KINRIX (Diphtheria and Tetanus Toxoids and Acellular Pertussis Adsorbed and Inactivated Poliovirus Vaccine) is a noninfectious, sterile vaccine for intramuscular administration. Each 0.5-mL dose is formulated to contain 25 Lf of diphtheria toxoid, 10 Lf of tetanus toxoid, 25 mcg of inactivated pertussin toxin (PT), 25 mcg of filamentous hemagglutinin (FHA), 8 mcg of pertactin (69 kiloDalton outer membrane protein), 40 D-antigen Units (DU) of Type 1 poliovirus (Mahoney), 8 DU of Type 2 poliovirus (MEF-1), and 32 DU of Type 3 poliovirus (Saukett). The diphtheria, tetanus, and pertussis components of KINRIX are the same as those in INFANRIX and PEDIARIX and the poliovirus component is the same as that in PEDIARIX.

The diphtheria toxin is produced by growing Corynebacterium diphtheriae in Fenton medium containing a bovine extract. Tetanus toxin is produced by growing Clostridium tetani in a modified Latham medium derived from bovine casein. The bovine materials used in these extracts are sourced from countries which the United States Department of Agriculture (USDA) has determined neither have nor are at risk of bovine spongiform encephalopathy (BSE). Both toxins are detoxified with formaldehyde, concentrated by ultrafiltration, and purified by precipitation, dialysis, and sterile filtration.

The acellular pertussis antigens (PT, FHA, and pertactin) are isolated from Bordetella pertussis culture grown in modified Stainer-Scholte liquid medium. PT and FHA are isolated from the fermentation broth; pertactin is extracted from the cells by heat treatment and flocculation. The antigens are purified in successive chromatographic and precipitation steps. PT is detoxified using glutaraldehyde and formaldehyde. FHA and pertactin are treated with formaldehyde.

Diphtheria and tetanus toxoids and pertussis antigens (inactivated PT, FHA, and pertactin) are individually adsorbed onto aluminum hydroxide.

The inactivated poliovirus component of KINRIX is an enhanced potency component. Each of the 3 strains of poliovirus is individually grown in VERO cells, a continuous line of monkey kidney cells, cultivated on microcarriers. Calf serum and lactalbumin hydrolysate are used during VERO cell culture and/or virus culture. Calf serum is sourced from countries the USDA has determined neither have nor are at risk of BSE. After clarification, each viral suspension is purified by ultrafiltration, diafiltration, and successive chromatographic steps, and inactivated with formaldehyde. The 3 purified viral strains are then pooled to form a trivalent concentrate.

Diphtheria and tetanus toxoid potency is determined by measuring the amount of neutralizing antitoxin in previously immunized guinea pigs. The potency of the acellular pertussis components (inactivated PT, FHA, and pertactin) is determined by enzyme-linked immunosorbent assay (ELISA) on sera from previously immunized mice. The potency of the inactivated poliovirus component is determined by using the D-antigen ELISA and by a poliovirus neutralizing cell culture assay on sera from previously immunized rats.

Each 0.5-mL dose contains 4.5 mg of NaCl and aluminum adjuvant (not more than 0.6 mg aluminum by assay). Each dose also contains ≤ 100 mcg of residual formaldehyde and ≤ 100 mcg of polysorbate 80 (Tween 80). Neomycin sulfate and polymyxin B are used in the poliovirus vaccine manufacturing process and may be present in the final vaccine at ≤ 0.05 ng neomycin and ≤ 0.01 ng polymyxin B per dose. KINRIX does not contain a preservative.

Last updated on RxList: 7/23/2008

A single dose of KINRIX is indicated for active immunization against diphtheria, tetanus, pertussis, and poliomyelitis as the fifth dose in the diphtheria, tetanus, and acellular pertussis (DTaP) vaccine series and the fourth dose in the inactivated poliovirus vaccine (IPV) series in children 4 through 6 years of age whose previous DTaP vaccine doses have been with INFANRIX® (Diphtheria and Tetanus Toxoids and Acellular Pertussis Vaccine Adsorbed) and/or PEDIARIX® [Diphtheria and Tetanus Toxoids and Acellular Pertussis Adsorbed, Hepatitis B (Recombinant) and Inactivated Poliovirus Vaccine Combined] for the first three doses and INFANRIX for the fourth dose.

