# Patent

## Title
Immunogenic composition

## Abstract

The present application discloses an immunogenic composition comprising a Hib saccharide conjugate, at least one additional bacterial, for example N. meningitidis, saccharide conjugate(s), and a further antigen selected from the group consisting of whole cell pertussis and hepatitis B surface antigen, wherein the saccharide dose of the Hib saccharide conjugate is less than 5 μg.

## Background
This application is a continuation application of U.S. application Ser. No. 11/917,726, filed Dec. 14, 2007 pursuant to 35 U.S.C. §371 as a United States National Phase Application of International Patent Application Serial No. PCT/EP2006/006220 filed Jun. 23, 2006, which claims priority from Great Britain Application No. 0513069.5 filed in the United Kingdom on Jun. 27, 2005, from Great Britain Application No. 0513071.1 filed in the United Kingdom on Jun. 27, 2005, from Great Britain Application No. 0515556.9 filed in the United Kingdom on Jul. 28, 2005, from Great Britain Application No. 0524204.5 filed in the United Kingdom on Nov. 28, 2005, from Great Britain Application No. 0526040.1 filed in the United Kingdom on Dec. 21, 2005, and from Great Britain Application No. 0526041.9 filed in the United Kingdom on Dec. 21, 2005, the entire contents of which are incorporated herein by reference.


FIELD OF THE INVENTION
The present application relates to immunogenic compositions and vaccines comprising a Hib saccharide conjugate and at least one additional bacterial saccharide conjugate(s) combined with further antigen(s) including whole cell pertussis and/or hepatitis B surface antigen, processes for making such immunogenic compositions and vaccines, and uses and methods of immunisation using the immunogenic composition and vaccine.
BACKGROUND OF THE INVENTION
Bacterial polysaccharides have been shown to be effective immunogens for use in vaccines, particularly when conjugated to a carrier protein. Commercial conjugate vaccines are available against Haemophilus influenzae type b (Hibtiter® Wyeth-Lederle), pneumococcal polysaccharides (Prevnar®—Wyeth-Lederle) and meningococcal polysaccharides (Meningitec®—Wyeth-Lederle and Menactra®—Sanofi).
Immunogenic compositions and vaccines comprising a Hib conjugate, a N. meningitidis saccharide conjugate, whole cell pertussis and hepatitis B surface antigen have also been described. For instance WO 02/00249 discloses a seven valent immunogenic composition comprising a diphtheria toxoid, tetanus toxoid, whole cell pertussis, Hepatitis B surface antigen, Hib conjugate, MenA conjugate and MenC conjugate. The clinical trial results presented use a 5 μg saccharide dose of each of the bacterial saccharide conjugates.
The present invention concerns the provision of a combination vaccine comprising a Hib conjugate, an additional bacterial saccharide conjugate (for example an N. meningitidis saccharide conjugate) and further antigens including one or both of whole cell pertussis and Hepatitis B surface antigen. The saccharide doses used allow a good immune response to be generated against Hib and the additional bacterial saccharides as well as against the pertussis component and/or the Hepatitis B surface antigen component.
The inventors have surprisingly found that by reducing the saccharide dose of Hib and/or additional bacterial conjugates to below 5 μg per dose, in a combination vaccine comprising whole cell pertussis and/or Hepatitis B surface antigen, a good immune response to the saccharide conjugates is maintained and the immunogenicity of whole cell pertussis and Hepatitis B surface antigen is enhanced (for example such that the GMC for Pw and/or Hepatitis B as measured by ELISA is higher than the level achieved after immunisation with an immunogenic composition containing a 5 μg saccharide dose of each conjugate).
Accordingly, a first aspect of the invention provides an immunogenic composition comprising a Hib saccharide conjugate, at least one additional bacterial saccharide conjugate(s), and a further antigen selected from the group consisting of whole cell pertussis and hepatitis B surface antigen, wherein the saccharide dose of the Hib saccharide conjugate is less than 5 μg per dose.


