The vaccines that should be given to prevent
from influenza type B and typhoid are
respectively
(1) Hib and BCG vaccines
(2) TAB and Hib vaccines
(3) BCG and TAB vaccines
(4) Mib and TAB vaccines
Answers
Explanation:
HepB/Hib combinations
Comvax (Merck & Co; also marketed by SP MSD in Europe as Procomvax and other trade names) combines HepB vaccine (Recombivax, 5 μg) and PRP-OMP conjugate Hib vaccine (PedvaxHIB, 7.5 μg). A study comparing Comvax and its constituent components given at 2, 4, and 12 to 15 months of age found no material difference in antibody responses.288–290 Mean PRP antibody levels for the combined and separate products (2.5 and 2.8 μg/mL, respectively) and proportions exceeding 1.0 μg/mL at 6 months of age (72% and 76%, respectively) were in the usual range for PedvaxHIB (see Chapter 13). When infants were given a booster dose at 12 to 15 months of age, the corresponding values were 9.5 and 10.2 μg/mL and 92% and 93%, respectively. Responses to the HepB component also were as expected, with 92% and 98% of subjects in the respective groups achieving protective levels of antibody (≥ 10 mIU/mL) at 6 months of age and with 98% and 100%, respectively, achieving these levels after boosting.
Combination Vaccines
Michael D. Decker, ... Barbara J. Howe, in Plotkin's Vaccines (Seventh Edition), 2018
Combinations Based on Hepatitis Vaccine, Without DTP or DTaP
HepB/Hib Combinations
Comvax (Merck & Co; also marketed by Sanofi Pasteur MSD in Europe as Procomvax and other trade names) combined HepB vaccine (Recombivax, 5 µg) and PRP-OMP conjugate Hib vaccine (PedvaxHIB, 7.5 µg). Merck discontinued production of this vaccine in 2014; readers interested in further information regarding Comvax are referred to the 2012 edition of this text.20
HepB/HepA Combinations
A combination incorporating HepA and HepB antigens (Twinrix; GlaxoSmithKline) is available in the United States, Canada, Europe, and elsewhere. The combined vaccine is available in an adult formulation that contains 720 EU of inactivated HepA antigen and 20 µg of recombinant HepB antigen (Twinrix Adult), in a pediatric formulation that contains half these amounts (Twinrix Pediatric), each given as a three-dose series, and in a pediatric formulation containing the adult dosage but given as a two-dose series (Ambirix).
A comparative trial in adults of Twinrix versus its individual components (Havrix and Engerix-B) given separately at 0, 1, and 6 months found excellent antibody responses, with 100% of combined-vaccine recipients achieving protective levels of both antibodies before the 6-month injection.342 Another comparative trial343 confirmed the equivalence of Twinrix and its component vaccines given separately at 0, 1, and 6 months: 99.6% of 264 Twinrix vaccinees developed antibodies against HepA (GMT: 4756 mIU/mL) versus 99.3% of 269 recipients of the monovalent vaccines (GMT: 2948 mIU/mL); for HepB, 95.1% of the Twinrix vaccinees achieved protective titers (GMT: 2099 mIU/mL) versus 92.2% (GMT: 1871 mIU/mL) of the subjects receiving monovalent vaccines. Other studies have provided comparable data.344,345
Northdurft and colleagues evaluated an accelerated schedule, developed for persons (e.g., travelers) in need of rapid protection against HepA and B, in which Twinrix is given at 0, 7, and 21 days, with a booster at 1 year, and compared it to HepB given on the same schedule plus HepA given at day 0 and at 1 year (the control group).346 One week after the third dose, 100% of Twinrix recipients and 99% of controls were positive for anti–HepA antibodies (GMT, 845 mIU/mL vs 512 mIU/mL) and 82% of the Twinrix vaccinees were protected against HepB versus 84% in the control group (GMTs: 65 vs 98 mIU/mL, respectively). At 3 months after the first dose, 100% of Twinrix recipients versus 98% of controls were seroprotected against HepA and 95% of Twinrix recipients versus 91% of controls were seroprotected against HepB. In all studies, Twinrix was well tolerated, with no increased reactogenicity compared with the individual components.
Several long-term follow-up studies among children, younger adults, and older adults have found excellent antibody persistence.347,348 Seventeen years following a three-dose Twinrix Adult series given to persons at 17 to 43 years of age, 96 to 100% remained seropositive for antibody to HepA and 88 to 92% had protective anti-HBS concentrations.348 Those given HepB vaccine boosters because their antibody had dropped below 10 mIU/mL demonstrated strong anamnestic responses.348
In addition, when two or more cases of invasive disease occur within a 60-day period in attendees of a group childcare facility and incompletely vaccinated children attend the facility, rifampin is recommended for all attendees and supervisory personnel. Management after a single case at a childcare facility is controversial and depends on the age and immunization status of the attendees and the duration of daily contact between attendees and the index patient. In-home group childcare settings are managed like families.
Treatment of the index case with cefotaxime
Epidemiology
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