Preparation for Administration

Shake vigorously to obtain a homogeneous, turbid, white suspension. Do not use if resuspension does not occur with vigorous shaking. Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. After removal of the dose, any vaccine remaining in the vial should be discarded.

Recommended Dose and Schedule

KINRIX is to be administered as a 0.5-mL dose by intramuscular injection. The preferred site of administration is the deltoid muscle of the upper arm. Do not administer this product intravenously, intradermally, or subcutaneously.

KINRIX may be used for the fifth dose in the DTaP immunization series and the fourth dose in the IPV immunization series in children 4 through 6 years of age (prior to the seventh birthday) whose previous DTaP vaccine doses have been with INFANRIX and/or PEDIARIX for the first three doses and INFANRIX for the fourth dose [see INDICATIONS].

Dosage Forms And Strengths

KINRIX is available in 0.5-mL single-dose vials and prefilled TIP-LOK® syringes. Each 0.5-mL dose contains a suspension for injection of diphtheria and tetanus toxoids, acellular pertussis antigens, and inactivated poliovirus types 1, 2, and 3. See DESCRIPTION for the complete listing of ingredients.

Storage And Handling

KINRIX is available in 0.5-mL single-dose vials and disposable prefilled TIP-LOK syringes.

Single-Dose Vials

NDC 58160-812-11 (package of 10)

Single-Dose Prefilled Disposable TIP-LOK Syringes (packaged without needles)

NDC 58160-812-46 (package of 5)

Store refrigerated between 2 and 8 C (36 and 46 F). Do not freeze. Discard if the vaccine has been frozen.

Manufactured by GlaxoSmithKline Biologicals Rixensart, Belgium, US License 1617 and Novartis Vaccines and Diagnostics GmbH & Co. KG Marburg, Germany, US License 1754. Distributed by GlaxoSmithKline Research Triangle Park, NC 27709. FDA Rev date: 6/24/2008

Last updated on RxList: 7/23/2008

Clinical Trials Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a vaccine cannot be directly compared with rates in the clinical trials of another vaccine, and may not reflect the rates observed in practice.

A total of 3,537 children were vaccinated with a single dose of KINRIX in 3 clinical trials. Of these, 381 children received a non-US formulation of KINRIX (containing ≤ 2.5 mg 2-phenoxyethanol per dose as preservative). The primary study (Study 048), conducted in the United States, was a randomized, controlled clinical trial in which children 4 to 6 years of age were vaccinated with KINRIX (N = 3,156) or control vaccines (INFANRIX and IPOL® vaccine [IPV, Sanofi Pasteur SA]; N = 1,053) as a fifth DTaP vaccine dose following 4 doses of INFANRIX and as a fourth IPV dose following 3 doses of IPOL. Subjects also received the second dose of US-licensed measles, mumps, and rubella (MMR) vaccine (Merck & Co., Inc.) administered concomitantly, at separate sites.

Data on adverse events were collected by parents/guardians using standardized forms for 4 consecutive days following vaccination with KINRIX or control vaccines (i.e., day of vaccination and the next 3 days). The reported frequencies of solicited local reactions and general adverse events in Study 048 are presented in Table 1.

In 3 studies (Study 046, 047, and 048), children were monitored for unsolicited adverse events, including serious adverse events, that occurred in the 31-day period following vaccination and in 2 studies (Study 047 and 048), parents/guardians were actively queried about changes in the child's the occurrence of serious adverse events, throughhealth status, 6 months post vaccination.

Table 1. Percentage of Children 4 to 6 Years of Age Reporting Solicited Local Reactions or General Adverse Events Within 4 Days of Vaccination* With KINRIX or Separate Concomitant Administration of INFANRIX and IPV When Coadministered With MMR Vaccine (Study 048) (Total Vaccinated Cohort)

