Kids' combination vaccines cut number of required shots

The Food and Drug Administration in June approved a pair of vaccines that provide as many as five childhood immunizations in one shot. The Advisory Committee on Immunization Practices followed up on this action by recommending that the vaccines be incorporated into the regular immunization schedule.

The FDA gave the nod to Pentacel, the first five-component vaccine giving protection against diphtheria, tetanus, pertussis, polio and haemophilus influenzae type b. Manufactured by Sanofi Pasteur, it is intended to be administered in a four-dose series at 2, 4, 6 and 15-18 months. According to a company statement, this product could reduce the number of injections from 23 to 16 that children receive before they reach 18 months.

In addition, agency approval was given to Kinrix, a shot protecting against diphtheria, tetanus, pertussis and polio, which is manufactured by GlaxoSmithKline. This is intended to boost protection for children ages 4-6.

The ACIP also voted to include these preventives in the Vaccines for Children Program.

Physicians generally have welcomed combination vaccines, although reimbursement is frequently an issue when new shots are introduced. Record keeping also could be problematic, especially for children who do not have a medical home.

In other action, the committee added GSK's rotavirus vaccine, Rotarix, as an option. This was licensed by the FDA in April. RotaTeq, manufactured by Merck & Co. Inc., has been on the schedule since February 2006. Neither is preferred, although it is recommended that children should receive all doses in the series with the same product if possible. Data are starting to emerge indicating that this immunization is making inroads in infection rates.

A paper in the June 25 Morbidity and Mortality Weekly Report found the usual spate of winter rotavirus infections started later and was less severe than usual. For the past 15 years, rotavirus season has started in November. But for the 2007-08 season, illnesses began to appear in February. The season peaked in April instead of March. Rotavirus also showed up in 79% fewer tests for gastroenteritis.

Experts suggest this finding may be a result of the vaccine protecting the individual as well as the community at large.

"The changes appear to be greater than expected based on the protective effects of the vaccine alone," said Anne Schuchat, MD, director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention. "It is also possible that current levels of vaccination may be helping to decrease the spread of rotavirus ... in the community."

The ACIP is a panel of experts convened by the Dept. of Health and Human Services to advise the CDC. Several medical societies are represented, including the American Medical Association. Recommendations become agency policy after they are accepted by the director and published in the MMWR.