DETAILED DESCRIPTION
The immunogenic composition of the invention comprises a Hib saccharide conjugate, and/or at least or exactly one, two, three or four bacterial saccharide conjugates, for example N. meningitidis saccharide conjugate(s), and a further antigen selected from the group consisting of whole cell pertussis and hepatitis B surface antigen, wherein the saccharide dose of the Hib saccharide conjugate is less than 5 μg or less than or between 1-4 μg or 1-3 μg, or 2-4 μg or 2-3 μg or around or exactly 2.5 μg and optionally the saccharide dose of the or each of the at least or exactly one, two, three or four additional bacterial saccharide conjugate(s) (for example N. meningitidis saccharide conjugate(s)) is less than 10 μg, 9 μg, 8 μg, 7 μg, 6 μg, 5 μg or 4 μg, or between 1-10 μg, 1-8 μg, 1-6 μg, 1-5 μg, 1-4 μg, 1-3 μg, or 2-4 μg or 2-3 μg or about or exactly 2.5 μg.
The term “saccharide” includes polysaccharides or oligosaccharides. Polysaccharides are isolated from bacteria or isolated from bacteria and sized to some degree by known methods (see for example EP497524 and EP497525) and optionally by microfluidisation. Polysaccharides can be sized in order to reduce viscosity in polysaccharide samples and/or to improve filterability for conjugated products. Oligosaccharides have a low number of repeat units (typically 5-30 repeat units) and are typically hydrolysed polysaccharides.
The “saccharide dose” is measured in the amount of immunogenic composition or vaccine that is administered to a human.
A Hib saccharide is the polyribosyl phosphate (PRP) capsular polysaccharide or oligosaccharide of Haemophilus influenzae type b.
“At least one additional bacterial saccharide conjugate(s)” refers to a conjugate of any bacterial saccharide linked to a carrier protein. The bacterial saccharide is optionally a capsular saccharide derived from an N. meningitidis strain, a S. pneumoniae strain, an S. typhi strain, or any of the bacterial saccharides described herein.
“At least one N. meningitidis saccharide conjugate(s)” refers to N. meningitidis serogroup A capsular saccharide (MenA), N. meningitidis serogroup C capsular saccharide (MenC), N. meningitidis serogroup W135 capsular saccharide (MenW), to N. meningitidis serogroup Y capsular saccharide (MenY), N. meningitidis serogroup B capsular saccharide (MenB), serogroup C and Y capsular saccharides (MenCY), serogroup C and A capsular saccharides (MenAC), serogroup C and W135 capsular saccharides (MenCW), serogroup A and Y capsular saccharide (MenAY), serogroup A and W135 capsular saccharides (MenAW), serogroup W135 and Y capsular saccharides (Men WY), serogroup A, C and W135 capsular saccharide (MenACW), serogroup A, C and Y capsular saccharides (MenACY); serogroup A, W135 and Y capsular saccharides (MenAWY), serogroup C, W135 and Y capsular saccharides (MenCWY); or serogroup A, C, W135 and Y capsular saccharides (MenACWY), serogroup B and C capsular saccharides (MenBC), serogroup B, C and Y capsular saccharides (MenBCY), serogroup B, C and A capsular saccharides (MenABC), serogroup B, C and W capsular saccharides (MenBCW), serogroup A, B and Y capsular saccharide (MenABY), serogroup A, B and W capsular saccharides (MenABW), serogroup B, W135 and Y capsular saccharides (MenBWY), serogroup A, B, C and W135 capsular saccharide (MenABCW), serogroup A, B, C and Y capsular saccharides (MenABCY); serogroup A, B, W135 and Y capsular saccharides (MenABWY), serogroup B, C, W135 and Y capsular saccharides (MenBCWY); or serogroup A, B, C, W135 and Y capsular saccharides (MenABCWY).
For example, any of the combinations of N. meningitidis saccharide conjugates listed above, with or without the addition of Hib saccharide conjugate, may be present at a saccharide dose of less than 5 μg or less than 4 μg, or 1-4 μg or 1-3 μg, or 2-4 μg or 2-3 μg or around or exactly 2.5 μg.
“Around” or “approximately” are defined as within 10% more or less of the given figure for the purposes of the invention.
In an embodiment the saccharide dose of Hib can be the same as, more than or less than the saccharide dose of the N. meningitidis saccharide conjugate. The saccharide dose of the Hib saccharide conjugate is for example 100% or less than 90%, 80%, 75%, 70%, 60%, 50%, 40%, 30%, 20% or 10% of the mean or lowest saccharide dose of the at least one additional bacterial (for example N. meningitidis) saccharide conjugate(s). The saccharide dose of the Hib saccharide is for example between 20% and 60%, 30% and 60%, 40% and 60% or around or exactly 50% of the mean or lowest saccharide dose of the at least one additional bacterial (for example N. meningitidis) saccharide conjugate(s).
In an embodiment of the invention, the dose of the or each of the at least one additional bacterial (for example N. meningitidis) saccharides is the same, or approximately the same.
Examples of immunogenic compositions of the invention are compositions consisting of or comprising:
Examples of immunogenic compositions of the invention are compositions consisting of or comprising:
Hib conjugate and MenA conjugate and MenC conjugate, optionally at saccharide dose ratios of 1:2:2, 1:2:1, 1:4:2, 1:6:3, 1:3:3, 1:4:4, 1:5:5, 1:6:6 (w/w). Optionally, the saccharide dose of MenA is greater than the saccharide dose of MenC.
Hib conjugate and MenC conjugate and MenY conjugate, optionally at saccharide dose ratios of 1:2:2, 1:2:1, 1:4:2, 1:4:1, 1:8:4, 1:6:3, 1:3:3, 1:4:4, 1:5:5, 1:6:6 (w/w). Optionally, the saccharide dose of MenC is greater than the saccharide dose of MenY.
Hib conjugate and MenC conjugate and MenW conjugate, optionally at saccharide dose ratios of 1:2:2, 1:2:1, 1:4:2, 1:4:1, 1:8:4, 1:6:3, 1:3:3, 1:4:4, 1:5:5, 1:6:6 (w/w). Optionally the saccharide dose of MenC is greater than the saccharide dose of MenW.
Hib conjugate and MenA conjugate and MenW conjugate, optionally at saccharide dose ratios of 1:2:2, 1:2:1, 1:4:2, 1:4:1, 1:8:4, 1:6:3, 1:3:3, 1:4:4, 1:5:5, 1:6:6 (w/w). Optionally, the saccharide dose of MenA is greater than the saccharide dose of MenW.
Hib conjugate and MenA conjugate and MenY conjugate, optionally at saccharide dose ratios of 1:2:2, 1:2:1, 1:4:2, 1:4:1, 1:8:4, 1:6:3, 1:3:3, 1:4:4, 1:5:5, 1:6:6 (w/w). Optionally the saccharide dose of MenA is greater than the saccharide dose of MenY.
Hib conjugate and MenW conjugate and MenY conjugate, optionally at saccharide dose ratios of 1:2:2, 1:2:1, 1:1:2, 1:4:2, 1:2:4, 1:4:1, 1:1:4, 1:3:6, 1:1:3, 1:6:3, 1:3:3, 1:4:4, 1:5:5, 1:6:6 (w/w). Optionally the saccharide dose of MenY is greater than the saccharide dose of MenW.
The “further antigen” comprises one or both of whole cell pertussis (Pw) and Hepatitis B surface antigen (HepB). In an embodiment, the further antigen further comprises diphtheria toxoid (DT), tetanus toxoid (TT), acellular pertussis (Pa) and/or polio virus (IPV). In an embodiment, the further antigen comprises or consists of DT, TT and Pw. In an embodiment, the further antigen comprises or consists of DT, TT, pertussis antigen (Pa or Pw) and HepB. In an embodiment, the further antigen comprises or consists of DT, TT, pertussis antigen (Pa or Pw), HepB and IPV.
Hib and/or the N. meningitidis saccharide(s) included in the immunogenic compositions of the invention are conjugated to a carrier protein such as tetanus toxoid, tetanus toxoid fragment C, non-toxic mutants of tetanus toxin, diphtheria toxoid, CRM197, other non-toxic mutants of diphtheria toxin [such as CRM176, CRM 197, CRM228, CRM 45 (Uchida et al J. Biol. Chem. 218; 3838-3844, 1973); CRM 9, CRM 45, CRM102, CRM 103 and CRM107 and other mutations described by Nicholls and Youle in Genetically Engineered Toxins, Ed: Frankel, Maecel Dekker Inc, 1992; deletion or mutation of Glu-148 to Asp, Gln or Ser and/or Ala 158 to Gly and other mutations disclosed in U.S. Pat. No. 4,709,017 or U.S. Pat. No. 4,950,740; mutation of at least one or more residues Lys 516, Lys 526, Phe 530 and/or Lys 534 and other mutations disclosed in U.S. Pat. No. 5,917,017 or U.S. Pat. No. 6,455,673; or fragment disclosed in U.S. Pat. No. 5,843,711], pneumococcal pneumolysin, OMPC (meningococcal outer membrane protein—usually extracted from N. meningitidis serogroup B—EP0372501), synthetic peptides (EP0378881, EP0427347), heat shock proteins (WO 93/17712, WO 94/03208), pertussis proteins (WO 98/58668, EP0471177), cytokines, lymphokines, growth factors or hormones (WO 91/01146), artificial proteins comprising multiple human CD4+ T cell epitopes from various pathogen derived antigens (Falugi et al (2001) Eur J Immunol 31; 3816-3824) such as N19 protein (Baraldoi et al (2004) Infect Immun 72; 4884-7) pneumococcal surface protein PspA (WO 02/091998) pneumolysin (Kuo et al (1995) Infect Immun 63; 2706-13), iron uptake proteins (WO 01/72337), toxin A or B of C. difficile (WO 00/61761) or Protein D (EP594610 and WO 00/56360).
In an embodiment, the immunogenic composition of the invention uses the same carrier protein (independently selected) in the Hib conjugate and the at least one N. meningitidis saccharide conjugate(s), optionally in the Hib conjugate and each of the N. meningitidis saccharide conjugates (optionally in all the saccharide conjugates present in the immunogenic composition).
In an embodiment, the immunogenic composition optionally comprises a Hib saccharide conjugate and MenA polysaccharide conjugate, a Hib saccharide conjugate and MenC saccharide conjugate, a Hib saccharide conjugate and MenW saccharide conjugate, a Hib saccharide conjugate and MenY saccharide conjugate, a Hib saccharide conjugate and MenA and MenC saccharide conjugates, a Hib saccharide conjugate and MenA and MenW saccharide conjugates, a Hib saccharide conjugate and MenA and MenY saccharide conjugates, a Hib saccharide conjugate and MenC and MenW saccharide conjugates, a Hib saccharide conjugate and MenC and MenY saccharide conjugates, a Hib saccharide conjugate and MenW and MenY saccharide conjugates, a Hib saccharide conjugate and MenA, MenC and MenW saccharide conjugates, a Hib saccharide conjugate and MenA, MenC and MenY saccharide conjugates, a Hib saccharide conjugate and MenA, MenW and MenY saccharide conjugates, a Hib saccharide conjugate and MenC, MenW and MenY saccharide conjugates or a Hib saccharide conjugate and MenA, MenC, MenW and MenY saccharide conjugates.