	KINRIX	INFANRIX + IPV
Local†	N = 3,121-3,128	N = 1,039-1,043
Pain, any	57.0†	53.3
Pain, grade 2 or 3§	13.7	12.0
Pain, grade 3§	1.6‡	0.6
Redness, any	36.6	36.6
Redness, ≥ 50 mm	17.6	20.0
Redness, ≥ 110 mm	2.9	4.1
Arm circumference increase, any	36.0	37.8
Arm circumference increase, >20 mm	6.9	7.4
Arm circumference increase, >30 mm	2.4	3.2
Swelling, any	26.0	27.0
Swelling, ≥ 50 mm	10.2	11.5
Swelling, ≥ 110 mm	1.4	1.8
General	N = 3,037-3,120	N = 993-1,036
Drowsiness, any	19.1	17.5
Drowsiness, grade 3||	0.8	0.8
Fever, ≥ 99.5° F	16.0	14.8
Fever, >100.4°	F	6.5‡4.4
Fever, >102.2° F	1.1	1.1
Fever, >104° F	0.1	0.0
Loss of appetite, any	15.5	16.0
Loss of appetite, grade 3¶	0.8	0.6
IPV manufactured by Sanofi Pasteur SA. MMR vaccine manufactured by Merck & Co., Inc. Total Vaccinated Cohort = all vaccinated subjects for whom safety data were available. N = number of children with evaluable data for the events listed. *Within 4 days of vaccination defined as day of vaccination and the next 3 days. †Local reactions at the injection site for KINRIX or INFANRIX. ‡Statistically higher than comparator group (p < 0.05). §Grade 2 defined as painful when the limb was moved; Grade 3 defined as preventing normal daily activities. || Grade 3 defined as preventing normal daily activities. ¶ Grade 3 defined as not eating at all.

In Study 048, KINRIX was non-inferior to INFANRIX with regard to swelling that involved > 50% of the injected upper arm length and that was associated with a > 30 mm increase in mid-upper arm circumference within 4 days following vaccination (upper limit of two-sided 95% Confidence Interval for difference in percentage of KINRIX [0.6%, n = 20] minus INFANRIX [1.0%, n = 11] ≤ 2%).

Serious Adverse Events: Within the 31-day period following study vaccination in 3 studies (Study 046, 047, and 048), in which all subjects received concomitant MMR vaccine (US licensed MMR vaccine [Merck & Co., Inc.] in Study 047 and 048; non-US licensed MMR vaccine in Study 046), 3 subjects (0.1% [3/3,537]) who received KINRIX reported serious adverse events (dehydration and hypernatremia; cerebrovascular accident; dehydration and gastroenteritis) and 4 subjects (0.3% [4/1,434]) who received INFANRIX and IPV (Sanofi Pasteur SA) reported serious adverse events (cellulitis; constipation; foreign body trauma; fever without identified etiology).

Postmarketing Experience

In addition to reports in clinical trials, the following adverse events, for which a causal relationship to components of KINRIX is plausible, have been reported since market introduction of DTaP-IPV manufactured by GlaxoSmithKline outside the U.S. Because these events are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to vaccination.

General Disorders and Administration Site Conditions: Injection site vesicles.

Skin and Subcutaneous Tissue Disorders: Pruritus. Additional adverse events reported following postmarketing use of INFANRIX, for which a causal relationship to vaccination is plausible, are: Allergic reactions, including anaphylactoid reactions, anaphylaxis, angioedema, and urticaria, apnea, collapse or shock-like state (hypotonic-hyporesponsive episode), convulsions (with or without fever), lymphadenopathy, and thrombocytopenia.

Concomitant Vaccine Administration

In clinical trials, KINRIX was administered concomitantly with the second dose of MMR vaccine [see Clinical Studies].

Data are not available on concomitant use of KINRIX and varicella vaccine.

When KINRIX is administered concomitantly with other injectable vaccines, they should be given with separate syringes. KINRIX should not be mixed with any other vaccine in the same syringe or vial.

Immunosuppressive Therapies

Immunosuppressive therapies, including irradiation, antimetabolites, alkylating agents, cytotoxic drugs, and corticosteroids (used in greater than physiologic doses), may reduce the immune response to KINRIX.

Last updated on RxList: 7/23/2008

Included as part of the PRECAUTIONS section.

Guillain-Barre Syndrome

If Guillain-Barré syndrome occurs within 6 weeks of receipt of a prior vaccine containing tetanus toxoid, the decision to give any tetanus toxoid-containing vaccine, including KINRIX, should be based on careful consideration of the potential benefits and possible risks. When a decision is made to withhold tetanus toxoid, other available vaccines should be given, as indicated.

Latex

The tip cap and the rubber plunger of the needleless prefilled syringes contain dry natural latex rubber that may cause allergic reactions in latex sensitive individuals. The vial stopper is latex-free.

