i vaccini approfondimento, Esercizi di Scienze Umane

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I vantaggi delle combinazioni vaccinali nell’età pediatrica Alberto Villani, Elena Bozzola UOC Pediatria Generale e Malattie Infettive Ospedale pediatrico Bambino Gesù, Roma - Società Italiana di Pediatria 2 Vaccinazioni 0-16 anni e anti-poliomelitica; ° anti-difterica; ° anti-tetanica; . . * esavalente (difterite-tetano-pertosse-epatite B-poliomielite-Haemophilus ° anti-epatite B; influenzae di tipo B); © anti-pertosse; e anti Haemophilusinfluenzae tipo B; o anti-meningococcica B; anti-meningococcica B; ° anti-meningococcica C; anti-meningococcica C; è anti-morbillo; ° anti-rosolia; ° anti-parotite; ® quadrivalente MPRV (morbillo-parotite-rosolia-varicella); ° anti-varicella. Vantaggi Migliore compliance famiglia Minor trauma per il bambino Più rapida pratica vaccinale Vaccinazioni più tempestive Minor accessi al centro vaccinale Ridotti costi personale 6 Use of Combination Vaccines Is Associated With Improved Coverage Rates (Pediatr Infect Dis J 2007:26: 496-500) . no Sori Combination —Reference Vaccine or Vaccine Series Cohort Cohort pi 4 DTaP 77.6% 72.7% <0.0001 3 DTaP 98.1 94.9 <0.0001 3 IPV 854 79.6 <0.0001 1 MMR 94.3 94.8 0.2684 3 or 4 Hib 87.6 86.7 0.1647 1 varicella 94.4 94.1 0.5058 4:3:1° 717 65.9 <0.0001 1 : 67.2 62.3 <0.0001 78.9 73.8 <0.0001 *Fisher's exact test. Î4 DTaP:3 IPV:1 MMR. #4 DTaP:3 IPV:1 MMR:3 Hib:1 varicella. $3 DTaP:3 IPV:3 Hib. DTaP indicates diphtheria, tetanus, acellular pertussis vaccino; Hib, Huemophilus influenzae type b conjugato vaccino; IPV, inactivated polio vaccine; MMR, measlos, mumps, rubella vaccine.  Combination Measles-Mumps-Rubella-Varicella Vaccine in Healthy Children A Systematic Review and Meta-analysis of Immunogenicity and Safety Shu-Juan Ma, MPH, Xing Li, MPH, Yi-Quan Xiong, MPH, A-ling Yao, MPH, and Qing Chen, PhD e IMmunogenicità - Sieroconversione - Sieroprotezione e Sicurezza 11 La risposta alle vaccinazioni II gute - venta Total Events Totat Wei R999% SNA Mumps Stime 1998 da 0 05 66 74% Vite 1967 204 207 205 97% 2001261006 2001 287 200127 11 eo” 2001261007 2001 927 1094 516 56 85% É 8 $ . 8 Î3 i 2008 392 "286 tia iso semo icomonion Sieroconversione RR: 0.98 Shinefield(b) 2005 1002 1012 350 351 103% ‘0.99 (0.98, 1.00] Khuf 2006 272 302 101 106 60% 0.95 (0.89, 1.00] 12006 2409 2509 854 872 101% 0.98 (0.97, 0.99 Goh 2007 13 133 108 18 36% 09310 85, 1.021 NCTO0839917 2008 10 10 8 8 10% 1001082, 12% Schuster 2008. 613 650 191 207 72% 1,02 (0.98, 1.07) Cha 2014. 262 295 145 164 60% 0.94 (0.89, 1.00) Subtotal (95% CI) 8052 3177 10,0% 0.98 [0.95, 1.00] Total vente 187 2060 Study Events, Events, % 0 RR (95% CD) MMRV MUR Wiesght Mumps Nolan (2002) e 099(0.94,103) 7072 = 772 2057 Rumke (2011) e _—_—__——_—_ 0961083, 1.16) 77110879103 627 Prymula (2014) —_ — 0195(092, 0.99) 580/663 81887 2267 2081361016 (2001) _—+_r 084(0.77, 092) MMG S661 = 1352 208136/007 (2001) Cennni 0.90 (0.87, 0.93) 927/1094 500532 2295 10999S/NCT009G9436 (2011) ——_—.