Journal Article

Immunogenicity and safety of measles-mumps-rubella vaccine delivered by disposable-syringe jet injector in India: A randomized, parallel group, non-inferiority trial

Jarrahian, Courtney, Pandit, Anand, Lalwani, Sanjay, Ramanan, Padmasani Venkat, Ingale, S.Y., Sapru, Amita, Kawade, Anand, Miller, Tara, Aundhkar, Chandrashekhar, Ramaganeshan, D., Bavdekar, Ashish, Krishna, Vidya, Venugopal, P., Hanumante, Nita, Oswal, Jitendra, Zehrung, Darin, Kulkarni, Prasad S., Palkar, Sonali, Saganic, Laura, McGray, Sarah, Chaudhari, Amol, Gunale, Bhagwat, Kapse, Dhananjay, Malshe, Nandini

2018

Overview

•We compared MMR vaccine administration by disposable-syringe jet injector (DSJI) and needle and syringe (N-S).•The study was conducted in 340 toddlers who had received a measles vaccine at 9 months.•On day 35, seropositivity for all three viruses was more than 97% in both the groups.•Reactogenicity by both methods was comparable.•MMR vaccination via DSJI is as immunogenic and safe as vaccination by N-S. We conducted a randomized, non-inferiority, clinical study of MMR vaccine by a disposable-syringe jet injector (DSJI) in toddlers in India in comparison with the conventional administration. MMR vaccine was administered subcutaneously by DSJI or needle-syringe (N-S) to toddlers (15–18 months) who had received a measles vaccine at 9 months. Seropositivity to measles, mumps, and rubella serum IgG antibodies was assessed 35 days after vaccination. Non-inferiority was concluded if the upper limit of the 95% CI for the difference in the percent of seropositive between groups was less than 10%. Solicited reactions were collected for 14 days after vaccination by using structured diaries. In each study group, 170 subjects received MMR vaccine. On day 35, seropositivity for measles was 97.5% [95% CI (93.8%, 99.3%)] in the DSJI group and 98.7% [95% CI (95.5%, 99.8%)] in the N-S group; for mumps, 98.8% [95% CI (95.6%, 99.8%)] and 98.7% [95% CI (95.5%, 99.8%)]; and for rubella, 98.8% [95% CI (95.6%, 99.8%)] and 100% [95% CI (97.7%, 100.0%)]; none of the differences were significant. The day 35 post-vaccination GMTs in DSJI and N-S groups were measles: 5.48 IU/ml [95% CI (3.71, 8.11)] and 5.94 IU/ml [95% CI (3.92, 9.01)], mumps: 3.83 ISR [95% CI (3.53, 4.14)] and 3.66 ISR [95% CI (3.39, 3.95)] and rubella: 95.27 IU/ml [95% CI (70.39, 128.95)] and 107.06 IU/ml [95% CI (79.02, 145.06)]; none of the differences were significant. The DSJI group reported 173 solicited local reactions and the N-S group reported 112; most were mild grade. Of the total of 156 solicited systemic adverse events, most were mild, and incidence between the two groups was similar. MMR vaccination via DSJI is as immunogenic as vaccination by N-S. Safety profile of DSJI method is similar to N-S except for injection site reactions which are more with DSJI and are well-tolerated. Registration US National Institutes of Health clinical trials identifier – NCT02253407. Clinical trial registry of India identifier – CTRI/2013/05/003702

• Publisher: Elsevier Ltd,Elsevier Limited,Elsevier Science
• Subject: Allergy and Immunology / Antibodies / blood serum / Clinical trials / Diaries / Disposable Equipment / Disposable-syringe jet injector (DSJI) / Drug delivery systems / Drug dosages / Female / Humans / Immunogenicity / Immunogenicity, Vaccine / Immunoglobulin G / India / Infant / Infections / Influenza / injection site / Injections, Jet - instrumentation / Injections, Jet - methods / Injectors / Male / Measles / Measles - prevention & control / Measles-mumps-rubella (MMR) vaccine / Measles-Mumps-Rubella Vaccine - administration & dosage / Measles-Mumps-Rubella Vaccine - adverse effects / Measles-Mumps-Rubella Vaccine - immunology / Medical research / Mumps / Mumps - prevention & control / National Institutes of Health / Needle-free / Randomization / Rubella / Rubella - prevention & control / Safety / seroprevalence / Skin / Slopes / Syringes / Tetanus / toddlers / Tropical diseases / Vaccination / Vaccines / Viral infections