In an embodiment, a single carrier protein may carry more than one saccharide antigen (WO 04/083251). For example, a single carrier protein might be conjugated to Hib and MenA, Hib and MenC, Hib and MenW, Hib and MenY, MenA and MenC, MenA and MenW, MenA and MenY, MenC and MenW, MenC and MenY or Men W and MenY.
In an embodiment, the immunogenic composition of the invention comprises a Hib saccharide conjugated to a carrier protein selected from the group consisting of TT, DT, CRM197, fragment C of TT and protein D.
Where the carrier protein is TT or fragment thereof for Hib and the at least one N. meningitidis saccharide(s), the total dose of carrier is between 2.5-25 μg, 3-20 μg, 4-15 μg, 5-12.5 μg, 15-20 μg, 16-19 μg or 17-18 μg.
In an embodiment, the immunogenic composition of the invention comprises at least one, two, three or four N. meningitidis bacterial saccharide(s) conjugated to a carrier protein selected from the group consisting of TT, DT, CRM197, fragment C of TT and protein D.
The immunogenic composition of the invention optionally comprises a Hib saccharide conjugate having a ratio of Hib to carrier protein of between 1:5 and 5:1; 1:2 and 2:1; 1:1 and 1:4; 1:2 and 1:3.5; or around or exactly 1:2.5 or 1:3 (w/w).
The immunogenic composition of the invention optionally comprises at least one meningococcal saccharide (for example MenA and/or MenC and/or MenW and/or MenY) conjugate having a ratio of Men saccharide to carrier protein of between 1:5 and 5:1, between 1:2 and 5:1, between 1:0.5 and 1:2.5 or between 1:1.25 and 1:2.5 (w/w).
The ratio of saccharide to carrier protein (w/w) in a conjugate may be determined using the sterilized conjugate. The amount of protein is determined using a Lowry assay (for example Lowry et al (1951) J. Biol. Chem. 193, 265-275 or Peterson et al Analytical Biochemistry 100, 201-220 (1979)) and the amount of saccharide is determined using ICP-OES (inductively coupled plasma-optical emission spectroscopy) for MenA, DMAP assay for MenC and Resorcinol assay for MenW and MenY (Monsigny et al (1988) Anal. Biochem. 175, 525-530).
In an embodiment, the immunogenic composition of the invention the Hib saccharide is conjugated to the carrier protein via a linker, for instance a bifunctional linker. The linker is optionally heterobifunctional or homobifunctional, having for example a reactive amino group and a reative carboxylic acid group, 2 reactive amino groups or two reactive carboxylic acid groups. The linker has for example between 4 and 20, 4 and 12, 5 and 10 carbon atoms. A possible linker is ADH. Other linkers include B-propionamido (WO 00/10599), nitrophenyl-ethylamine (Geyer et al (1979) Med. Microbiol. Immunol. 165; 171-288), haloalkyl halides (U.S. Pat. No. 4,057,685) glycosidic linkages (U.S. Pat. No. 4,673,574, U.S. Pat. No. 4,808,700) and 6-aminocaproic acid (U.S. Pat. No. 4,459,286).
The saccharide conjugates present in the immunogenic compositions of the invention may be prepared by any known coupling technique. For example the saccharide can be coupled via a thioether linkage. The conjugation method may rely on activation of the saccharide with 1-cyano-4-dimethylamino pyridinium tetrafluoroborate (CDAP) to form a cyanate ester. The activated saccharide may thus be coupled directly or via a spacer (linker) group to an amino group on the carrier protein. Optionally, the cyanate ester is coupled with hexane diamine or ADH and the amino-derivatised saccharide is conjugated to the carrier protein using heteroligation chemistry involving the formation of the thioether linkage, or is conjugated to the carrier protein using carbodiimide (e.g. EDAC or EDC) chemistry. Such conjugates are described in PCT published application WO 93/15760 Uniformed Services University and WO 95/08348 and WO 96/29094.
Other suitable techniques use carbiinides, hydrazides, active esters, norborane, p-nitrobenzoic acid, N-hydroxysuccinimide, S-NHS, EDC, TSTU. Many are described in WO 98/42721. Conjugation may involve a carbonyl linker which may be formed by reaction of a free hydroxyl group of the saccharide with CDI (Bethell et al J. Biol. Chem. 1979, 254; 2572-4, Hearn et al J. Chromatogr. 1981. 218; 509-18) followed by reaction of with a protein to form a carbamate linkage. This may involve reduction of the anomeric terminus to a primary hydroxyl group, optional protection/deprotection of the primary hydroxyl group reaction of the primary hydroxyl group with CDI to form a CDI carbamate intermediate and coupling the CDI carbamate intermediate with an amino group on a protein.
The conjugates can also be prepared by direct reductive amination methods as described in U.S. Pat. No. 4,365,170 (Jennings) and U.S. Pat. No. 4,673,574 (Anderson). Other methods are described in EP-0-161-188, EP-208375 and EP-0-477508.
A further method involves the coupling of a cyanogen bromide (or CDAP) activated saccharide derivatised with adipic acid hydrazide (ADH) to the protein carrier by carbodiimide condensation (Chu C. et al Infect. Immunity, 1983 245 256), for example using EDAC.
In an embodiment, a hydroxyl group on a saccharide is linked to an amino or carboxylic group on a protein either directly or indirectly (through a linker). Where a linker is present, a hydroxyl group on a saccharide is optionally linked to an amino group on a linker, for example by using CDAP conjugation. A further amino group in the linker for example ADH) may be conjugated to a carboxylic acid group on a protein, for example by using carbodiimide chemistry, for example by using EDAC. In an embodiment, the Hib or at least one N. meningitidis saccharide(s) is conjugated to the linker first before the linker is conjugated to the carrier protein.
In an embodiment, the Hib saccharide, where present, is conjugated to the carrier protein using CNBr, or CDAP, or a combination of CDAP and carbodiimide chemistry (such as EDAC), or a combination of CNBr and carbodiimide chemistry, (such as) EDAC. Optionally Hib is conjugated using CNBr and carbodiimide chemistry (optionally EDAC. For example, CNBr is used to join the saccharide and linker and then carbodiimide chemistry is used to join linker to the protein carrier.
In an embodiment, at least one of the at least one N. meningitidis saccharide(s) is directly conjugated to a carrier protein optionally Men W and/or MenY and/or MenC and/or MenA saccharide(s) is directly conjugated to a carrier protein. For example MenW; MenY; MenC; MenA; MenW and MenY; MenW and MenC; MenY and MenC; or MenW, MenY and MenC are directly linked to the carrier protein. Optionally at least one of the at least one N. meningitidis saccharide(s) is directly conjugated by CDAP. For example MenW; MenY; MenC; MenW and MenY; MenW and MenC; MenY and MenC; or MenW, MenY and MenC are directly linked to the carrier protein by CDAP (see WO 95/08348 and WO 96/29094).
Optionally the ratio of Men W and/or Y saccharide to carrier protein is between 1:0.5 and 1:2 (w/w) or the ratio of MenC saccharide to carrier protein is between 1:0.5 and 1:2 or 1:1.25 and 1:1.5 or 1:0.5 and 1:1 (w/w), especially where these saccharides are directly linked to the protein, optionally using CDAP.
In an embodiment, at least one N. meningitidis saccharide(s) is conjugated to the carrier protein via a linker, for instance a bifunctional linker. The linker is optionally heterobifunctional or homobifunctional, having for example a reactive amino group and a reative carboxylic acid group, 2 reactive amino groups or two reactive carboxylic acid groups. The linker has for example between 4 and 20, 4 and 12, 5 and 10 carbon atoms. A possible linker is ADH.
In an embodiment, MenA; MenC; or MenA and MenC is conjugated to a carrier protein via a linker.
In an embodiment, the N. meningitidis saccharide is conjugated to a carrier protein via a linker using CDAP and EDAC. For example, MenA; MenC; or MenA and MenC are conjugated to a protein via a linker (for example those with two amino groups at its ends such as ADH) using CDAP and EDAC as described above. For example, CDAP is used to conjugate the saccharide to a linker and EDAC is used to conjugate the linker to a protein. Optionally the conjugation via a linker results in a ratio of saccharide to carrier protein of of between 1:0.5 and 1:6; 1:1 and 1:5 or 1:2 and 1:4, for MenA; MenC; or MenA and MenC.
In an embodiment of the invention, the immunogenic composition comprises N. meningitidis capsular polysaccharides from at least one, two, three or four of serogroups A, C, W and Y conjugated to a carrier protein, wherein at least one, two, three or four or each N. meningitidis polysaccharide is either a native polysaccharide or is sized by a factor up to ×1.5, ×2, ×3, ×4, ×5, ×6, ×7, ×8, ×9, ×10 or ×20. For example, the average size of at least one, two, three or four or each N. meningitidis polysaccharide is above 50 kDa, 60 kDa, 75 kDa, 100 kDa, 110 kDa, 120 kDa or 130 kDa.
“Native polysaccharide” refers to a polysaccharide that has not been subjected to a process, the purpose of which is to reduce the size of the polysaccharide.
“Sized by a factor up to ×2” means that the polysaccharide is subject to a process intended to reduce the size of the polysaccharide but to retain a size more than half the size of the native polysaccharide. ×3, ×4 etc. are to be interpreted in the same way i.e. the polysaccharide is subject to a process intended to reduce the size of the polysaccharide but to retain a size more than a third, a quarter etc. the size of the native polysaccharide respectively.
In an aspect of the invention, the immunogenic composition comprises N. meningitidis capsular polysaccharides from at least one, two, three or four of serogroups A, C, W and Y conjugated to a carrier protein, wherein at least one, two, three or four or each N. meningitidis polysaccharide is native polysaccharide.