Adverse Events Following Prior Pertussis Vaccination

If any of the following events occur in temporal relation to receipt of a pertussis­containing vaccine, the decision to give any pertussis-containing vaccine, including KINRIX,

should be based on careful consideration of the potential benefits and possible risks:

• Temperature of ≥ 40.5°C (105°F) within 48 hours not due to another identifiable cause;
• Collapse or shock-like state (hypotonic-hyporesponsive episode) within 48 hours;
• Persistent, inconsolable crying lasting ≥ 3 hours, occurring within 48 hours;
• Seizures with or without fever occurring within 3 days.

When a decision is made to withhold pertussis vaccination, other available vaccines should be given, as indicated.

Children at Risk for Seizures

For children at higher risk for seizures than the general population, an appropriate antipyretic may be administered at the time of vaccination with a pertussis-containing vaccine, including KINRIX, and for the ensuing 24 hours to reduce the possibility of post-vaccination fever.

Preventing and Managing Allergic Vaccine Reactions

Prior to administration, the healthcare provider should review the history for possible vaccine sensitivity and previous vaccination-related adverse reactions to allow an assessment of benefits and risks. Epinephrine and other appropriate agents used for the control of immediate allergic reactions must be immediately available should an acute anaphylactic reaction occur.

Nonclinical Toxicology

Carcinogenesis, Mutagenesis, Impairment of Fertility

KINRIX has not been evaluated for carcinogenic or mutagenic potential, or for impairment of fertility.

Use In Specific Populations

Pregnancy

Pregnancy Category C

Animal reproduction studies have not been conducted with KINRIX. It is also not known whether KINRIX can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity.

Pediatric Use

Safety and effectiveness of KINRIX in children younger than 4 years of age and children 7 to 16 years of age have not been evaluated. KINRIX is not approved for use in persons in these age groups.

Last updated on RxList: 7/23/2008

No information provided.

Hypersensitivity

Severe allergic reaction (e.g., anaphylaxis) after a previous dose of any diphtheria toxoid, tetanus toxoid, pertussis or poliovirus-containing vaccine, or to any component of KINRIX, including neomycin and polymyxin B, is a contraindication to administration of KINRIX [see DESCRIPTION]. Because of the uncertainty as to which component of the vaccine might be responsible, no further vaccination with any of these components should be given. Alternatively, such individuals may be referred to an allergist for evaluation if immunization with any of these components is considered.

Encephalopathy

Encephalopathy (e.g., coma, decreased level of consciousness, prolonged seizures) within 7 days of administration of a previous dose of a pertussis-containing vaccine that is not attributable to another identifiable cause is a contraindication to administration of any pertussis­containing vaccine, including KINRIX.

Progressive Neurologic Disorder

Progressive neurologic disorder, including infantile spasms, uncontrolled epilepsy, or progressive encephalopathy is a contraindication to administration of any pertussis-containing vaccine, including KINRIX. Pertussis vaccine should not be administered to individuals with such conditions until a treatment regimen has been established and the condition has stabilized.

Last updated on RxList: 7/23/2008

Mechanism of Action

Diphtheria: Diphtheria is an acute toxin-mediated infectious disease caused by toxigenic strains of C. diphtheriae. Protection against disease is due to the development of neutralizing antibodies to the diphtheria toxin. A serum diphtheria antitoxin level of 0.01 IU/mL is the lowest level giving some degree of protection; a level of 0.1 IU/mL is regarded as protective.¹

Tetanus: Tetanus is an acute toxin-mediated disease caused by a potent exotoxin released by C. tetani. Protection against disease is due to the development of neutralizing antibodies to the tetanus toxin. A serum tetanus antitoxin level of at least 0.01 IU/mL, measured by neutralization assays, is considered the minimum protective level.^2,3 A level of ≥ 0.1 IU/mL is considered protective.⁴

Pertussis: Pertussis (whooping cough) is a disease of the respiratory tract caused by B. pertussis. The role of the different components produced by B. pertussis in either the pathogenesis of, or the immunity to, pertussis is not well understood. There is no well established serological correlate of protection for pertussis. The efficacy of the pertussis component of KINRIX was determined in clinical trials of INFANRIX administered as a 3-dose series in infants (see INFANRIX prescribing information).

