP) on 11January,1991. There are some
differences in the timing of booster doses to fit in with existing
Canadian immunization schedules.
Le 30aout1991, le Canada autorisait l' utilisation de 2 nouveaux
vaccins conjugues contre Haemophilus influenzae b (/' un de la societe
Merck Frosst, l' autre de la Lederle-Praxis) chez les nourrissons de 2 mois
et plus. La declaration du CCNI dont fait etat le texte qui suit expose en
detail /es recommendations concernant ces 2 vaccins ainsi que celui de la
societe Connaught approuve anterieurement pour les enfants de 18 mois et
plus. Les recommendations s' accordent avec eel/es qui ont ete publiees le
11janvier1991 par I' Immunization Practices Advisory Committee des
Etats-Unis, saufpour ce qui est des dates des rappels, lesquelles ont ete
adaptees aux calendriers de vaccination appliques au Canada.
Introduction
Haemophilus inf/uenzae type b (Hib) is a bacterial pathogen that
Introduction
Haemophilus injluenzae de type b (Hib) est un bacterie pathogene
produces invasive, blood-borne infections, primarily in young
children. It is the most common cause of bacterial meningitis in
Canada, outnumbering all other reported bacterial causes combined.
It also causes epiglottitis, septicemia, cellulitis, pneumonia, septic
arthritis and other invasive infections. Approximately 55-65% of all
invasive infections due to H. influenzae present as meningitis.
responsable d 'infections invasives adiffusion Mmatogene, surtout chez les
jeunes enfants. C 'est la principale cause de la meningite bacterienne au
Canada; elle depasse toutes !es autres causes bacreriennes reunies. Elle est
egalement Cause d I epiglottites, de Septicemies, de cellulites, de
pneumonies, d'arthrites aigues suppurees et d'autres infections invasives.
Environ 55 a 65 % de toutes les infections invasives aH. influenzae sont
des meningites.
.
Mortality from invasive Hib infections is between 1-5% and
permanent neurologic sequelae occur in 20-30% of survivors of
meningitis. Infection rates increase sharply 4 to 6 months of age
and peak during the second 6 months of life >. Approx~ately
two-thirds of cases occur in children <18 months of age and over
80% in children <5 years of age (LCDC, unpublished data).
La mortalire due aux infections invasives aHib varie de 1 a5 % et, dans
le cas de la meningite, la maladie laisse des sequelles neurologiques
permanentes chez 20 a30 % des survivants. Le taux d'infection augmenm
rapidement vers 4 a6 mois et culmine dans la periode de 6 mois aun an .
Environ !\lS deux tiers des cas sont signal es chez des enfants de moins de
18 mois < :i et plus de 80 % chez les mo ins de 5 ans (LLCM, donnees non
publiees).
Prior to the introduction of Haemophilus vaccines in 1987, it
was estimated that one in 200 children developed invasive Hib
infections by the age of 5 years. In Canada, this represented
approximately 2,000 cases annually, slightly more than half
presenting as meningitis. Since the introduction of vaccine,
incidence has fallen by as much as half in many jurisdictions in
Canada (LCDC, unpublished data) and the U.S.A. Even though use
of vaccine was limited to those 15-18 months of age or older, this
decline in incidence has also been observed in children less than 18
months of age and may be due to a herd immunity effect.
Avant I' introduction des vaccins i;ontre Haemophilus en 1987, on
estimait qu 'un enfant sur 200 etait susceptible de contracter une infection
invasive aHib avant l'age de 5 ans. Au Canada, celarepresentait environ
2 000 cas par annee, dont un peu plus de la moitie etaient des cas de
meningite. Depuis I 'introduction des vaccins, la frequence des infections a
Hib a diminue de pres de la moitie dans beaucoup de regions au Canada
(LLCM, donnees non publiees) et aux Etats-Unis. Meme si les vaccins
n'etaient utilises que chez les enfants de 15 a 18 mois et plus, cette
diminution de la frequence de la maladie a ere observee egalement chez les
moins de 18 mois et pourrait etre due aun phenomene d'immunite de
groupe.
The risk of invasive Hib infections is increased several fold in
children attending day care fulltime compared to children cared for
at home. Risk is also increased in Inuit and Indian children and in
persons with splenic dysfunction (e.g. sickle cell disease, asplenia),
antibody deficiency, HIV infection or certain malignancies.
