A randomized study of fever prophylaxis and the immunogenicity of routine pediatric vaccinations

• DOI: 10.1016/j.vaccine.2017.02.035
• Publication Date: 2017-03-03T14:31:02Z
• Authors: Jacek Wysocki; Kimberly J. Center; Jerzy Brzostek; Ewa Majda-Stanisl...; Henryk Szymanski; Leszek Szenborn; Hanna Czajka; Barbara Hasiec; Jerzy Dziduch; Teresa Jackowska; Anita Witor; Elżbieta Kopińska; Ryszard Konior; Peter C. Giardina; Vani Sundaraiyer; Scott Patterson; William C. Gruber; Daniel A. Scott; Alejandra Gurtman
• Keywords: Male; Antipyretics; Fever; Ibuprofen; Chemoprevention; Pneumococcal Vaccines; 03 medical and health sciences; 0302 clinical medicine; Phagocytosis; Immunology and Microbiology(all); Humans; Drug Interactions; Hepatitis B Vaccines; Vaccines, Combined; Diphtheria-Tetanus-Pertussis Vaccine; Acetaminophen; Haemophilus Vaccines; Public Health, Environmental and Occupational Health; Infant; Opsonin Proteins; veterinary(all); Antibodies, Bacterial; 3. Good health; Poliovirus Vaccine, Inactivated; Infectious Diseases; Molecular Medicine; Female

Prophylactic antipyretic use during pediatric vaccination is common. This study assessed whether paracetamol or ibuprofen prophylaxis interfere with immune responses to the 13-valent pneumococcal conjugate vaccine (PCV13) given concomitantly with the combined DTaP/HBV/IPV/Hib vaccine.Subjects received prophylactic paracetamol or ibuprofen at 0, 6-8, and 12-16 h after vaccination, or 6-8 and 12-16 h after vaccination at 2, 3, 4, and 12months of age. At 5 and 13months, immune responses were evaluated versus responses in controls who received no prophylaxis.After the infant series, paracetamol recipients had lower levels of circulating serotype-specific pneumococcal anticapsular immunoglobulin G than controls, reaching significance (P<0.0125) for 5 serotypes (serotypes 3, 4, 5, 6B, and 23F) when paracetamol was started at vaccination. Opsonophagocytic activity assay (OPA) results were similar between groups. Ibuprofen did not affect pneumococcal responses, but significantly (P<0.0125) reduced antibody responses to pertussis filamentous hemagglutinin and tetanus antigens after the infant series when started at vaccination. No differences were observed for any group after the toddler dose.Prophylactic antipyretics affect immune responses to vaccines; these effects vary depending on the vaccine, antipyretic agent, and time of administration. In infants, paracetamol may interfere with immune responses to pneumococcal antigens, and ibuprofen may reduce responses to pertussis and tetanus antigens. The use of antipyretics for fever prophylaxis during infant vaccination merits careful consideration. ClinicalTrials.gov identifier: NCT01392378https://clinicaltrials.gov/ct2/show/NCT01392378?term=NCT01392378&rank=1.