1. Name Of The Medicinal Product
TicoVac Junior 0.25 ml Suspension for injection in a pre-filled syringe
Tick-Borne Encephalitis Vaccine (whole Virus, inactivated)
2. Qualitative And Quantitative Composition
One dose (0.25 ml) contains:
Tick-Borne Encephalitis Virus1,2 (strain Neudörfl) 1.2 micrograms
1adsorbed on aluminium hydroxide, hydrated (0.17 milligrams Al3+)
2 produced in chick embryo fibroblast cells (CEF cells)
For a full list of excipients, see section 6.1.
3. Pharmaceutical Form
Suspension for injection in a pre-filled syringe
After shaking the vaccine is an off-white, opalescent suspension.
4. Clinical Particulars
4.1 Therapeutic Indications
TicoVac Junior 0.25 ml is indicated for the active (prophylactic) immunization of children above 1 year of age and below 16 years of age against tick-borne encephalitis (TBE).
TicoVac Junior 0.25 ml is to be given on the basis of official recommendations regarding the need for, and timing of, vaccination against TBE.
4.2 Posology And Method Of Administration
Posology
Primary vaccination schedule
The primary vaccination schedule is the same for all persons above 1 year of age and below 16 years of age and consists of three doses of TicoVac Junior 0.25 ml.
The first dose should be given on an elected date and the second dose should be given 1 to 3 months later. If there is a need to achieve an immune response rapidly, the second dose may be given two weeks after the first dose. The third dose should be given between 5 and 12 months after the second vaccination.
To achieve immunity before the beginning of the seasonal tick activity, which is in spring, the first and second doses should preferably be given in the winter months. The third vaccination should be given before the start of the following tick season.
Extending the interval between the three doses may leave subjects with inadequate protection against infection in the interim period (see sections 4.4. and 5.1.).
Booster doses
The first booster should be given no more than 3 years after the third dose (see section 5.1.).
Sequential booster doses should be given following official recommendations, but not less than 3 years after the last booster dose. Based on local epidemiology and experience, intervals of 3 up to 5 years for sequential boosters have been officially recommended.
Children with an impaired immune system (including those undergoing immunosuppressive therapy)
There are no specific clinical data on which to base dose recommendations. However, consideration may be given to determining the antibody concentration at four weeks after the second dose and administering an additional dose if there is no evidence of seroconversion at this time. A third dose should be given as scheduled and the need for subsequent booster doses may then be assessed by serological tests at intervals (see sections 4.4 and 5.1).
Method of administration
The vaccine should be given by intramuscular injection into the upper arm (deltoid muscle).
In children up to 18 months of age, or dependent on a child's development and nutrition status, the vaccine is administered into the thigh muscle (vastus lateralis muscle). Care must be taken to avoid accidental intravascular administration (see section 4.4).
4.3 Contraindications
Hypersensitivity to the active substance, any of the excipients, or production residues (formaldehyde, neomycin, gentamicin, protamine sulfate).
Severe hypersensitivity to egg and chick proteins (anaphylactic reaction after oral ingestion of egg protein).
TBE vaccination should be postponed if the child is suffering from an acute febrile infection.
4.4 Special Warnings And Precautions For Use
As with all vaccines that are administered by injection, appropriate emergency treatment and supervision should always be readily available in case of a rare anaphylactic event following the administration of the vaccine.
Non-severe allergy to egg protein does not usually constitute a contraindication to vaccination with TicoVac Junior 0.25 ml. Nevertheless, such persons should only be vaccinated under appropriate supervision and facilities for emergency management of hypersensitivity reactions should be available.
The container of this medicinal product contains latex rubber which may cause severe allergic reactions in persons allergic to latex.
The levels of potassium and sodium are at less than 1 mmol per dose, i.e. essentially “potassium and sodium-free”.
Intravascular administration must be avoided as this might lead to severe reactions, including hypersensitivity reactions with shock.
Fever may occur in children after the first immunization in particular in the very young (see Section 4.8). In general, the fever subsides within 24 hours. Fever rates reported after the second vaccination are generally lower as compared to the fever rates after the first vaccination. In children with a history of fever convulsions or high fever following vaccinations, antipyretic prophylaxis or treatment may be considered.