In an aspect of the invention, the immunogenic composition comprises N. meningitidis capsular polysaccharides from at least one, two, three or four of serogroups A, C, W and Y conjugated to a carrier protein, wherein at least one, two, three or four or each N. meningitidis polysaccharide is sized by a factor up to ×1.5, ×2, ×3, ×4, ×5, ×6, ×7, ×8, ×9 or ×10.
In an embodiment, the mean size of at least one, two, three, four or each N. meningitidis polysaccharide is between 50 KDa and 1500 kDa, 50 kDa and 500 kDa, 50 kDa and 300 KDa, 101 kDa and 1500 kDa, 101 kDa and 500 kDa, 101 kDa and 300 kDa as determined by MALLS.
In an embodiment, the MenA saccharide, where present, has a molecular weight of 50-500 kDa, 50-100 kDa, 100-500 kDa, 55-90 KDa, 60-70 kDa or 70-80 kDa or 60-80 kDa as determined by MALLS.
In an embodiment, the MenC saccharide, where present, has a molecular weight of 100-200 kDa, 50-100 kDa, 100-150 kDa, 101-130 kDa, 150-210 kDa or 180-210 kDa as determined by MALLS.
In an embodiment the MenY saccharide, where present, has a molecular weight of 60-190 kDa, 70-180 kDa, 80-170 kDa, 90-160 kDa, 100-150 kDa or 110-140 kDa, 50-100 kDa, 100-140 kDa, 140-170 kDa or 150-160 kDa as determined by MALLS.
In an embodiment the MenW saccharide, where present, has a molecular weight of 60-190 kDa, 70-180 kDa, 80-170 kDa, 90-160 kDa, 100-150 kDa, 110-140 kDa, 50-100 kDa or 120-140 kDa as determined by MALLS.
The molecular weights of the saccharide refers to the molecular weight of the polysaccharide measured prior to conjugation and is measured by MALLS.
In an embodiment the N. meningitidis saccharides are native polysaccharides or native polysaccharides which have reduced in size during a normal extraction process.
In an embodiment, the N. meningitidis saccharides are sized by mechanical cleavage, for instance by microfluidisation or sonication. Microfluidisation and sonication have the advantage of decreasing the size of the larger native polysaccharides sufficiently to provide a filterable conjugate.
In an embodiment, the polydispersity of the saccharide is 1-1.5, 1-1.3, 1-1.2, 1-1.1 or 1-1.05 and after conjugation to a carrier protein, the polydispersity of the conjugate is 1.0-2.5, 1.0-2.0, 1.0-1.5, 1.0-1.2, 1.5-2.5, 1.7-2.2 or 1.5-2.0. All polydispersity measurements are by MALLS.
For MALLS analysis of meningococcal saccharides, two columns (TSKG6000 and 5000PWxI TOSOH Bioscience) may be used in combination and the saccharides are eluted in water. Saccharides are detected using a light scattering detector (for instance Wyatt Dawn DSP equipped with a 10 mW argon laser at 488 nm) and an inferometric refractometer (for instance Wyatt Otilab DSP equipped with a P100 cell and a red filter at 498 nm).
In an embodiment, the MenA saccharide, where present is at least partially O-acetylated such that at least 50%, 60%, 70%, 80%, 90%, 95% or 98% of the repeat units are O-acetylated at at least one position. O-acetylation is for example present at least at the O-3 position.
In an embodiment, the MenC saccharide, where present is is at least partially O-acetylated such that at least 30%. 40%, 50%, 60%, 70%, 80%, 90%, 95% or 98% of (α2→9)-linked NeuNAc repeat units are O-acetylated at at least one or two positions. O-acetylation is for example present at the O-7 and/or O-8 position.
In an embodiment, the MenW saccharide, where present is is at least partially O-acetylated such that at least 30%. 40%, 50%, 60%, 70%, 80%, 90%, 95% or 98% of the repeat units are O-acetylated at at least one or two positions. O-acetylation is for example present at the O-7 and/or O-9 position.
In an embodiment, the MenY saccharide, where present is at least partially O-acetylated such that at least 40%, 50%, 60%, 70%, 80%, 90%, 95% or 98% of the repeat units are O-acetylated at at least one or two positions. O-acetylation is present at the 7 and/or 9 position.
The percentage of O-acetylation refers to the percentage of the repeat units containing O-acetylation. This may be measured in the saccharide prior to conjugate and/or after conjugation.
A further aspect of the invention is a vaccine comprising the immunogenic composition of the invention and a pharmaceutically acceptable excipient.
Optionally, the immunogenic composition or vaccine contains an amount of an adjuvant sufficient to enhance the immune response to the immunogen. Suitable adjuvants include, but are not limited to, aluminium salts (aluminium phosphate or aluminium hydroxide), squalene mixtures (SAF-1), muramyl peptide, saponin derivatives, mycobacterium cell wall preparations, monophosphoryl lipid A, mycolic acid derivatives, non-ionic block copolymer surfactants, Quil A, cholera toxin B subunit, polphosphazene and derivatives, and immunostimulating complexes (ISCOMs) such as those described by Takahashi et al. (1990) Nature 344:873-875.
For the HibMen combinations discussed above, it may be advantageous for the Hib and Men saccharide conjugates not to be adsorbed to aluminium salt adjuvant or any adjuvant at all.
In an embodiment, the immunogenic composition is unadjuvanted. For the purpose of the invention, “unadjuvanted” means that an adjuvant component which is not an antigenic component in its own right is not present in the immunogenic composition.
In an embodiment of the invention HepB is adsorbed to aluminium phosphate (WO 93/24148).
In an embodiment, the immunogenic composition comprises a Hib saccharide conjugated to tetanus toxoid via a linker and MenC saccharide conjugated to tetanus toxoid either directly or through a linker and MenA saccharide conjugated to tetanus toxoid either directly or through a linker.
In an embodiment, the immunogenic composition of the invention is buffered at, or adjusted to, between pH 7.0 and 8.0, pH 7.2 and 7.6 or around or exactly pH 7.4.
The immunogenic composition or vaccines of the invention are optionally lyophilised in the presence of a stabilising agent for example a polyol such as sucrose or trehalose.
As with all immunogenic compositions or vaccines, the immunologically effective amounts of the immunogens must be determined empirically. Factors to be considered include the immunogenicity, whether or not the immunogen will be complexed with or covalently attached to an adjuvant or carrier protein or other carrier, route of administrations and the number of immunising dosages to be administered. Such factors are known in the vaccine art and it is well within the skill of immunologists to make such determinations without undue experimentation.
The active agent can be present in varying concentrations in the pharmaceutical composition or vaccine of the invention. Typically, the minimum concentration of the substance is an amount necessary to achieve its intended use, while the maximum concentration is the maximum amount that will remain in solution or homogeneously suspended within the initial mixture. For instance, the minimum amount of a therapeutic agent is optionally one which will provide a single therapeutically effective dosage. For bioactive substances, the minimum concentration is an amount necessary for bioactivity upon reconstitution and the maximum concentration is at the point at which a homogeneous suspension cannot be maintained. In the case of single-dosed units, the amount is that of a single therapeutic application. Generally, it is expected that each dose will comprise 1-100 μg of protein antigen, optionally 5-50 μg or 5-25 μg. The vaccine preparations of the present invention may be used to protect or treat a mammal (for example a human patient) susceptible to infection, by means of administering said vaccine via systemic or mucosal route. A human patient is optionally an infant (under 12 months), a toddler (12-24, 12-16 or 12-14 months), a child (2-10, 3-8 or 3-5 years) an adolescent (12-25, 14-21 or 15-19 years) or an adult (any age over 12, 15, 18 or 21). These administrations may include injection via the intramuscular, intraperitoneal, intradermal or subcutaneous routes; or via mucosal administration to the oral/alimentary, respiratory, genitourinary tracts. Intranasal administration of vaccines for the treatment of pneumonia or otitis media is preferred (as nasopharyngeal carriage of pneumococci can be more effectively prevented, thus attenuating infection at its earliest stage). Although the vaccine of the invention may be administered as a single dose, components thereof may also be co-administered together at the same time or at different times (for instance if saccharides are present in a vaccine these could be administered separately at the same time or 1-2 weeks after the administration of a bacterial protein vaccine for optimal coordination of the immune responses with respect to each other). In addition to a single route of administration, 2 different routes of administration may be used. For example, viral antigens may be administered ID (intradermal), whilst bacterial proteins may be administered IM (intramuscular) or IN (intranasal). If saccharides are present, they may be administered IM (or ID) and bacterial proteins may be administered IN (or ID). In addition, the vaccines of the invention may be administered IM for priming doses and IN for booster doses.
Vaccine preparation is generally described in Vaccine Design (“The subunit and adjuvant approach” (eds Powell M. F. & Newman M. J.) (1995) Plenum Press New York). Encapsulation within liposomes is described by Fullerton, U.S. Pat. No. 4,235,877.
A further aspect of the invention is a vaccine kit for concomitant or sequential administration comprising two multi-valent immunogenic compositions for conferring protection in a host against diease caused by Bordetella pertussis, Clostridium tetani, Corynebacterium diphtheriae, Haemophilus influenzae and Neisseria meningitidis. For example, the kit optionally comprises a first container comprising one or more of:
tetanus toxoid (TT),
diphtheria toxoid (DT), and