Le risque d'infection invasive aHib est beaucoup plus grand chez !es
enfants en garderie aplein temps que chez ceux gardes dans leur foyer. Le
risque est egalement plus important chez les enfants inuit et amerindiens et
chez les sujets atteints d'insuffisance splenique (par ex. drepanocytose,
asplenie); de. carence immunitaire, d'infection aVIH ou de certains cancers.
The recent licensure of conjugate Haemophilus vaccines for use
in infants offers the prospect of preventing most of the morbidity
and mortality associated with Hib infections.
L'autorisation donnee recemment d'utiliser !es vaccins conjugues
contreHaemophilus chez les nourrissons permet d'envisager la prevention
de la plus grande partie de la morbidire et de la mortalire associees aux
infections aHib.
Haemophilus influenzae is also commonly associated with o_titis
media, sinusitis, bronchitis and other upper respiratory infections.
These infections are seldom caused by type b organisms. Thus
Haemophilus b vaccines will have no effect on the incidence of
these infections.
Haemophilus influenzae est courarnment associe aussi ii.l'otite
moyenne, ala sinusite, ala bronchite et ad'autres infections des voies
respiratoires superieures. Ces infections sont rarement causees par des
micro-organismes de type b. Les vaccins contre Haemophilus b n'auront
done aucun effet sur la frequence de ces infections.
Preparations Used for Immunization
Haemophilus b conjugate vaccines represent the second
generation of vaccines against Hib disease, having replaced an
earlier polysaccharide product (polyribosylribitol phosphate, PRP).
Conjugate vaccines talce advantage of the greater immune responses
of infants and young children to polysaccharide-protein conjugate
antigens compared to purified polysaccharide.vaccine. The latter
stimulates only B-cells while the former activate macrophages,
T-helper cells and B-cells, resulting in greatly enhanced antibody
responses. Various protein carriers are used in the conjugate
vaccines as summarized in Table 1.
Les vacclns utilises
Les vaccins conjugues contre Haemophilus b font partie de la deuxieme
generation de vaccins contre les maladies aHib; ils ont en effet remplace
les anciens produits abase de polysaccharides (phosphate de
polyribosylribitol, PRP). Les nouveaux vaccins conjugues abase de
polysaccharides et de proteines provoquent une meilleure reponse
immunitaire chez !es nourrissons et les jeunes enfants que les vaccins a
base de polysaccharides purifies qui ne stimulaient que !es lymphocytes B,
car ils activent aussi les macrophages et les lymphocytes T auxiliaires.
Divers vecteurs proteiques sont utilises dans les vaccins conjugues, comme
on peut le voir dans le tableau 1.
N
210
Table iffableau 1
Characteristics of Haemophi/us b conjugate vaccines .
Description des vaccins conjugues contre Haemophi/us b
Vaccine (producer)
Vaccln (fabrlcant)
Status In Canada
Statut all Canada
Protein carrier
Vecteur protelqlie
HbOC, HibTITER®
(Laderle·Praxis)
CRM197 mutant Corynebacterium d(f,htheriae protein
Proteins de la souche mutants CR 191 de
Corynebacterium i:Jiphtheriae
Licensed for use ~ 2 months of age
Autorise cliez las enfants d'au mains 2 mols
PRP~OMP, PadvaxHIB®
(Marek Frosst)
Neisseria meningitidis outer-membrane protein
complex
·
Coinplaxe protelque d1:1 la membrane exterl(;lure de
Ne/sseria meningitidis
Licensed for use ~ 2 months of age
Autorise chez las anfants d'au mains 2 mois
PRP·D, ProHIBIT®
Diphtheria toxold
Anatoxlne dlphtherlqua
Licensed for use ~i 8 months of a~e
·
Autorlse chez las enfants d'au mo ns i8 mols
Tetanus toxoid
Anatoxlne tetanlque
Cllnlcal trials
Essais cliniques
~Connaught Laboratories~
Laboratolras Conn aught
PRP-T (Pasteur-Merleux)
lmmunogenicity of the varioils conjugate vaccines is difficult
to compare since they have been tested in different populations
with different r~sponsiveness to vaccine and because assays for
antibody to PRP are not standardized. HbOC and PRP-OMP .
