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Quadrivalent vaccine – more important than compliance is full compliance.
Release date:
2017-12-22
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Abstract
As is well known, with the vigorous development of China’s immunization program, the state has been incorporating an increasing number of vaccines into the national immunization schedule, particularly those administered to infants under six months of age. Combination vaccines represent the future direction of vaccine development; their use can reduce the number of doses required, minimize injection‑related pain for children, decrease the frequency of parent visits to vaccination clinics, lower the incidence of adverse reactions, and alleviate the workload of vaccination personnel. By enhancing parents’ adherence to vaccination schedules, combination vaccines help mitigate the risk of missed doses, boost full‑course vaccination coverage, effectively prevent vaccine‑preventable diseases, and safeguard children’s health.
Quadrivalent vaccine: a combination vaccine that better aligns with the national immunization schedule for children.
According to the national “Immunization Work Guidelines (2016 Edition)” and the childhood immunization schedule, inactivated poliovirus vaccine (IPV, provided free of charge) is administered at 2 months of age, while oral bivalent attenuated poliovirus vaccine (bOPV, also provided free of charge) is given at 3 months, 4 months, and 4 years of age. Why is the 1+3 immunization schedule—IPV followed by bOPV—used?
According to the results of the study “Basic Immunogenicity of Different Sequential Immunization Schedules Using Inactivated Poliovirus Vaccine and Attenuated Live Poliovirus Vaccine,” the 1+3 immunization schedule can achieve protective antibody levels against all serotypes of poliovirus, with no significant difference in protection compared to a three-dose IPV regimen (see Tables 2 and 3 below). (I denotes IPV, O denotes OPV.)
Regarding the reasons for the relatively low geometric mean titer (GMT) following complete inactivated poliovirus vaccine (IPV) immunization, some international studies have suggested that shorter intervals between doses are one of the primary factors contributing to a weaker serological immune response. As wild poliovirus remains endemic in several countries worldwide, the risk of its introduction into China persists at all times; therefore, children in China must maintain a high level of immune protection to prevent viral importation. Currently, the WHO‑recommended polio immunization schedule is a sequential regimen of IPV followed by bOPV, which not only elicits serum antibodies but also establishes an intestinal immune barrier, thereby providing more effective protection against poliovirus infection.
As shown in the figure, the immunization schedule for the quadrivalent vaccine simplifies the vaccination regimen for infants under six months of age. Its schedule is identical to that of the routine DPT vaccine, allowing it to replace the single‑dose DTaP and Hib vaccines. It can also be administered concurrently with bOPV, enabling more timely protection against invasive diseases such as pertussis, diphtheria, tetanus, poliomyelitis, and Haemophilus influenzae type b–caused pneumonia and meningitis, while reducing both the number of doses and the risk of adverse reactions.
Since its introduction, over 4 million doses of the quadrivalent vaccine have been administered, and observational data confirm that it offers a convenient immunization schedule, a lower incidence of adverse reactions, and more comprehensive safety protection for infants—before they reach the age at which disease risk is highest. Moreover, in the context of the current shortage of pentavalent vaccines, the quadrivalent vaccine represents the optimal alternative for continued vaccination. It fully complies with the national immunization schedule, and co-administration with bOPV is entirely consistent with China’s polio prevention and control strategy and the needs of eligible children for disease prevention.
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