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Pharmacy and Medications

Combination Vaccine and Monovalent Vaccine

02/22/2011

Question:

Hi

I wonder why there is a need for 4 doses of hepatitis B vaccine which is in combination with other vaccine after birth dose rather than 2 more doses of Hepatitis B monovalent? This is permissible for any combination vaccine containing Hepatitis B or just Twinrix (Hep A + Hep B)?

Answer:

Monovalent Vaccines

There are 2 monovalent hepatitis B vaccines, Engerix-B® and Recombivax HB®, which only immunize for hepatitis B, and are interchangeable in a hepatitis B vaccination schedule. The recommended vaccination schedule for monovalent vaccines usually consists of 3 doses, with the first dose ideally given at birth, the second given at 1-2 months of age, and the third given at 6-18 months of age.

Combination Vaccines

Comvax® is a combined hepatitis B and Haemophilus influenzae type b (Hib) vaccine. Comvax cannot be administered before 6 weeks of age or after age 71 months (5 years and 11 months of age). Children who receive one dose of monovalent hepatitis B vaccine at or shortly after birth may receive Comvax on a schedule of 2, 4, and 12-15 months of age, equaling a total of 1 dose of a monovalent hepatitis B vaccine at birth and 3 doses of the Comvax vaccine.

Another combination vaccine, Pediarix® contains hepatitis B, diphtheria, tetanus, acellular pertussis (DTaP), and inactivated poliovirus (IPV) vaccine. Pediarix cannot be administered before 6 weeks or after 7 years of age. Similar to Comvax, children who receive one dose of monovalent hepatitis B vaccine at or shortly after birth may receive Pediarix on a schedule of 2, 4, and 12-15 months of age equaling a total of 1 dose of a monovalent hepatitis B vaccine at birth and 3 doses of the Pediarix vaccine.

The third and final hepatitis B combination vaccine, Twinrix®, is a combination of hepatitis A and B vaccines. However, Twinrix is only recommended in persons =18 years who are at increased risk for both Hepatitis A and B infections. The twinrix dosing schedule usually consists of three doses, and a booster dose if warranted.

Summary

In conclusion, the recommended schedule for monovalent hepatitis B vaccines (Engerix-B and Recombivax HB) usually consists of 3 doses, with the first dose ideally given at birth, the second given at 1-2 months of age, and the third given at 6-18 months of age, for a total of 3 doses. However, combination hepatitis B vaccines (Comvax and Pediarix) can be used in place of the second and third doses of monovalent hepatitis B vaccines, and a 4th dose is also given, for a total of 4 doses, consisting of 1 dose of monovalent hepatitis B vaccine, and 3 doses of a combination hepatitis B vaccine. Combination vaccines are commonly used to minimize the number of injections children receive. Twinrix, a combination hepatitis A and B vaccine, is only recommended in persons =18 years who are at increased risk for both Hepatitis A and B infections.

Submitted by Jay Ofat, PharmD Candidate 2011, University of Toledo College of Pharmacy

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Response by:

David Baker, PharmD, DABAT
Formerly, Clinical Assistant Professor of Pharmacy
College of Medicine
The Ohio State University