whole cell pertussis components and
optionally further comprising Hepatitis B surface antigen
and a second container comprising:
Hib saccharide conjugate, and
at least one, two, three or four N. meningitidis saccharide conjugate(s),
wherein the saccharide dose of the Hib conjugate is is less than 5 μg or 4 μg, or 1-4 μg or 1-3 μg, or 2-4 μg or 2-3 μg or around or exactly 2.5 μg and optionally the saccharide dose of the or each of the at least or exactly one, two, three or four additional bacterial saccharide conjugate(s) (for example N. meningitidis saccharide conjugate(s)) is less than 10 μg, 9 μg, 8 μg, 7 μg, 6 μg, 5 μg or 4 μg, or between 1-10 μg, 1-8 μg, 1-6 μg, 1-5 μg, 1-4 μg, 1-3 μg, or 2-4 μg or 2-3 μg or about or exactly 2.5 μg
Examples of the Hib conjugate and the at least one additional bacterial saccharide (for example N. meningitidis saccharide) conjugate(s) are as described above. Any of the properties of the conjugates described above can be present in a vaccine kit.
Optionally, the vaccine kits of the invention comprise a third component. For example, the kit optionally comprises a first container comprising one or more of:
tetanus toxoid (TT),
diphtheria toxoid (DT), and
wholecell pertussis components and
optionally comprises Hepatitis B surface antigen;
and a second container comprising:
one or more conjugates of a carrier protein and a capsular saccharide from Streptococcus pneumoniae [where the capsular saccharide is optionally from a pneumococcal serotype selected from the group consisting of 1, 2, 3, 4, 5, 6A, 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19A, 19F, 20, 22F, 23F and 33F].
and a third container comprising:
Hib saccharide conjugate, and
at least one N. meningitidis saccharide conjugate(s),
wherein the saccharide dose of the Hib conjugate is is less than 5 μg or 4 μg, or 1-4 μg or 1-3 μg, or 2-4 μg or 2-3 μg or around or exactly 2.5 μg and optionally the saccharide dose of the or each of the at least or exactly one, two, three or four additional bacterial saccharide conjugate(s) (for example N. meningitidis saccharide conjugate(s)) is less than 10 μg, 9 μg, 8 μg, 7 μg, 6 μg, 5 μg or 4 μg, or between 1-10 μg, 1-8 μg, 1-6 μg, 1-5 μg, 1-4 μg, 1-3 μg, or 2-4 μg or 2-3 μg or about or exactly 2.5 μg
Immunogenic compositions comprising meningococcal conjugates, for example HibMenC, HibMenAC, HibMenAW, HibMenAY, HibMenCW, HibMenCY, HibMenWY, MenAC, MenAW, MenAY, MenCW, MenCY, MenWY or MenACWY, including kits of similar composition to those described above, optionally comprise antigens from measles and/or mumps and/or rubella and/or varicella. For example, the meningococcal immunogenic composition contains antigens from measles, mumps and rubella or measles, mumps, rubella and varicella. In an embodiment, these viral antigens are optionally present in the same container as the meningococcal and/or Hib saccharide conjugate(s). In an embodiment, these viral antigens are lyophilised.
A further aspect of the invention is a process for making the immunogenic composition of the invention, comprising the step of mixing a Hib saccharide conjugate with at least one additional bacterial (for example N. meningitidis) saccharide conjugate(s) and a further antigen selected from the group consisting of whole cell pertussis and hepatitis B surface antigen to form a composition wherein the saccharide dose of the Hib conjugate is less than 5 μg or 4 μg, or between 1-4 μg or 1-3 μg, or 2-4 μg or 2-3 μg or around or exactly 2.5 μg and optionally the saccharide dose of the or each of the at least or exactly one, two, three or four additional bacterial (for example N. meningitidis) saccharide conjugate(s) is less than 10 μg, 9 μg, 8 μg, 7 μg, 6 μg, 5 μg or 4 μg, or between 1-10 μg, 1-8 μg, 1-6 μg, 1-5 μg, 1-4 μg, 1-3 μg, or 2-4 μg or 2-3 μg or about or exactly 2.5 μg.
A further aspect of the invention is a method of immunising a human host against disease caused by Haemophilus influenzae and optionally N. meningitidis infection comprising administering to the host an immunoprotective dose of the immunogenic composition or vaccine or kit of the invention.
A further aspect of the invention is an immunogenic composition of the invention for use in the treatment or prevention of disease caused by Haemophilus influenzae and/or N. meningitidis. 
A further aspect of the invention is use of the immunogenic composition or vaccine or kit of the invention in the manufacture of a medicament for the treatment or prevention of diseases caused by Haemophilus influenzae and/or N. meningitidis. 
The terms “comprising”, “comprise” and “comprises” herein are intended by the inventors to be optionally substitutable with the terms “consisting of”, “consist of” and “consists of”, respectively, in every instance.
All references or patent applications cited within this patent specification are incorporated by reference herein.
The invention is illustrated in the accompanying examples. The examples below are carried out using standard techniques, which are well known and routine to those of skill in the art, except where otherwise described in detail. The examples are illustrative, but do not limit the invention.
EXAMPLES
Example 1
Preparation of Polysaccharide Conjugates
The covalent binding of Haemophilus influenzae (Hib) PRP polysaccharide to TT was carried out by a coupling chemistry developed by Chu et al (Infection and Immunity 1983, 40 (1); 245-256). Hib PRP polysaccharide was activated by adding CNBr and incubating at pH10.5 for 6 minutes. The pH was lowered to pH8.75 and adipic acid dihyrazide (ADH) was added and incubation continued for a further 90 minutes. The activated PRP was coupled to purified tetanus toxoid via carbodiimide condensation using 1-ethyl-3-(3-dimethyl-aminopropyl)carbodiimide (EDAC). EDAC was added to the activated PRP to reach a final ratio of 0.6 mg EDAC/mg activated PRP. The pH was adjusted to 5.0 and purified tetanus toxoid was added to reach 2 mg TT/mg activated PRP. The resulting solution was left for three days with mild stirring. After filtration through a 0.45 μm membrane, the conjugate was purifed on a sephacryl S500HR (Pharmacia, Sweden) column equilibrated in 0.2M NaCl.
MenC-TT conjugates were produced using native polysaccharides (of over 150 kDa as measured by MALLS) or were slightly microfluidised. MenA-TT conjugates were produced using either native polysaccharide or slightly microfluidised polysaccharide of over 60 kDa as measured by the MALLS method of example 2. MenW and MenY-TT conjugates were produced using sized polysaccharides of around 100-200 kDa as measured by MALLS (see example 2). Sizing was by microfluidisation using a homogenizer Emulsiflex C-50 apparatus. The polysaccharides were then filtered through a 0.2 μm filter.
Activation and coupling were performed as described in WO96/29094 and WO 00/56360. Briefly, the polysaccharide at a concentration of 10-20 mg/ml in 2M NaCl pH 5.5-6.0 was mixed with CDAPsolution (100 mg/ml freshly prepared in acetonitrile/WFI, 50/50) to a final CDAP/polysaccharide ratio of 0.75/1 or 1.5/1. After 1.5 minutes, the pH was raised with sodium hydroxide to pH10.0. After three minutes tetanus toxoid was added to reach a protein/polysaccharide ratio of 1.5/1 for MenW, 1.2/1 for MenY, 1.5/1 for MenA or 1.5/1 for MenC. The reaction continued for one to two hours.
After the coupling step, glycine was added to a final ratio of glycine/PS (w/w) of 7.5/1 and the pH was adjusted to pH9.0. The mixture was left for 30 minutes. The conjugate was clarified using a 10 μm Kleenpak filter and was then loaded onto a Sephacryl S400HR column using an elution buffer of 150 mM NaCl, 10 mM or 5 mM Tris pH7.5. Clinical lots were filtered on an Opticap 4 sterilizing membrane. The resultant conjugates had an average polysaccharide:protein ratio of 1:1-1:5 (w/w).
In order to conjugate MenA capsular polysaccharide to tetanus toxoid via a spacer, the following method was used. The covalent binding of the polysaccharide and the spacer (ADH) is carried out by a coupling chemistry by which the polysaccharide is activated under controlled conditions by a cyanylating agent, 1-cyano-4-dimethylamino-pyridinium tetrafluoroborate (CDAP). The spacer reacts with the cyanylated PS through its hydrazino groups, to form a stable isourea link between the spacer and the polysaccharide.
A 10 mg/ml solution of MenA was treated with a freshly prepared 100 mg/ml solution of CDAP in acetonitrile/water (50/50 (v/v)) to obtain a CDAP/MenA ratio of 0.75 (w/w). After 1.5 minutes, the pH was raised to pH 10.0. Three minutes later, ADH was added to obtain an ADH/MenA ratio of 8.9. The pH of the solution was decreased to 8.75 and the reaction proceeded for 2 hours.
Prior to the conjugation reaction, the purified TT solution and the PSAAH solution were diluted to reach a concentration of 10 mg/ml for PSAAH and 10 mg/ml for TT.
EDAC was added to the PSAH solution in order to reach a final ratio of 0.9 mg EDAC/mg PSAAH. The pH was adjusted to 5.0. The purified tetanus toxoid was added with a peristaltic pump (in 60 minutes) to reach 2 mg TT/mg PSAAH. The resulting solution was left 60 min at +25° C. under stirring to obtain a final coupling time of 120 min. The conjugate was clarified using a 10 μm filter and was purified using a Sephacryl S400HR column.
Example 2
Determination of Molecular Weight Using MALLS
Detectors were coupled to a HPLC size exclusion column from which the samples were eluted. On one hand, the laser light scattering detector measured the light intensities scattered at 16 angles by the macromolecular solution and on the other hand, an interferometric refractometer placed on-line allowed the determination of the quantity of sample eluted. From these intensities, the size and shape of the macromolecules in solution can be determined.
The mean molecular weight in weight (Mw) is defined as the sum of the weights of all the species multiplied by their respective molecular weight and divided by the sum of weights of all the species.