stirimlate good antibody response~f~er primary immunization in
infants starting at 2 months of age ' . PRP-D appears to elicit
significantly lower levels of antibody than either HbOC or
PRP-OMP in young infants. However, all conjugate vaccines
awear to induce excellent priming of the immune system so that no
differences in immunogenicity ate observed among children 15
months of age and over who have received 3-4 doses (i.e., primary
series pl~!~ booster) of one of the three.licensed conjugate vaccine
products
. There ·are no data concerniJ).g the response to a
booster of one conjugate vaccine if a different conjugate product
was used for the primary series in infants.
Il est difficile de comparer l'immunogenicite des divers vaccins
conjugues, parce que les essais ont ete realises chez des populations
differentes repondant differemni.ent a Uil v accin donne et que le dosage des
anticorps induits par le PRP n'est pas normalise. Le HbOC et le PRP-OMP
prod\]isent une bonne reponse ~unitaire a la suited 'une premiere sene
d'injections debutant a 2mois ' . Le PRP-D produit apparemment un titre
d'anticorps beaucoup moins eleve que le HbOC et le PRP-OMP chez les
jeunes nourrissons. Toutefois, tousles vaccins conjugues semblent
provoquer une excellente stimulation du syst~me immunitaire, car on
n'observe aucune difference d'irrnnunogenicite chez les enfants de 15 mois
et plus qui ont re~:u 3 mi 4 doses (c.-a-?4-~~ premiere serie et un rappel) de
l'un des 3 vaccins conjugues autorises
. Nous n'avons aucune donnee
concemant la reponse au rappel lorsque le nourrissson a regu un vaccin
conjugue different lors de la vaccination pi:imaire.
Efficacy studies of the three licensed conjugate products have
also been carried out in different populations and under different
circumstances, making comparison difficult. The first efficacy
trial, usiilg PRP-D f~ a cohort of 114,000 Finnish infants, reported
an efficacy of 94% but in 2,102 A1ask;1E't'Wtives the same
·
vaccine produced an efficacy of only 35% .
Les etudes d'efficaciti des 3 produits conjugues autorises jusqu'ici ont
egalement ete effec):uees chez des populations differentes et dans des
conditions differentes, ce qui rend les comparaisons difficiles. Dans une
premiere etude d 'efficacite du PRP-D dans une cohorte de bJ-4 000
nourrisso!)S finlandais, on .a observe une efficacite de 94 % , mais chez
2 102 autochf9:nes de I' Alaska le meni.e vaccin a donne une efficacite de 35
% seulement l.
In contrast. in a study of HbOC in over 60,000 infants in
northern California (vaccinated at 2, 4 and 6 months of age) there
were n~ v%yin? f~ures .in childre:n who, reeei,ved ~or mote doses
of vaccme . Sunilarly, m a study mvolvmg approXllllately 5,000
Navajo infants (a group with a very high risk of disease),
PRP~OMP vaccine (given at 2 and 4 months of age with a booster
at 15-18 months) had orily one vaccine fai(We after 2 doses,
compared to 22 cases in the control group .
Par ailleurs, clans une etude de plus de 60 000 nourrissons du nord de la
CaJifornie vaccines par le Hboc a 2, 4 et 6 mois, &~cun echec n'a ete
observe chez ceux qui ont regu .au moins 2 doses . On a observe des
resultats comparables chez 5 000. nourrissons Navajo (un groupe a risque
tres eleve) vaccines au PRP-OMP (a 2 et 4 mois, puis une dose de rappel a
.15-18 mois): un seul echec aete constate chez un sujet ayantreyu 2 doses,
alors que 22 cas d'infection se sont declares dans le groupe temoin<9>.
Recommencied Usa~e
Routine immunization of all children is recommended
beginning at2 months of age. Different schedules are
recommended depending on the product used. The
recommendations for routine .infant immunization are summarized
in Table 2. Until data are available, vaccines cannot be considered
interchangeable for doses below 18 months of age. The
immunization series should be completed using the vaccine
initially chosen. It is important that the child's immunization record
indicate the type of Hib vaccine used and/or the manufacturer's
name.
