ComBE Five prevents diphtheria, tetanus, pertussis, HiB and Hepatitis B

ComBE Five (DPT+HiB+Hepatitis B) vaccine

ComBE Five vaccine is given to children below 6 years of age. This vaccine is produced by Biological E ltd. As its name indicates it is a pentavalent vaccine. It protects from diphtheria, pertussis, tetanus, hepatitis B and Haemophilus influenzae type B disease (HiB)

It contains purified diphtheria > 25 IU and tetanus toxoid > 40 IU, killed whole cell pertussis component > 4 IU, recombinant Hepatitis B surface antigen (rHBsAg) > 10 mcg , Haemophilus influenzae type B polysaccharide antigen (PRP) conjugated to the tetanus toxoid 10 mcg, adsorbed aluminium phosphate < 1.25 mcg, thiomersal 0.005%. Effectively it is (DPT – HiB)  + Hepatitis B

How is this vaccine available?

ComBE Five vaccine is available as an injection liquid form. It is available in a single dose or multi dose vial. Generally single dose vial is widely used. It looks hazy, colorless and cloudy in appearance.

How is ComBE Five vaccine stored?

ComBE Five vaccine is stored at 2 – 8 degree Celsius. The temperature range should be kept by the cold chain during transport and storage till the end user. If a vaccine is accidentally frozen it should be discarded and should not be used. Safe injection precautions should be taken care while administration. 

The disposables should be discarded in a color coded bag as indicated and needle burner and sharp disposable should be taken care as indicated protocol of bio-medical waste management.

How is ComBE Five vaccine administered?

ComBE Five vaccine is administered by injection generally on antero-lateral aspect of thigh in infants. 

It should be administered deep intramuscular. Subcutaneous, intradermal or intravenous administration should be avoided as efficacy and safety is not proven through these routes. 

If Multi-dose vial is used it should be stored and used as per instruction on the packet by the manufacturer.

How does ComBE Five vaccine work?

ComBE Five vaccine is an active method of immunization and this is a killed vaccine. When the ComBE Five vaccine is injected the human immune system recognizes antigens in it as foreign antigens and the immunity induced against it by various mechanisms. Antibodies are produced and also in the process memory immunity is produced. 

HiB antigen (PrP) is polysaccharide so it is not able to induce the memory immunity by itself so it is conjugated to the tetanus toxoid as carrier protein. This process of conjugation is important as it enhances the immune response and also helps to produce the memory immune response. 

So when real infection of diphtheria, tetanus, HiB, pertussis, and Hepatitis B occurs the individual’s immune response very swiftly ramps up the immunity against these diseases and these diseases are prevented very easily. 

ComBE Five contains the whole cell pertussis component which further enhances immune response to diphtheria and tetanus. Again this vaccine contains aluminium phosphate salt as adsorbent which helps to boost the immune response. Vaccinated people can still be carriers for diphtheria but do not show the disease symptoms.

Safety with other vaccines:

ComBE Five vaccine can be safely given with other vaccines including BCG, OPV, IPV, MMR, Measles, yellow fever, rotavirus and pneumococcal vaccine.

At what age ComBE Five vaccine is given?

ComBE Five vaccine is given at age 6-10-14 weeks and followed by a booster of DPT-HiB vaccine at 15-18 months and DPT at 5 years. 

Further boosters are given 5 yearly by Tdap vaccine. In HIV infected children both symptomatic and asymptomatic groups this vaccine is administered in standard schedule as in other children.

What if someone has missed the ComBE Five vaccine?

Missed ComBE Five vaccine doses has to be given after discussion with a pediatrician. 

This vaccine can be used below 7 years of age for those 7 years and above Tdap should be used instead of this vaccine.

What are side effects of ComBE Five vaccine?

ComBE Five vaccine contains the whole cell pertussis component so it is a relatively more painful vaccine than other painless vaccines.

  • Fever is a common side effect after ComBE Five vaccine and it may last till 3 days after vaccination. Fever can be moderate to high grade. It can be controlled easily with oral medication like paracetamol in indicated doses. It can be usually managed by parents at home and does not need admission. Those who have a tendency of febrile convulsion may get convulsion in fever like all other fever. The fever medication is prescribed after the vaccinations according to the local norms.
  • Swelling and pain is a common side effect after the vaccination. It may last 3 days after vaccination. In some children it may last for 7 days. This pain and swelling can be controlled with oral medication like paracetamol and local cold fomentation. It can be usually managed at home and does not need admission.
  • Irritability and crying may occur in children after ComBE Five vaccination. This side effect may last for 1-3 days after vaccination and can be usually managed at home.
  • Decreased feeding may occur in some children after ComBE Five vaccination. It generally resolves by itself in 1-2 days.
  • There is a causal relationship found with autoimmune diseases, asthma, permanent brain disease with ComBE Five vaccine.
  • Currently hexavalent vaccine Infanrix hexa or EasySix vaccine or Hexaxim is preferred.
  • Very rarely it can cause allergy and anaphylaxis which can be life threatening.

To whom this ComBE Five vaccine should not be given? (Contraindications)

Contraindications are few and rare:

  • Those who got anaphylaxis reaction after giving the previous dose of ComBE Five vaccine should not be given the same vaccine in future.
  • Those who are allergic to any of its components should not receive this vaccine.
  • Those who developed encephalopathy within 7 days of the last dose should not be given this vaccine.
  • Those who have progressive disease should not get this vaccine. The static brain disease like cerebral palsy is not contraindicated for this vaccine.

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