Licensure of a Diphtheria and Tetanus Toxoids and Acellular Pertussis, Inactivated Poliovirus, Haemophilus influenzae Type b Conjugate, and Hepatitis B Vaccine, and Guidance for Use in Infants

Sara E. Oliver MD; Kelly L. Moore, MD

Morbidity and Mortality Weekly Report. 2020;69(5):136-139.

Special Considerations

Before the routine use of Hib vaccines, incidence of H. influenzae meningitis among American Indian/Alaska Native (AI/AN) infants peaked at a younger age (4–6 months) than it did among other U.S. infant populations (6–7 months). Vaccination with a primary series of a Hib vaccine that contains PRP-OMP is preferred for AI/AN infants to provide early protection because these vaccines can provide a protective antibody response after the first dose.^[13] Data on antibody response after the first dose of DTaP-IPV-Hib-HepB in AI/AN infants are not currently available; therefore, DTaP-IPV-Hib-HepB does not have a preferential recommendation for AI/AN infants at this time. If data on antibody response after the first dose of DTaP-IPV-Hib-HepB become available, ACIP will re-evaluate the preferential language for the Hib component for AI/AN infants.

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Acknowledgments
Laura Hammitt, Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health.

ACIP Combination Vaccines Work Group
Chair: Kelly L. Moore; Members: Jillian Doss-Walker, Phil Griffin, Jennifer L. Hamilton, Veronica McNally, Sarah McQueen, Sean T. O'Leary, Elizabeth Rausch-Phung, Ann Schwartz, Patsy Stinchfield, Thomas Weiser; CDC Contributors: Anna Acosta, Mike Bruce, Fiona P. Havers, Andrew Kroger, Pedro Moro, Janell A. Routh, Sarah Schillie, Rosalyn Singleton, Cindy Weinbaum, JoEllen Wolicki.

Table. Recommended minimum ages for administration of DTaP-IPV-Hib-HepB vaccine and intervals between doses — United States, 2020*
Parameter	Age/Interval
Minimum age for any dose	6 weeks
Minimum interval between doses 1 and 2	4 weeks
Minimum age for dose 2	10 weeks
Minimum interval between doses 2 and 3	4 weeks
Minimum age for dose 3	24 weeks^†
Maximum age for any dose	4 years, 364 days (do not administer on or after the fifth birthday)

Abbreviations: DTaP = diphtheria and tetanus toxoids and acellular pertussis; Hib = Haemophilus influenzae type b; HepB = hepatitis B; IPV = inactivated poliovirus.
*The DTaP-IPV-Hib-HepB vaccine (Vaxelis; MCM Vaccine Company) was licensed in December 2018 and will not be commercially available in the United States before 2021.
^†If the third dose of DTaP-IPV-Hib-HepB is given before age 24 weeks, an additional dose of hepatitis B vaccine should be given at age ≥24 weeks to complete the hepatitis B series.