Utilisation recommandae
On recommande la vaccination systematique de tousles enfants a
partir de l' age de 2 mois; le programme varie selon le produit utilise
(tableau 2). Jusqu 'al' obtention de donnees ace sujet, les divers produits ne
peuventpas etre consideres comme interchangeables pour les enfants de
mains de 18 mois. La serie doit etre execuree entierement avec le produit
choisi au depart. Il est important que la fiche d'immunisation de l 'enfant
indique soit le type de vaccin utilise, soit le nom du fabricant.
211
HbOC: Pour !es enfants chez quila v.accination commeni:e a!'age de 2
a 6 mois, on recommande 3 doses aau moins 2 mois d'intervalle et un
H,bOC: For children beginning inununization at 2 - 6 months of
age, 3 doses are recommended at least 2 months apart, with a
booster dose at 18 months* of age (or as soon as possible
thereafter), and at least 2 months after the third dose.
rappel al'age de 18 mois OU des que possible apres cet age, mais au moins 2
mois apres la troisienie dose.
Children beginning inununization at 7 - 11 months of age
should receive 2 doses of vaccine atleast 2 months apart with a
booster dose at 18 months* of age (or as soon as possible
thereafter), and at least 2 months after the second dose (Table 3 ).
Aux enfanis qu' on commence avacciner al' age de 7 a 11 mois, ii faut
administrer 2 do~es de vaccin au moins 2 mois d'intervalle et un rappel
!'age de 18 mois OU des que possible apres cet age, rnais au moins.2 rnois
apres la deuxieme dose (tableau 3 ).
Unvaccinated children 12 - 17 months of age should receive a
single dose ofvj.lccine as soon as possible and a booster dose at or
after 18 months of age (or as soon as possible thereafter), and at
least 2 months after the first dose.
Les enfants qui n' ont pas encore ete vaccines a l' age de 12 a 17 mois
doivent recevoir une dose unique.de vaccin des que possible et une dose de
rappel al'age de 18 rnois OU plus (OU des que possible apres cet age), rnais
au moins 2 mois apres la premiere dose.
Unvaccinated children 18 - 59 months of age should receive a
single dose of vaccine.
Les enfants non vaccines ]'age de 18
unique de vaccin.
PRP-OMP: Infanis beginning inununization at 2 - 6 months of
age should receive 2 doses of vaccine 2 months apart with a booster
dose at 12 months of age.
PRP-OMP: Les enfants qu'on commence vacciner l'age de 2 6
mois doivent recevoir 2 doses 2 mois d'intervalle etunrappel 12 mois.
Unvaccinated children 7 - 11 months of age should receive 2
doses 2 months apart with a booster at 18 months* of age (or as
soon as possible thereafter), and at least 2 months after the second
dose.
Les enfants non vaccines al'age qe 7a11 mois doiventrei,;.evoir 2 doses
de vaccin 2 mois d'intervalle et Un rappel l'fige de 18 mois .OU des que.
possible apres cet age, mais au moins 2 mois apres la deuxieme dose.
Unvaccinated children 12 - 17 montlis of age should receive a
single dose of vaci;ine as soon as possible and a booster dose at or
after 18 mo~ths* of age (or as soon as possible thereafter), and at
lea5t 2 months after the first dose.
Ceux qui n'ontpas encore ete vaccines a l'age de 12a17 mois recevront
une dosp unique de vaccin des que possible et un rappel I 'age de 18 mois
ou plus (ou des que possible apres cet age), mais au moins 2 mois apres la
premiere dose.
Unvaccinated children 18 - 59 months of age should receive a
single dose of vaccine.
Les enfants non vaccines aI' age de 18 a59 mois doivent recevoir une
dose Unique de vaccin.
PRP-D: This vaccine is recommended only for children 18 - 59
months of age. A single dose is reqUi.red.
PRP-D : Ce vaccin est recommande uniquement pour les enfants de 18 a
59 mois. Une seule dose est necessaire,
Other Considerations
Remarques supplementalres
Since a single dose of any of the above products after 18 monthS
of age is believed to be effective, any of the products may be used
for a "booster" dose at or after 18 months. However, using the
same product as was used in the initial series may produce a better
antibody response.