Poliomyelitis: Poliovirus is an enterovirus that belongs to the picornavirus family. Three serotypes of poliovirus have been identified (Types 1, 2, and 3). Neutralizing antibodies against the 3 poliovirus serotypes are recognized as conferring protection against poliomyelitis disease.⁵

Clinical Studies

Immunological Evaluation

In a US multicenter study (Study 048), 4,209 children were randomized in a 3:1 ratio to receive either KINRIX or INFANRIX and IPV (Sanofi Pasteur SA) administered concomitantly at separate sites. Subjects also received MMR vaccine (Merck & Co., Inc.) administered concomitantly at a separate site. Subjects were children 4 through 6 years of age who previously received 4 doses of INFANRIX, 3 doses of IPV, and 1 dose of MMR vaccine. Among subjects in both vaccine groups combined, 49.6% were female; 45.6% of subjects were White, 18.8% Hispanic, 13.6% Asian, 7.0% Black, and 15.0% were of other racial/ethnic groups.

Levels of antibodies to the diphtheria, tetanus, pertussis (PT, FHA, and pertactin), and poliovirus antigens were measured in sera obtained immediately prior to vaccination and 1 month (range 31 to 48 days) after vaccination (Table 2). The co-primary immunogenicity endpoints were anti-diphtheria toxoid, anti-tetanus toxoid, anti-PT, anti-FHA, and anti-pertactin booster responses, and anti-poliovirus Type 1, Type 2, and Type 3 geometric mean antibody titers (GMTs) 1 month after vaccination. KINRIX was shown to be non-inferior to INFANRIX and IPV administered separately, in terms of booster responses to DTaP antigens and post­vaccination GMTs for anti-poliovirus antibodies (Table 2).

Table 2. Pre-vaccination Antibody Levels and Post-vaccination* Antibody Responses Following KINRIX Compared With Separate Concomitant Administration of INFANRIX and IPV in Children 4 to 6 Years of Age When Coadministered With MMR Vaccine (Study 048) (ATP Cohort for Immunogenicity)

	KINRIX	INFANRIX + IPV
	N = 787-851	N = 237-262
Anti-Diphtheria Toxoid
Pre-vaccination % ≥ 0.1 IU/mL (95% CI)†	87.7 (85.3, 89.9)	85.5 (80.6, 89.5)
Post-vaccination % ≥ 0.1 IU/mL (95% CI)†	100 (99.6, 100)	100 (98.6, 100)
% Booster Response (95% CI)‡	99.5 (98.8, 99.9)§	100 (98.6, 100)
Anti-Tetanus Toxoid
Pre-vaccination % ≥ 0.1 IU/mL (95% CI)†	87.8 (85.4, 90.0)	88.2 (83.6, 91.8)
Post-vaccination % ≥ 0.1 IU/mL (95% CI)†	100 (99.6, 100)	100 (98.6, 100)
% Booster Response (95% CI)‡	96.7 (95.2, 97.8)§	93.9 (90.2, 96.5)
Anti-PT
% Booster Response (95% CI)||	92.2 (90.2, 94.0)§	92.6 (88.7, 95.5)
Anti-FHA
% Booster Response (95% CI)||	95.4 (93.7, 96.7)§	96.2 (93.1, 98.1)
Anti-Pertactin
% Booster Response (95% CI)||	97.8 (96.5, 98.6)§	96.9 (94.1, 98.7)
Anti-Poliovirus 1
Pre-vaccination % ≥ 1:8 (95% CI)†	88.3 (85.9, 90.4)	85.1 (80.1, 89.2)
Post-vaccination % ≥ 1:8 (95% CI)†	99.9 (99.3, 100)	100 (98.5, 100)
Post-vaccination GMT (95% CI)	2,127 (1,976, 2,290)¶	1,685 (1,475, 1,925)
Anti-Poliovirus 2
Pre-vaccination % ≥ 1:8 (95% CI)†	91.8 (89.7, 93.6)	87.0 (82.3, 90.8)
Post-vaccination % ≥ 1:8 (95% CI)†	100 (99.6, 100)	100 (98.5, 100)
Post-vaccination GMT (95% CI)	2,265 (2,114, 2,427)¶	1,818 (1,606, 2,057)
Anti-Poliovirus 3
Pre-vaccination % ≥ 1:8 (95% CI)†	84.7 (82.0, 87.0)	85.0 (80.1, 89.1)
Post-vaccination % ≥ 1:8 (95% CI)†	100 (99.5, 100)	100 (98.5, 100)
Post-vaccination GMT (95% CI)	3,588 (3,345, 3,849)¶	3,365 (2,961, 3,824)
IPV manufactured by Sanofi Pasteur SA. MMR vaccine manufactured by Merck & Co., Inc. ATP = according-to-protocol; CI = Confidence Interval; GMT = geometric mean antibody titer N = number of subjects with available results. *One month blood sampling, range 31 to 48 days. †Seroprotection defined as anti-diphtheria toxoid and anti-tetanus toxoid antibody concentrations ≥ 0.1 IU/mL by ELISA and as anti-poliovirus Type 1, Type 2, and Type 3 antibody titer ≥ 1:8 by micro-neutralization assay for poliovirus. †Booster response: In subjects with pre-vaccination < 0.1 IU/mL, post-vaccination concentration ≥ 0.4 IU/mL. In subjects with pre-vaccination concentration ≥ 0.1 IU/mL, an increase of at least 4 times the pre-vaccination concentration. §KINRIX was non-inferior to INFANRIX + IPV based on booster response rates (upper limit of two-sided 95% CI on the difference of INFANRIX + IPV minus KINRIX ≤ 10%). || Booster response: In subjects with pre-vaccination < 5 EL.U./mL, post-vaccination concentration ≥ 20 EL.U./mL. In subjects with pre-vaccination ≥ 5 EL.U./mL and < 20 EL.U./mL, an increase of at least 4 times the pre-vaccination concentration. In subjects with pre-vaccination ≥ 20 EL.U./mL, an increase of at least 2 times the pre-vaccination concentration. ¶ KINRIX was non-inferior to INFANRIX + IPV based on post-vaccination anti-poliovirus antibody GMTs adjusted for baseline titer (upper limit of two-sided 95% CI for the GMT ratio [INFANRIX + IPV:KINRIX] ≤ 1.5).

