Meningococcal Groups C and Y and Haemophilus b Tetanus Toxoid Conjugate Vaccine

MENHIBRIX (Meningococcal Groups C and Y and Haemophilus b Tetanus Toxoid Conjugate Vaccine), for intramuscular injection, is supplied as a sterile, lyophilized powder which is reconstituted at the time of use with the accompanying saline diluent. MENHIBRIX contains Neisseria meningitidis serogroup C and Y capsular polysaccharide antigens and Haemophilus b capsular polysaccharide (polyribosyl-ribitol-phosphate [PRP]). The Neisseria meningitidis C strain and Y strain are grown in semi-synthetic media and undergo heat inactivation and purification. The PRP is a high molecular weight polymer prepared from the Haemophilus influenzae type b strain 20,752 grown in a synthetic medium that undergoes heat inactivation and purification. The tetanus toxin, prepared from Clostridium tetani grown in a semi-synthetic medium, is detoxified with formaldehyde and purified. Each capsular polysaccharide is individually covalently bound to the inactivated tetanus toxoid. After purification, the conjugate is lyophilized in the presence of sucrose as a stabilizer. The diluent for MENHIBRIX is a sterile saline solution (0.9% sodium chloride) supplied in vials.

When MENHIBRIX is reconstituted with the accompanying vial of saline diluent, each 0.5-mL dose is formulated to contain 5 mcg of purified Neisseria meningitidis C capsular polysaccharide conjugated to approximately 5 mcg of tetanus toxoid, 5 mcg of purified Neisseria meningitidis Y capsular polysaccharide conjugated to approximately 6.5 mcg of tetanus toxoid, and 2.5 mcg of purified Haemophilus b capsular polysaccharide conjugated to approximately 6.25 mcg of tetanus toxoid. Each dose also contains 96.8 mcg of Tris (trometamol)-HCl, 12.6 mg of sucrose, and ≤ 0.72 mcg of residual formaldehyde. MENHIBRIX does not contain preservatives. The lyophilized vaccine and saline diluent vial stoppers are not made with natural rubber latex.

Clinical Trials Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a vaccine cannot be directly compared with rates in the clinical trials of another vaccine, and may not reflect the rates observed in practice. There is the possibility that broad use of MENHIBRIX could reveal adverse reactions not observed in clinical trials.

A total of 7,521 infants received at least one dose of MENHIBRIX in 6 clinical studies.1-6 In 5 of these studies, 6,686 children received 4 consecutive doses of MENHIBRIX.2-6 Across all studies, approximately half of participants were female; 50% were white, 41% were Hispanic, 4% were black, 1% were Asian and 4% were of other racial/ethnic groups.

Two randomized, controlled, pivotal trials enrolled participants to receive 4 doses of MENHIBRIX or a monovalent Haemophilus b Conjugate (Hib) vaccine, administered at 2, 4, 6, and 12 to 15 months of age (Study 009/0105 and Study 011/0126). Together, these trials evaluated safety in 8,571 infants who received at least one dose of MENHIBRIX (N = 6,414) or Hib vaccine (N = 2,157).5,6

In Study 009/0105, conducted in the United States, Australia, and Mexico, 4,180 infants were randomized 3:1 to receive MENHIBRIX or a control US-licensed Hib vaccine. Safety data are available for 3,136 infants who received MENHIBRIX and 1,044 infants who received a control Haemophilus b Conjugate Vaccine (Tetanus Toxoid Conjugate) (PRP-T, manufactured by Sanofi Pasteur SA) at 2, 4, and 6 months of age. For dose 4 administered at 12 to 15 months of age, safety data are available for 2,769 toddlers who received MENHIBRIX and 923 toddlers who received a control Haemophilus b Conjugate Vaccine (Meningococcal Protein Conjugate) (PRP-OMP, manufactured by Merck and Co., Inc.). With doses 1, 2, and 3 of MENHIBRIX or PRP-T, infants concomitantly received PEDIARIX® [Diphtheria and Tetanus Toxoids and Acellular Pertussis Adsorbed, Hepatitis B (Recombinant) and Inactivated Poliovirus Vaccine] and Pneumococcal 7-valent Conjugate Vaccine (Diphtheria CRM197 Protein) (PCV7, manufactured by Wyeth Pharmaceuticals, Inc.). With dose 4 of MENHIBRIX or PRP-OMP, toddlers concomitantly received PCV7, Measles, Mumps, and Rubella Virus Vaccine Live (MMR, manufactured by Merck & Co., Inc.), and Varicella Virus Vaccine Live (manufactured by Merck & Co., Inc.).

Data on solicited adverse events were collected by parents/guardians using standardized forms for 4 consecutive days following vaccination with MENHIBRIX or control Hib vaccine (i.e., day of vaccination and the next 3 days).5 Children were monitored for unsolicited adverse events that occurred in the 31-day period following vaccination and were monitored for serious adverse events, new onset chronic disease, rash, and conditions prompting emergency department visits or physician office visits during the entire study period (6 months following the last vaccine administered). Among participants in both groups, 66% were from the United States, 19% were from Mexico, and 14% were from Australia. Forty-eight percent of participants were female; 64% were white, 22% were Hispanic, 6% were black, 1% were Asian, and 7% were of other racial/ethnic groups.

In the second pivotal study (Study 011/0126), conducted in the United States and Mexico and evaluating the same vaccines and vaccination schedule, participants were monitored for serious adverse events, new onset chronic disease, rash, and conditions prompting emergency department visits during the entire study period (6 months following the last vaccine administered). Among participants in both groups, 30% were from the United States and 70% were from Mexico.