Comme les 3 produits ci-dessus sont reputes efficaces en dose unique
apres l'age de 18 mois, n'irnporte lequel d'entre eux peut etre utilise corillne
rappel partir de I' age dil 18 mois. Toutefois, il se peut que !'utilisation du
meme produit que dans la serie prirnaire donne une meilleure reponse
inununitaire.
'
·
While an interval of 2 months is recommended between doses,
an interval as short as one month is aeceptable but not optimal.
Bien qu 'on recommande un intervalle de 2 inois entre !es doses, un
intervalle d'un mois seuiement est acceptable mais min optimal.
Children who developed invasive Hib c1isease prior to 24
months of age should still receive vaccine as recommended above,
since such children may not develop adequate antibody levels
following natural disease.
L'enfant qui a contracte une infection invasive Hib avant !'age de 24
mois doit quand meme etre vaccine selon le programme recommande
ci-dessus, car chez les enfants de cet age la maladie risque de ne pas avoir
induit un titre d' anticorps suffisant.
This booster dose may be given as early as 15 months of age.
a
a
a
a59 niois recevront une dose
'
a
a
a
a
a
a
a
a
a
a
Cette dose de rappel peut-@tre admlnlstree des l'llge de 15 mols.
Table 2ffableau 2
Recommends~ routli:e irpmunizatiqn schedule for Haemephilus b 9onjug~te vaccines
.
Programme d'1mmun1sat1on de routine recommande avecles vaccms con1ugues contra Haemophilus b
Vaccine
Vaccln
HbOC
{Lederle-Praxis)
2 months
2mols
4months
4mols
dose 1
1re dose
dose2
2° dose
dose 1
ire dose
dose2
2° dose
6 months
6mols
12 months
12mols
dose3
36 dose
booster
rappel
I
PRP-OMP
(Merck Frosst)
.
booster
rappel
May be given as early as 15 months
.
Cetta dose peul €lire adminislraa des !'age de 15 mois,
212
18 months*
18 mols*
As immunization does not prevent acquisition and carriage of
Hib, children in families and day-care centres in which a case
occurs should receive rifarnpin or other appropriate
chemoprophylaxis in accordance with the usual recommendations.
Comme la vaccination n'empeche pas les sujets d'acquerir etde porter
le Rib, ii faut administrer de la rifarnpine aux autres enfants d'une farnille
OU d 'une garderie clans Jaquelle Uil Cas de maladie a Rib S 'est declare OU
prendre toute autre mesure de chimioprophylaxie selon Jes
recommandations usuelles.
Conjugate vaccines should be administered intramuscularly.
They may be given simultaneously with, but at separate sites than,
DPT, DPT-Polio, MMR, IPV or OPV. There are no known
contraindications to simultaneous administration ofHib vaccines
with either pneumococcal or meningococcal vaccine.
Les vaccins conjugues s' administrent par voie intrarnusculaire. Ils
peuvent etre administres enmeme temps que le DCT, le DCT-polio, le
RRO, le vaccin antipoliomyelitique injectable OU buvable, mais a des
endroits differents. On ne connait pas de contre-indication
!'administration simultanee d'un vaccin contre le Rib et d'un vaccin
antipneumococcique ou antimeningococcique.
For infants born prematurely, immunization should be initiated
at the chronologic age of 2 months as recommended for other
infants.
Dans le cas des nourrissons nes prematurement, la vaccination doit
debuter a !'age chronologique de 2 mois, comme pour Jes autres nourrissons.
Older children or adults with chronic conditions associated with
increased risk of invasive Rib disease as indicated above may be
immunized with a single dose of conjugate vaccine. There are no
efficacy data for such individuals but good immunogenicity has
been demonstrated for the vaccine in persons wi~~ickle cell
disease, leukemia, splenectomy or HIV infection .
Les enfants plus ages et les adultes dont l' et at chronique accroit le risque
de contracter une infection invasive, comme on l' a <lit plus haut, peuvent
etre immunises par une dose unique de vaccin conjugue. On ne dispose
d'aucune donnee d'efficacite pour ces sujets, mais le vaccin presente une
bonne immunogenicite chez des personnes so~{~ant de drepanocytose, de
leucemie, d'asplenie OU d'une infection a VIH .
