Diphtheria, Tetanus Toxoids, Acellular Pertussis and Inactivated Polio Vaccine (KINRIX™)

By William T. Elliott, MD, FACP, and James Chan, PharmD, PhD.

Dr. Elliott is Chair, Formulary Committee, Northern California Kaiser Permanente; Assistant Clinical Professor of Medicine, University of California, San Francisco; Dr. Chan is Pharmacy Quality and Outcomes Manager, Kaiser Permanente, Oakland, CA.

Drs. Chan and Elliott report no financial relationship to this field of study.

This article originally appeared in the August 15, 2008 issue of Internal Medicine Alert.

A single injection has been approved for a fifth dose of DTaP and the fourth dose of inactivated polio (IPV) in children 4-6 years of age. The combination vaccine is marketed by GlaxoSmithKline as KINRIX.

Indications: DTaP-IPV is indicated as the fifth dose of DTaP and the fourth dose of IVP in children ages 4-6 who have previously been vaccinated with INFANRIX and/or PEDIATRIX for the first three doses and INFANRIX for the fourth dose.1

Dosage: The dose is 0.5 mL administered intramuscularly. The DTaP components of KINRIX are the same as that in INFANRIX and PEDIATRIX. The inactivated polio component is the same as that in PEDIATRIX.1

Potential Advantages: The combination vaccine reduces the number of injections and the time to administer the immunizations and is considered non-inferior to administration of separate injections of DTaP and IPV.

Potential Disadvantages: Pain and Grade 3 pain were statistically higher for the DTaP-IPV compared to separate vaccine (57% vs 53.3% and 1.6% vs 0.6% respectively).2

Comments: Randomized multicenter studies show similar immunogenicity and reactogenicity between DTaP-IPV and DTaP and IPV given separately.1,2,3 Non-inferiority of the DTaP-IPV vaccine to separate DTaP and IPV vaccines was demonstrated for all DTaP antigen booster response rates and poliovirus geometric mean titers of antibody ratios. Solicited adverse events during the 4-day follow-up were similar between groups, although any pain and Grade 3 pain was higher in the combination group (57% vs 53.3% and 1.6% vs 0.6%).2 Unsolicited adverse events reported by children were similar between groups, 30.5% for the combined vaccine and 29.2% for separate vaccines. The DTaP-IPV vaccine also had no negative effect on the response to co-administered MMR vaccine.3

Clinical Implications: The vaccination schedule for children ages 4-6 are DTaP (5th dose), IPV (4th dose), MMR (2nd dose), and varicella (2nd dose).4 DTaP-IPV provides an effective vaccination of DTaP and polio and requires one less injection, from 4 injections to 3.

References

  1. KINRIX product information. GlaxoSmithKline. June 2008.
  2. Black S, et al. Pediatr Infect Dis J. 2008:27:341-346.
  3. Black S, et al. Vaccine. 2006; 24:6163-6171.
  4. Recommended Immunization Schedule for Persons Aged 0-6 Years. http://www.aafp.org/online. Accessed 7/28/08.