    
    
        a) Weight-average molecular weight: -Mw-
    
    






  
    M
    w
  
  =
  
    
      
        ∑
        
          
            W
            i
          
          ·
          
            M
            i
          
        
      
      
        ∑
        
          W
          i
        
      
    
    =
    
      
        m
        2
      
      
        m
        
          1
          ⁢
          
            
          
        
      
    
  




    
    
        b) Number-average molecular weight: -Mn-
    
    






  
    M
    n
  
  =
  
    
      
        ∑
        
          
            N
            i
          
          ·
          
            M
            i
          
        
      
      
        ∑
        
          N
          i
        
      
    
    =
    
      
        m
        1
      
      
        m
        0
      
    
  




    
    
        c) Root mean square radius: -Rw- and R2w is the square radius defined by:
    
    






  
    
      R
      2
    
    ⁢
    w
    ⁢
    
      
    
    ⁢
    or
    ⁢
    
      
    
    ⁢
    
      (
      
        r
        2
      
      )
    
    ⁢
    w
  
  =
  
    
      ∑
      
        
          m
          i
        
        ·
        
          r
          i
          2
        
      
    
    
      ∑
      
        m
        i
      
    
  




    
    
        
        
            (-mi- is the mass of a scattering centre i and -ri- is the distance between the
            scattering centre i and the center of gravity of the macromolecule).
        
        
        d) The polydispersity is defined as the ratio -Mw/Mn-.
    