—— 1.03 (0.94, 1.12) 124/144 188/224 1402 Subtotal (squared = 76.2%, p = 0.001) => 0.94 (0.90, 0:99) 2121/2527 1702/1879 100.00 Sieroprotezione RR:0.94  Immunogenicity and Safety of Two Doses of Tetravalent Measles-Mumps-Rubella-Varicella Vaccine in Healthy Children Any Grade 3% s Vaccine Injection MMRV MMR+V MMRY MMR+V Symptom di - — 95% CI 95% CI 95% CI 95% CI no % n n n % —— LL UL LL UL LL UL LL UL Pain (days 0-%) Dose 1 Regardless 450121 90 1590 80650 281240 00 00 10 0 00 00 30 Priorix —_ _ —_ _ 7 29 114 _ _ _ _ o 00 00 3.0 Varilrix 8 29 125 0 00 00 30 Dose 2*, regardless 53 146 111 186 5 13 938 0 00 00 10 0 00 00 30 0, Redness (days 0-3) Dose 1 Rogardless 113 30.5 258 364 90 244 171 330 08 02 23 0 00 00 30 Priorix — 29 236 164 321 — 0 00 00 30 Vorilrix — — 25 20.5 137 287 — 0 00 00 30 Dose 2*, regardless 123 33.8 289 389 27 221 151 805 20 55 84 S4 0 00 00 30 _, Swelling (days 0-3) Dose 1 Rogardless 87100 71 185 14 114 64 1842 05 01 19 0 00 00 30 Priorix — 20-00 10 81 40 dd — — — — 0 00 00 30 Varilrix — 1298 52 166 — — — — 0 00 00 30 Dose 2*, regardless 52 143 10.9 183. 11 90 46 156 9 25 11 46 0 00 00 30 “Grade 3 pain defined as crying when limb is moved or spontaneously painful; grade 3 redness and swelling defined as diameter >20 mm. ’Number of symptom sheets: MMRV: dose 1, N = 371; dose 2, N = 364. MMR | V: MMR dose 1, N = 123; V = dose 1, N = 122; MMR dose 2, N = 122. (Pediatr Infeci Dis J 2006:25: 12 18)  Immunogenicity and Safety of Two Doses of Tetravalent Measles-Mumps-Rubella-Varicella Vaccine in Healthy Children 40 —MMR+V grade 3 == MMRV grade3 35 7 «---MMR+Vany [] À e MMRY any 30 8 325 $ 5 ? 5 3,20 3 È 5 $ $ 15 è 10 5 FIGURE 1. Daily prevalence of 0 È sn rapa ENI a fever (any fever and grade 3 fever) 024 8 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 (Pediatr Infect Dis J 2006;25: 12-18)  Immunogenicity, Safety, and Tolerability of a Hexavalent Vaccine in Infants Gary S. Marshall, MD, Gregory L. Adams, MD, Michael L Leonardi, MD*, Maria Petrecz, BS Sheryl A. Flores, PhD4, Angela Li Ngai, BS, din Xu, POS Guanghan Liu, PhDS Jon E. Stek, MS", Ginamarie Foglia, DO", Andrew WI Lee, MD? 100 o a Dx ca 0a a_i È 05 4 90 3 3 e |} sl Ì 8 80 } @ $ } o d 570 s a $ x 60 10 DI PRP_PRP HBsAg DT mm PT FHA PRNFIM-2,3 IPV1 IPV2 IPV3 210 20.45 _ pgimi pgimL Antigens —Q- Group 1 (Hexavalent Vaccine) —&- Group 2 (Control Vaccine) FIGURE 2 Antibody responses to antigens contained in DTAPSIPV-Hib.HepB after the infant s as. Antibady rosponsos as defined in Supplemental Table 9. Nate that antibody responses to pertussis FIM2 and FIM3 are measured indicated with brackets above and below cach symbol, with a single assay Ninety-five percent CI