Adverse Reactions
Effets secondalres
Fever >38.3'C and localized redness and swelling have been
reported in <5% of infants but similar rates were observed in some
instances in those receiving placebo. No severe adverse reactions
have been noted in clinical trials although a few temporally
associated allergic reactions have been reported in older children
receiving the vaccine as part of their routine immunizations.
On a signale une fievre depassant 38,3 'C accompagnee d' erytheme et de
tumefaction au point d' injection chez moins de 5 % des nourrissons, mais
des taux semblables ont ere observes a la suite d'injection de placebos. Si
aucun effet secondaire grave n'a ete observe !ors des essais cliniques, on a
signale des reactions allergiques associees aces vaccins chez des enfants
plus ages a qui on l'administrait dans le cadre du calendrier regulier
d'immunisation.
Precautions and Contraindications
Precautions et contra-Indications
Immunization should be deferred in children with acute febrile
illness.
Lav accination do it etre differee chez l' enfant presentant une maladie
febrile aigue.
Immunization is contraindicated in individuals who are allergic
to any component o.f the vaccine.
Elle est contre-indiquee chez Jes sujets allergiques a l'un quelconque des
constituants du vaccin.
a
Table 3/Tableau 3
Detailed vaccination schedule for Haemophilus b conjugate vaccines
Programme detaille d'administration des vaccins coniugues centre Haemophi/us b
Vaccine
Vaccln
HbOC
(Lederle-Praxis)
3 doses, 2 months apart
3 doses a 2 mols d'interv.
18 months*
18 mols*
7-11
2 doses, 2 months apart
2 doses a2 mois d'interv.
18 months*
18 mois*
1 dose
18 months*
18 mols*
18·59
PRP-D (Connaught)
Booster
Rappel
2-6
12·17
PRP-OMP
(Merck Fross!)
Primary Serles
Serie prlmalre
A£e at 1st dose (months)
ge a la 1re dose (mols)
1 dose
2-6
2 doses, 2 months apart
2 doses a 2 mols d'lnterv.
12 months*
12 mols*
7-11
2 doses, 2 months apart
2 doses a 2 mols d'interv.
18 months*
18 mois*
12-17
1 dose
18 months*
18 mols*
18-59
1 dose
18-59
1 dose
• At least 2 months following the previous dose; the booster recommended at 18 months may be given as early as 15 months provided the 2-month interval from the previous dose is
observed.
• Au moins 2 mois apres !'administration de la dose precedente; la dose de rappel recommandea l'age de 18 mois peut Eltra administree des 15 mois pourvu qua la dose
precedente ait ate administree au moins 2mois auparavant.
a
213
Conjugate vaccines should not be considered as a11
immunizing agent against diphtheria, tetanus or meni11gococcal
disease.
Les vaccins conjugues ne doivent pas etre co11sideres comme des agents
d'im111u11isation CO/lire la diphterie, fe fe/a/IOS OU la meningococcie.
Capsular polysaccharide antigen can be detected in the urine of
vaccinees for up to 2 weeks following immunization with
conjugate vaccines. This phenomenon should not be confused with
invasive Hib infections.
On peut deceler dans I 'urine des anti genes polysaccharidiques capsulaires au
cours des 2 semaines qui suivent la vaccination. Ce phenomene ne doit pas etre
pris pour un signe d'infection invasive Hib.
Despite surveillance for such cases, no increased incidence of
Hib disease in the first 2 weeks following immunization with
conjugate vaccines has been observed to date.
On n' a observe jusqu'a maintenant aucune augmentation de la frequence des
infections Hib dans Jes 2 premieres semaines suivant !'injection des vaccins
conjugues, en depit d 'une surveillance particuliere acet effet.
References
References
1. Mu~hy.TV. The 1990s: a decade of new vaccines. Pediatrlnfect Dis J
1. Murphy TV. The 1990s: a decade of new vaccines. Pediatr
Infect Dis J 1991;10:89-91.
2. Broome CV. Epidemiology of Haemophilus i11flue11zae type b
infections in the United States. Pediatr Infect Dis J
1987;6:779-882.
3. Black SB, Shinefield HR, Lampert D, et al. Safety and
immunogenicity of oligosaccharide conjugate Haemophilus
in[luenwe type b (HbOC) vaccine in infancy. Pediatr Infect
DIS J 1991; 10:92-6.