Whenever serological testing is considered necessary in order to determine the need for sequential doses, assays should be performed in an experienced, qualified laboratory. This is because cross reactivity with pre-existing antibodies due to natural exposure or previous vaccination against other flaviviruses (e.g. Japanese encephalitis, yellow fever, Dengue virus) may give false positive results.
In case of a known or suspected auto-immune disease in the intended recipient, the risk of TBE infection must be weighed against the risk that TicoVac Junior 0.25 ml might have an adverse effect on the course of the auto-immune disease.
Caution is required when considering the need for vaccination in children with pre-existing cerebral disorders.
In case of a tick bite before or within 2 weeks after receiving the first dose, a single administration of TicoVac Junior 0.25 ml cannot be expected to prevent the onset of a clinically apparent TBE infection.
As with all vaccines, TicoVac Junior 0.25 ml may not completely protect all vaccinees against the infection that it is intended to prevent.
Tick bites may transmit infections other than TBE, including certain pathogens that can sometimes cause a clinical picture that resembles tick-borne encephalitis. TBE vaccines do not provide protection against Borrelia infection. Therefore, the appearance of clinical signs and symptoms of possible TBE infections in a vaccinee should be thoroughly investigated for the possibility of alternative causes.
4.5 Interaction With Other Medicinal Products And Other Forms Of Interaction
No interaction studies with other vaccines or medicinal products have been performed. The administration of other vaccines at the same time as TicoVac Junior 0.25 ml should be performed only in accordance with official recommendations. If other injectable vaccines are to be given at the same time, administrations should be into separate sites and, preferably, into separate limbs.
A protective immune response may not be elicited in children undergoing immunosuppressive therapy or children with an impaired immune system. In such cases antibody concentrations should be determined in order to assess the response and the need for sequential doses.
4.6 Pregnancy And Lactation
Relevant human data on use during pregnancy and adequate animal reproduction studies are not available. It is not known whether TicoVac Junior 0.25 ml enters breast milk.
Therefore, TicoVac Junior 0.25 ml should only be administered during pregnancy and to breastfeeding mothers when it is considered urgent to achieve protection against TBE infection and after careful consideration of the risk-benefit- relationship.
4.7 Effects On Ability To Drive And Use Machines
TicoVac Junior 0.25 ml is unlikely to affect a child's motor skills (e.g., when playing in the street or cycling) or a person's ability to drive and use machines. It should be taken into account, however, that impaired vision or dizziness may occur.
4.8 Undesirable Effects
In clinical studies in children aged 1 to 15 years fever and other undesirable effects were actively documented after vaccination. Fever was measured rectally in children up to at least 3 years of age and orally in children 3 years of age and older. The analysis includes any fever temporally associated with vaccination whether or not causally related.
The fever rates after the first vaccination were as follows:
1 to 2 year olds (n=262): mild fever (38-39°C) in 27.9%; moderate fever (39.1-40.0°C) in 3.4%; no severe fever >40°C)
3 to 15 year olds (n=2519): mild fever in 6.8%; moderate fever in 0.6%; no severe fever.
Fever rates reported after the second vaccination are generally lower as compared to the fever rates after the first vaccination. The overall fever rates after the second vaccination were 15.6% (41/263) in 1 to 2 year old children and 1.9% (49/2522) in 3 to 15 year old children.
In an active postmarketing surveillance in children aged 1 to 12 years the reported fever rates (fever measured rectally) after the first vaccination were 23.7% in 1 to 3 year olds (n=1198) and 13.7% in 4 to 12 year olds (n=234).
The following other undesirable effects listed in this Section are given according to the recommended frequency convention:
Very common:
Common:
Uncommon:
Rare:
Very rare: <1/10,000
Not known: Cannot be estimated from the available data
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* Undesireable effects under this frequency category are derived from a spontaneous reporting system and thus, there is no valid estimate of incidence rates.
4.9 Overdose
No case of overdose has been reported. However, due to the presentation of the vaccine, accidental overdose in terms of volume is unlikely. If doses are administered closer together than recommended or more doses than requested are applied, undesirable effects may be expected.