In addition to the pivotal studies, safety data are available from 4 studies which either did not include a fourth dose of MENHIBRIX1, used a dosing regimen not approved in the United States2,3, or incorporated a comparator vaccine which was not licensed in the United States.4 In these studies, participants were monitored for unsolicited adverse events and serious adverse events occurring in the 31–day period following vaccination. In 2 of these studies3,4, participants were monitored for serious adverse events, new onset chronic disease, rash, and conditions prompting emergency department visits or physician office visits through 6 months after the last vaccination.

The reported frequencies of solicited local and systemic adverse events from US participants in Study 009/010 are presented in Table 1.5 Because of differences in reported rates of solicited adverse events between US and non-US participants, only the solicited adverse event data in US participants are presented. Among the US participants included in Table 1, 48% were female; 76% were white, 10% were black, 4% were Hispanic, 2% were Asian, and 8% were of other racial/ethnic groups.

Table 1: Percentage of US Children from Study 009/010 With Solicited Local and General Adverse Events within 4 Days of Vaccinationa With MENHIBRIX or Haemophilus b Conjugate Vaccine (Total Vaccinated Cohort)

The reported rates of some solicited adverse events in participants from Australia and Mexico varied from those in the United States.5 For example, in Australia, pain after dose 1 was reported in 28.4% of participants who received MENHIBRIX and 33.3% of control participants, while in Mexico pain after dose 1 was reported in 73.7% of participants who received MENHIBRIX and 79.4% of control participants. Fever after dose 1 was reported in 10.4% of participants who received MENHIBRIX and 10.7% of control participants in Australia, while it was reported in 44.0% of participants who received MENHIBRIX and 35.7% of control participants in Mexico. The reported incidences of pain and fever in US participants after dose 1 are provided in Table 1.

Among participants who received MENHIBRIX or Hib control vaccine co-administered with US-licensed vaccines at 2, 4, 6 and 12 to 15 months of age1,3-5, the incidence of unsolicited adverse events reported within the 31-day period following study vaccination (doses 1, 2, and 3) was comparable between MENHIBRIX (61.9%; 2,578/4,166) and PRP-T (62.5%; 1,042/1,666). The incidence of unsolicited adverse events reported within the 31-day period following dose 4 was also comparable between MENHIBRIX (42.5%; 1,541/3,630) and PRP-OMP (41.4%; 520/1,257).

Following doses 1, 2, and 31,3-6, 1.8% (137/7,444) of participants who received MENHIBRIX and 2.1% (59/2,779) of participants who received PRPT reported at least one serious adverse event within the 31-day period. Up to 6 months following the last vaccine administered (doses 1, 2, and 3) or until administration of dose 43-6, 4.8% (365/7,362) of participants who received MENHIBRIX and 5.0% (134/2,697) of participants in the PRP-T group reported at least one serious adverse event.

Following dose 43-6, 0.5% (35/6,640) of participants who received MENHIBRIX and 0.5% (12/2,267) of participants who received PRP-OMP reported at least one serious adverse event within the 31-day period. Up to 6 months following the last vaccine administered (dose 4), 2.5% (165/6,640) of participants who received MENHIBRIX and 2.0% (46/2,267) of participants who received PRP-OMP reported at least one serious adverse event.

Postmarketing Experience

The following adverse events have been spontaneously reported during post-approval use of HIBERIX® (Haemophilus b Conjugate Vaccine [Tetanus Toxoid Conjugate]) in the United States and other countries. These events are relevant because the Haemophilus b capsular polysaccharide tetanus toxoid conjugate is included as a component antigen in both MENHIBRIX and HIBERIX. Because these events are reported voluntarily from a population of uncertain size, it is not possible to reliably estimate their frequency or to establish a causal relationship to vaccine exposure.

The following adverse events were included based on one or more of the following factors: seriousness, frequency of reporting, or strength of evidence for a causal relationship to HIBERIX.

General Disorders and Administration Site Conditions: Extensive swelling of the vaccinated limb, injection site induration.

Immune System Disorders: Allergic reactions (including anaphylactic and anaphylactoid reactions), angioedema.

Nervous System Disorders: Convulsions (with or without fever), hypotonichyporesponsive episode, somnolence, syncope or vasovagal responses to injection.

Respiratory, Thoracic, and Mediastinal Disorders: Apnea.

Skin and Subcutaneous Tissue Disorders: Rash, urticaria.

No information provided.

Haemophilus B is a type of influenza (flu) caused by bacteria. This bacteria can infect the lungs or throat, and can also spread to the blood, bones, joints, brain, or spinal cord. It can cause breathing problems or meningitis (inflammation of the membranes around the brain and spinal cord), and can be fatal.

Meningococcal disease is a serious infection caused by a bacteria. Meningococcal bacteria can infect the blood, spinal cord, and brain, and can cause meningitis. These conditions can be fatal.

Haemophilus B influenza and meningococcal disease can spread from one person to another through small droplets of saliva that are expelled into the air when an infected person coughs or sneezes. The bacteria can also be passed through contact with objects the infected person has touched, such as a door handle, or other surface. The bacteria can also be passed through kissing, or sharing a drinking glass or eating utensil with an infected person.

The haemophilus B and meningococcal conjugate vaccine is used to help prevent these diseases in children.

This vaccine works by exposing your child to a small dose of bacteria or a protein from the bacteria, which causes your body to develop immunity to the disease. This vaccine will not treat an active infection that has already developed in the body.

Haemophilus B and meningococcal conjugate vaccine is for use in children between the ages of 6 weeks and 18 months old.

Like any vaccine, haemophilus B conjugate vaccine may not provide protection from disease in every person.