Concomitant Vaccine Administration

In a US study (Study 047), among recipients of DTaP-IPV (same formulation as KINRIX but also containing 2-phenoxyethanol) and the second dose of MMR vaccine (Merck & Co., Inc.) who had pre-vaccination sera tested for antibodies to measles, mumps, and rubella (N = 175-181), 99% of subjects were seropositive for antibodies to measles, mumps, and rubella prior to vaccination.

REFERENCES

1. Vitek CR and Wharton M. Diphtheria Toxoid. In: Plotkin SA, Orenstein WA, and Offit PA, eds. Vaccines. 5th ed. Saunders; 2008:139-156.

2. Wassilak SGF, Roper MH, Kretsinger K, and Orenstein WA. Tetanus Toxoid. In: Plotkin SA, Orenstein WA, and Offit PA, eds. Vaccines. 5th ed. Saunders; 2008:805-839.

3. Department of Health and Human Services, Food and Drug Administration. Biological products; Bacterial vaccines and toxoids; Implementation of efficacy review; Proposed rule. Federal Register December 13, 1985;50(240):51002-51117.

4. Centers for Disease Control and Prevention. General Recommendations on Immunization. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2006;55(RR-15):1-48.

5. Sutter RW, Pallansch MA, Sawyer LA, et al. Defining surrogate serologic tests with respect to predicting protective vaccine efficacy: Poliovirus vaccination. In: Williams JC, Goldenthal KL, Burns DL, Lewis Jr BP, eds. Combined vaccines and simultaneous administration. Current issues and perspectives. New York, NY: The New York Academy of Sciences; 1995:289-299.

Last updated on RxList: 7/23/2008

• Parents or guardians should be informed by the healthcare provider of the potential benefits and risks of immunization with KINRIX.
• The healthcare provider should inform the parents or guardians about the potential for adverse reactions that have been temporally associated with administration of KINRIX or other vaccines containing similar components.
• The parent or guardian accompanying the recipient should be instructed to report any adverse events to their healthcare provider where the vaccine was administered.
• The parent or guardian should be given the Vaccine Information Statements, which are required by the National Childhood Vaccine Injury Act of 1986 to be given prior to immunization. These materials are available free of charge at the Centers for Disease Control and Prevention (CDC) website (www.cdc.gov/nip).

KINRIX is a trademark and INFANRIX, PEDIARIX, and TIP-LOK are registered trademarks of GlaxoSmithKline. IPOL is a registered trademark of Sanofi Pasteur Limited.

Last updated on RxList: 7/23/2008

IMPORTANT NOTE: This is a summary and does not contain all possible information about this product. For complete information about this product or your specific health needs, ask your health care professional. Always seek the advice of your health care professional if you have any questions about this product or your medical condition. This information is not intended as individual medical advice and does not substitute for the knowledge and judgment of your health care professional. This information does not contain any assurances that this product is safe, effective, or appropriate for you.