4. Santosham M, Hill J, Wolff M, et al. Safety and
5.
6.
7.
8.
9.
immunol{enicity of a Haemophilus l11fl11e11zae type b cof'ugate
vaccine ma high risk American Indian population. Ibid: 13-17.
Eskola J, Kaxhty H, Takala AK, et al. A randomized,
prospective field trial of a conjugate vaccine in the protection
of infants and youn~ children against invasive Haemophilus
influenwe type b disease. N Engl J Med 1990; 323:1381-87.
Kayhty H, Peltola H, Eskola J, et al. Immunogenicity of
Haemophilus influenzae oligosaccharide-protein and
polysaccharide-protein conjugate vaccination of children at
4,6, and 14 months of age. Pediatrics 1989;84:995-99.
Ward J, Brenneman G, Letson GW, He>'ward WL, Alaska
H. influenzae Vaccine Study Group. Limited efficacy of a
Haemophilus influenzae type b conjugate vaccine in Alaska
Native mfants. N Engl JMed 1990; 323:1393-1401.
Black SB, Shinefield HR, Fireman B, et al. Efficacy in infancy
of oligosaccharide conjugate Haemophilus lnfluenzae type b
{i-lbOC) vaccine in a United States population of61,080
children. Pediatr Infect Dis J 1991; 10:97-104.
Santosham M, Wolff M, Reid R, et al. The efficacy in Navajo
infants of a conjugate vaccine consisting of Haemophilus
influenzae type b polysaccharide and Neisseria meningltidis
outer-membraneprotein complex. N Engl J Med
a
a
1991;10.89-91.
2. Broome CV. EpiclemiologlofHaemopbilus jntluenzae zyve b infections in
the United Sta/es. Pediatr Infect Dis J 1987;6:779-882.
3. Black SB, Shinefield HR, Lampert D, et coll. Safety and immunogenjcity of
oli¥osaccharjde conjugate Haemophilus influenwe t.y,pe b (HbOC) vaccine
in infancy. Pediatr Infect Dis J 1991; 10:92-6.
4. Santosham M, Hill J, WolffM, et coll. S<Jfezy and immunogenjcizy ofa
Haemopbilus influenzae zype b coniugate vaccine in a high risk American
Indian popPlation. Ibid:ll3-17.
5. Eskola (Kayhty H, Takala AK, et coll. A randomized. orospective field trial
ofa coniugale vaccine in the protection of infants and young children
agai~t iW:asiveHaemovhilus influe11zae l)'.pe b disease. N Engl J Med
1990, 323.1381-87.
.
6. Kayhty H, Peltola H, Eskola J, et coll. Imm1mo~enicizy Q[Haemovhilus
~'11l~t;f;/ftOn°!fJggna;':~f'~f°an!f1f~gfr::;/J;:.ii~ilia~dic0n.iugate
1989;84:995-99.
7. Ward J, Brenneman G, Letson GW, Heyward WL, Alaska H. ln,fluenzae
Vaccine Study Group. Limited efficacy ofa Haem1:whilus injluenzae type b
coniugate vaccine in Alaska Native infants. N Engl J Med 1990;
323: 1393-1401.
8. Black SB, Shine.field HR, Fireman B, et coll...."""""""';.L.tJ"-""!~~!-1!:.
0 i OS
•
'
if • 10:97-104.
9. S antosham M, Wolff M, Reid R, et coll. The r;fficacv in Navqjo jnfqn!s of a
conjugate vaccine consisting ofHaemqpbilus influenzae Cl,De b
polysaccharide and Neisseria menjngitidis O!{ter-membrane protein
~.
NEnglJMed 1991;324:1767-72.
1991;324:1767-72.
10. Centers for Disease Control. Haemophilus b conjugate
vaccines for prevention of Haemophilus influenzae type b
disease among infants and children two months of aQe and
older: recommendations of the Immunization Practices
Advisory Committee (AC!f'). MMWR 1991;40 (no. RR-1): 1-7.
Tho Canada DU!cue1 Wooldy RcpcrtpmsenlB cuncnt information on infectious and otb::r dllease1
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tuthmtlcity. CwtributiOIU ue welcomed (in the official }11Dguagc of your chol"') from enyooc
working in the health rield and will not preclude publication elsewhere.
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