    


Meningococcal polysaccharides were analysed by MALLS by loading onto two HPLC columns (TSKG6000 and 5000PWxI TOSOH Bioscience) used in combination. 25 μl of the polysaccharide were loaded onto the column and was eluted with 0.75 ml of filtered water. The polyaccharides are detected using a light scattering detector (Wyatt Dawn DSP equipped with a 10 mW argon laser at 488 nm) and an inferometric refractometer Wyatt Otilab DSP equipped with a P100 cell and a red filter at 498 nm).
The molecular weight polydispersities and recoveries of all samples were calculated by the Debye method using a polynomial fit order of 1 in the Astra 4.72 software.
Example 3
Phase II Clinical Trial on HibMenAC-TT Conjugate Vaccine Mixed with DTPw-HepB
Study design: Open, randomized (1:1:1:1:1), single centre study with five groups. The five groups received the following vaccination regimen respectively, at 6, 10 and 14 weeks of age.

    
    
        TritanrixTM-HepB/Hib-MenAC 2.5/2.5/2.5: henceforth referred to as 2.5/2.5/2.5
        TritanrixTM-HepB/Hib-MenAC 2.5/5/5: henceforth referred to as 2.5/5/5
        TritanrixTM-HepB/Hib-MenAC 5/5/5: henceforth referred to as 5/5/5
        TritanrixTM-HepB+HiberixTM: henceforth referred to as Hiberix
        TritanrixTM-HepB/HiberixTM+MeningitecTM: henceforth referred to as Meningitec
    
    


Blood samples were taken at the time of the first vaccine dose (Pre) and one month after the third vaccine dose (Post-dose 3).
TritanrixTM is a DTPw vaccine marketted by GlaxoSmithKline Biologicals S.A.
105 subjects were used in each of the five groups giving a total of 525 subjects in the study.










TABLE 1





Components per dose (0.5 ml)
2.5/2.5/2.5*
2.5/5/5
5/5/5







Hib capsular polysaccharide PRP
2.5 μg
2.5 μg
5 μg


conjugated to tetanus toxoid (TT)





Neisseria meningitidis A capsular
2.5 μg
  5 μg
5 μg


polysaccharide (PSA) conjugated to TT





Neisseria meningitidis C capsular
2.5 μg
  5 μg
5 μg


polysaccharide (PSC) conjugated to TT





*The 2.5/2.5/2.5 vaccine was a dose dilution of GSK Biologicals' Hib-MenAC 5/5/5 vaccine containing 2.5 μg of each of PRP-TT, MenA-TT and MenC-TT.






The Hib-MenAC vaccine formulations were mixed extemporaneously with Tritanirix-HepB. GSK Biologicals' combined diphtheria-tetanus-whole cell Bordetella pertussis—hepatitis B (DTPw-HB) vaccine (Tritanrix-HepB) contains not less than 30 International Units (IU) of diphtheria toxoid, not less than 60 IU of tetanus toxoid, not less than 4 IU of killed Bordetella pertussis and 10 μg of recombinant hepatitis B surface antigen.
Reference Therapy, Dose, Mode of Administration, Lot No.:
Vaccination schedule/site: One group received Tritanrix.-HepB vaccine intramuscularly in the left thigh and HiberixTM intramuscularly in the right thigh at 6, 10 and 14 weeks of age. Another group received TritanrixTM-HepB/HiberixTM vaccine intramuscularly in the left thigh and MeningitecTM vaccine intramuscularly in the right thigh at 6, 10 and 14 weeks of age.
Vaccine/composition/dose/lot number: The TritanrixTM-HepB vaccine used was as described above.
One dose (0.5 ml) of GSK Biologicals' Haemophilus influenzae type b conjugate vaccine: HiberixTM contained 10 μg of PRP conjugated to tetanus toxoid. In the Hiberix Group, it was mixed with sterile diluent and in the Meningitec Group it was mixed with Tritanrix-HepB.
One dose (0.5 ml) of Wyeth Lederle's MENINGITECTM vaccine contained: 10 μg of capsular polysaccharide of meningococcal group C conjugated to 15 μg of Corynebacterium diphtheria CRM197 protein and aluminium as salts.
Results—Immune Responses Generated Against Hib, MenA and MenC







TABLE 2a







Anti - PRP (μg/ml)









Group













2.5/2.5/2.5
2.5/5/5
5/5/5
Hiberix TM
Meningitec TM


















%
95% CL
%
95% CL
%
95% CL
%
95% CL
%
95% CL























GMC/T
LL
UL
GMC/T
LL
UL
GMC/T
LL
UL
GMC/T
LL
UL
GMC/T
LL
UL

























% ≧ 0.15
100
96.5
100
99.0
94.8
100
100
96.5
100
100
96.5
100
100
96.5
100


GMC
20.80
15.96
27.10
22.62
17.72
28.88
19.36
15.33
24.46
38.55
29.93
49.64
10.94
8.62
13.88
















TABLE 2b







SBA -MenC









Group













2.5/2.5/2.5
2.5/5/5
5/5/5
Hiberix TM
Meningitec TM


















%
95% CL
%
95% CL
%
95% CL
%
95% CL
%
95% CL























GMC/T
LL
UL
GMC/T
LL
UL
GMC/T
LL
UL
GMC/T
LL
UL
GMC/T
LL
UL

























% ≧ 1:8
99
94.7
100
100
96.5
100
100
96.5
100
2.9
0.6
8.4
100
96.5
100


GMT
3132
2497
3930
4206
3409
5189
3697
3118
4384
4.7
3.9
5.6
4501
3904
5180
















TABLE 2c







SBA MenA









Group













2.5/2.5/2.5
2.5/5/5
5/5/5
Hiberix TM
Meningitec TM


















%
95% CL
%
95% CL
%
95% CL
%
95% CL
%
95% CL























GMC/T
LL
UL
GMC/T
LL
UL
GMC/T
LL
UL
GMC/T
LL
UL
GMC/T
LL
UL

























% ≧ 1:8
99.7
91.9
99.7
100
95.8
100
100
96.2
100
6.8
2.5
14.3
9.1
4.0
17.1


GMT
316.7
251.4
398.9
418.5
358.6
488.5
363
310.5
424.4
5.6
4.3
7.4
5.6
4.4
7.2
















TABLE 2d







Anti-PSC (μg/ml)









Group













2.5/2.5/2.5
2.5/5/5
5/5/5
Hiberix TM
Meningitec TM


















%
95% CL
%
95% CL
%
95% CL
%
95% CL
%
95% CL























GMC/T
LL
UL
GMC/T
LL
UL
GMC/T
LL
UL
GMC/T
LL
UL
GMC/T
LL
UL

























% ≧ 0.3
100
96.5
100
100
96.4
100
100
96.5
100
8.2
3.6
15.6
100
96.5
100


GMC
49.03
43.24
55.59
71.11
62.49
80.92
61.62
54.88
69.20
0.17
0.15
0.19
58.02
51.42
65.46
















TABLE 2e







Anti - PSA (μg/ml)









Group













2.5/2.5/2.5
2.5/5/5
5/5/5
Hiberix TM
Meningitec TM


















%
95% CL
%
95% CL
%
95% CL
%
95% CL
%
95% CL























GMC/T
LL
UL
GMC/T
LL
UL
GMC/T
LL
UL
GMC/T
LL
UL
GMC/T
LL
UL

























% ≧ 0.3
100
96.4
100
100
96.5
100
99.0
94.8
100
1.0
0.0
5.4
5.9
2.2
12.5


GMC
18.10
15.34
21.35
26.51
22.93
30.79
23.40
20.05
27.30
0.15
0.15
0.15
0.17
0.15
0.18
















TABLE 2f







Anti-BPT (EL · U/ml)









