Editorials

Safety and efficacy of combination vaccines

BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7397.995 (Published 10 May 2003) Cite this as: BMJ 2003;326:995

Combinations reduce distress and are efficacious and safe

  1. David Elliman (elliman@compuserve.com), consultant in community child health,
  2. Helen Bedford, lecturer in child health
  1. Department of Child Health, St George's Hospital, London SW17 0QT
  2. Centre for Paediatric Epidemiology, Institute of Child Health, London WC1N 1EH

    For 130 years or more after Jenner introduced a vaccine for smallpox this was the only vaccine in general use. Ten vaccines are now included in the routine childhood vaccination programme in the United Kingdom, with multiple doses of most. The use of combination vaccines reduces distress to the recipients and is likely to increase uptake rates. Many combinations are as efficacious as the separate vaccines, but the increasing number of antigens could theoretically pose problems in terms of reduced immunogenicity or increased reactogenicity.

    Good post-marketing surveillance will become important in monitoring both the clinical efficacy of combination vaccines and adverse effects. With respect to clinical efficacy this may be a particular problem with combination conjugate vaccines. Using combination vaccines in the routine childhood programme in the United Kingdom amounts to giving 11 injections (24 in the United States), whereas, if given separately, 27 (almost 70 in the United States) would be needed. The alternative approaches are combining as many antigens into as few injections as possible, giving multiple simultaneous injections, or giving the required vaccines over several visits. Generally parents tend to have fewer concerns than health professionals about multiple injections. 1 2 However, it …

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