5. Pharmacological Properties
5.1 Pharmacodynamic Properties
Pharmacotherapeutic group: encephalitis vaccines, ATC Code: J07 BA01
The pharmacodynamic effect of the product consists of the induction of a sufficiently high concentration of anti-TBE antibody to provide protection against the TBE virus.
The protection rate of the previous generation and current TBE vaccine has been determined during a continuous surveillance as performed among the total Austrian population since 1984. In this surveillance a protection rate in children of above 98% after completion of the primary vaccination schedule (3 doses) was calculated for the period 1994 to 2003. Based on a follow up surveillance performed among the total Austrian population for the years 2000 to 2006, a protection rate of 99 % was calculated with no statistically significant difference between age groups in regularly vaccinated persons. The protection rate is at least as high after the first two vaccinations, following the regular vaccination i.e before completion of the basic vaccination scheme by the third vaccination, but it is significantly lower in those with a record of irregular vaccination.
In several clinical studies with TicoVac Junior 0.25 ml, seroconversion was defined as a baseline ELISA value of < 63 VIE U/ml rising to> 126 VIE U/ml after vaccination. By these criteria, Table 1 shows that seroconversion was observed in> 96 % of vaccinees (N=780) 3 to 5 weeks after the 2nd dose. Seroconversion after the 3rd dose increased to 99.7%. Therefore, completion of the primary vaccination schedule of three doses is necessary to achieve protective antibody levels in almost all recipients.
Table 1: Seroconversion as determined by ELISA
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Further investigations into the optimal timing of booster doses in children are ongoing.
5.2 Pharmacokinetic Properties
Not applicable
5.3 Preclinical Safety Data
Non-clinical data reveal no special hazard for humans based on conventional studies of safety pharmacology.
6. Pharmaceutical Particulars
6.1 List Of Excipients
Human albumin
Sodium chloride
Disodium phosphate-dihydrate
Potassium dihydrogenphosphate
Water for injections
Sucrose
Aluminium hydroxide, hydrated.
6.2 Incompatibilities
In the absence of compatibility studies, TicoVac Junior 0.25 ml must not be mixed with other medicinal products.
6.3 Shelf Life
30 months for pre-filled syringe with attached needle.
2 years for pre-filled syringe without needle attached.
6.4 Special Precautions For Storage
Store in a refrigerator (2°C - 8°C). Keep the syringe in the outer carton in order to protect from light. Do not freeze.
6.5 Nature And Contents Of Container
0.25 ml of suspension in pre-filled syringe (type I glass) with a plunger stopper (chlorobutyl isoprene rubber), available with or without attached needle. Pack size of 1, 10, 20 and 100. Not all pack sizes may be marketed.
6.6 Special Precautions For Disposal And Other Handling
The vaccine should reach room temperature before administration. Shake well prior to administration to thoroughly mix the vaccine suspension. After shaking, TicoVac Junior 0.25 ml is an off-white, opaque, homogeneous suspension. The vaccine should be inspected visually for any foreign particulate matter and/or variation in physical appearance prior to administration. In the event of either being observed, discard the vaccine.
Any unused product or waste material should be disposed of in accordance with local requirements.
For vaccine with integrated needle, remove needle guard as follows:
1. Hold syringe at the lower part of the needle guard fixed onto the glass recipient.
2. Use the other hand to take the upper part of the needle guard between thumb and forefinger and twist to break the seal (tamper evident).
3. Remove the detached part of the needle guard from the needle by a vertical movement.
Following the removal of the needle guard TicoVac Junior 0.25 ml must be used immediately.
To avoid loss of sterility and/or clogging of the needle, it should not be left without protection for prolonged periods of time. Therefore, the needle guard should only be removed after shaking and immediately prior to use.
The administration of the vaccine should be documented by the physician, and the lot number recorded. A detachable documentation label is attached to each preloaded syringe.
7. Marketing Authorisation Holder
Baxter AG, Industriestrasse 67, A-1221 Vienna, Austria
8. Marketing Authorisation Number(S)
PL 06009/0010
9. Date Of First Authorisation/Renewal Of The Authorisation
11.12.2001/18.07.2006
10. Date Of Revision Of The Text
May 2009
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