DIPHTHERIA/TETANUS/PERTUSSIS/POLIO VACCINE - INJECTION

(dip-THEER-ee-uh/TET-un-us/per-TUSS-iss/ POE-lee-oh)

COMMON BRAND NAME(S): Kinrix

USES: This medication is a combination of vaccines against diphtheria, tetanus (lockjaw), pertussis (whooping cough), and polio. Vaccination is the best way to protect against these life-threatening infections. Vaccines work by causing the body to produce its own protection (antibodies).

This combination of vaccines is usually used in children who are between 4 and 6 years old.

HOW TO USE: Read the Vaccine Information Materials provided by the health care professional before the first vaccination and with each following dose. If you have any questions, consult the doctor or pharmacist.

This medication is injected into a muscle by a health care professional. It is usually given in the upper arm.

Vaccines are usually given in a series of doses to provide the best protection. Closely follow the vaccination schedule provided by the doctor. Keep all scheduled medical appointments. It may be helpful to mark a calendar as a reminder. There are various combinations of vaccines available. Based on your child's age, vaccination history, and previous reaction to vaccines, the health care professional will decide which vaccines are best for your child. Discuss the risks and benefits of vaccination with the health care professional.

This combination of vaccines may be given at the same time as other childhood vaccines (such as hepatitis, measles/mumps/rubella) using a separate needle and injection site.

SIDE EFFECTS: Pain/swelling/redness at the injection site may occur. Mild fever, sleepiness, and loss of appetite may also occur. If any of these effects persist or worsen, tell the doctor or pharmacist promptly. Consult the doctor or pharmacist about the temporary use of acetaminophen to treat pain and fever due to this vaccine.

Remember that the doctor has prescribed this medication because he or she has judged that the benefit to your child is greater than the risk of side effects. Many children using this medication do not have serious side effects.

Seek immediate medical attention if any of these rare but serious side effects occur: persistent crying (beginning within 48 hours of the injection and lasting longer than 3 hours), high fever (105 degrees F/40 degrees C or higher), little or no response to sound/touch, weak/floppy muscles, seizures.

A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact the doctor or pharmacist.

Contact your doctor for medical advice about side effects. The following numbers do not provide medical advice, but in the US you may report side effects to the Food and Drug Administration (FDA) at 1-800-FDA-1088. In Canada, you may call Health Canada at 1-866-234-2345.

PRECAUTIONS: Before your child receives this vaccination, tell the doctor or pharmacist if your child is allergic to it; or to any other vaccine; or to neomycin or polymyxin B; or to latex; or if your child has any other allergies.

Before receiving this vaccination, tell the doctor or pharmacist your child's medical history, especially of: current fever/illness, bleeding/blood clotting problems (such as hemophilia, low platelets), immune system problems (such as HIV infection), cancer, brain/nervous system disorders (such as seizures), history of Guillain-Barre syndrome.

This vaccine is not usually used in adults. Therefore, it is unlikely to be used during pregnancy or by a mother while breast-feeding. Consult the doctor if you have any questions about using this vaccine.

DRUG INTERACTIONS: The doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring your child for them. Do not start, stop, or change the dosage of any medicine before checking with your child's doctor or pharmacist first.

Before using this medication, tell the doctor or pharmacist of all prescription and nonprescription/herbal products your child may use, especially of: corticosteroids taken by mouth or given by injection (such as dexamethasone), drugs that weaken the immune system (such as azathioprine, cyclosporine, cancer chemotherapy).

This document does not contain all possible interactions. Therefore, before your child gets this product, tell the doctor or pharmacist of all the products your child may use. Keep a list of all your child's medications with you, and share the list with the doctor and pharmacist.

OVERDOSE: If overdose is suspected, contact your local poison control center or emergency room immediately. US residents can call the US National Poison Hotline at 1-800-222-1222. Canada residents can call a provincial poison control center.

NOTES: Even if your child has already had diphtheria, pertussis, tetanus, or polio, he or she may not be protected from getting them again. Your child should still receive this vaccine if the doctor orders it.

MISSED DOSE: It is important that your child receives each vaccination as scheduled. Be sure to make a note of when your child received their last vaccination for their medical record.

STORAGE: Store in the refrigerator between 35-46 degrees F (2-8 degrees C) away from light and moisture. Do not freeze. Keep all medicines away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

Information last revised August 2008 Copyright(c) 2008 First DataBank, Inc.