Group













2.5/2.5/2.5
2.5/5/5
5/5/5
Hiberix TM
Meningitec TM


















%
95% CL
%
95% CL
%
95% CL
%
95% CL
%
95% CL























GMC/T
LL
UL
GMC/T
LL
UL
GMC/T
LL
UL
GMC/T
LL
UL
GMC/T
LL
UL

























% VR
100
96.4
100
98
93.1
99.8
94.2
87.8
97.8
100
96.3
100
99.0
94.7
100


CMC
108.2
94.4
123.9
81.4
70.5
94.0
60.1
51.0
70.8
110.2
96.1
126.3
86.7
75.4
99.7
















TABLE 2g







Anti-HBs (mlU/ml)









Group













2.5/2.5/2.5
2.5/5/5
5/5/5
Hiberix TM
Meningitec TM


















%
95% CL
%
95% CL
%
95% CL
%
95% CL
%
95% CL























GMC/T
LL
UL
GMC/T
LL
UL
GMC/T
LL
UL
GMC/T
LL
UL
GMC/T
LL
UL

























% ≧ 10
92.1
85.0
96.5
83.8
75.1
90.5
82.5
73.8
89.3
91.6
84.1
96.3
83.2
74.4
89.9


CMC
128.6
95.4
173.4
71.8
53.2
96.9
55.3.1
41.0
74.6
104.5
76.0
143.7
71.1
52.1
97.1









CONCLUSION
Tables 2f and 2g demonstrate that, when HibMenAC is mixed with DTPwHepB in a vaccine, a dose of 2.5/2.5/2.5 for Hib/MenA/MenC gives a higher immune response against pertussis toxoid and Hepatitis surface antigen than a dose of 2.5/5/5 which in turn generates a higher immune response against pertussis toxoid and Hepatitis B surface antigen than a dose of 5/5/5. Table 2a-e demonstrate that a low dose of HibMenA and MenC still achieves a good immune response against Hib, MenA and MenC with 99-100% of patients achieving an immune response above the chosen thresholds.
Example 4
HibMenAC Clinical Trial—Priming with HibMenAC Conjugates
A phase II, open, randomized study was carried out to assess the immune memory induced by primary vaccination course of TritanrixTM-HepB/HibMenAC vaccine, and to assess the immunogenicity and reactogenicity of a booster dose of GSK Biologicals' TritanrixTM-HepB vaccine mixed with either GSK Biologicals' Hib-MenAC conjugate vaccine or GSK Biologicals' Hib2.5 vaccine at 15 to 18 months of age in subjects primed with TritanrixTM-HepB/Hib-MenAC. Five groups received the primary vaccination regimens at 6, 10 and 14 weeks of age as presented in table 3.










TABLE 3





Primary vaccination
Grp
At 10 months of age
At 15 to 18 months of age















Treatment groups










Tritanrix TM-HepB/Hib-MenAC
1
1⁄5th dose of Mencevax TM AC (10 μg MenA & 10 μg MenC) and 10 μg
Tritanrix TM-HepB/Hib2.5


2.5/2.5/2.5

of Plain PRP




2
—
Tritanrix TM-HepB/Hib2.5


Tritanrix TM-HepB/Hib-MenAC 5/5/5
3
1⁄5th dose of Mencevax TM AC (10 μg MenA & 10 μg MenC) and 10 μg
Tritanrix TM-HepB/Hib2.5




of Plain PRP




4
—
Tritanrix TM-HepB/Hib2.5


Tritanrix TM-HepB/Hib-MenAC
5
1⁄5th dose of Mencevax TM AC (10 μg MenA & 10 μg MenC) and 10 μg
Tritanrix TM-HepB/Hib2.5


2.5/5/5

of Plain PRP




6
—
Tritanrix TM-HepB/Hib2.5







Control groups










Tritanrix TM-HepB + Hiberix TM
7
1⁄5th dose of Mencevax TM AC (10 μg MenA & 10 μg MenC) and 10 μg
Tritanrix TM-HepB/Hib-




of Plain PRP
MenAC



8
—
Tritanrix TM-HepB/Hib-





MenAC


Tritanrix TM-HepB/Hiberix TM +
9
1⁄5th dose of Mencevax TM AC (10 μg MenA & 10 μg MenC) and 10 μg
Tritanrix TM-HepB/Hib-


Meningitec TM

of Plain PRP
MenAC



10 
—
Tritanrix TM-HepB/Hib-





MenAC









Blood samples were taken from Groups 1, 3, 5, 7 and 9 at the time of the plain polysaccharide (PS) booster (i.e. Pre-PS—Month 10) and one month after the plain polysaccharide booster (i.e. Post-PS—Month 11).
Note:
The immunogenicity results obtained in the five groups who received the plain polysaccharide booster (i.e. Groups 1, 3, 5, 7 and 9) have been presented.
Number of Subjects:
Planned: 450 (45 subjects per group)
Enrolled:
In Groups 1, 3, 5, 7 and 9 receiving the plain polysaccharide booster a total of 193 subjects (42 in Group 1, 39 in Group 3, 37 in Group 5, 36 in Group 7 and 39 in Group 9) were enrolled. Completed: Not applicable
Immunogenicity:
Total enrolled cohort=193 subjects
Note:
In this study the total enrolled cohort=total vaccinated cohort.
Diagnosis and Criteria for Inclusion:
A male or female subject aged 10 months of age who had completed the three-dose primary vaccination course described in example 1, free of obvious health problems, who had not received previous booster vaccination against diphtheria, tetanus, pertussis, hepatitis B, meningococcal serogroups A or C and/or Hib disease since the study conclusion visit of the primary study. Written informed consent was obtained from the parent/guardian of the subject prior to study entry.
Study Vaccines, Dose, Mode of Administration, Lot No.: All vaccines used in this study were developed and manufactured by GSK Biologicals.
Vaccination Schedule/Site:
Subjects in Groups 1, 3, 5, 7 and 9 received the combined polysaccharide A and polysaccharide C vaccine, 1⁄5th dose of MencevaxTM AC and 10 μg of plain PRP as an intramuscular injection in the left and right anterolateral thigh at 10 months of age, respectively.
Duration of Treatment:
The duration of the entire study was approximately 6 to 9 months per subject which included the booster vaccination administered at 15 to 18 months of age. Interim analysis was done at Month 11 (i.e. one month after administration of the plain polysaccharide booster at Month 10).
Criteria for Evaluation:
Prior to and one month after administration of the plain polysaccharide booster the criteria for evaluation for Groups 1, 3, 5, 7 and 9 were as follows—

    
    
        SBA-MenA antibody titre≧1:8
        SBA-MenC antibody titre≧1:8
        Anti-PSA antibody concentration≧0.3 μg/ml
        Anti-PSC antibody concentration≧0.3 μg/ml
        Anti-PRP antibody concentration≧0.15 μg/ml.
    
    


Statistical Methods:
This interim analysis was based on the total enrolled cohort. All analyses were purely descriptive and no statistical inference on any endpoints was calculated. Analyses were performed only for the five groups (i.e. Groups 1, 3, 5, 7 and 9) that received the plain polysaccharide booster at 10 months of age. Though these five groups were sub-groups of the main groups in the primary study, the results are presented as per the primary study group allocation.
Analysis of Immunogenicity:
The results obtained at three time points have been presented in this example namely—one month after the third vaccine dose in the primary vaccination study (Example 1), prior to the administration of the polysaccharide booster (i.e. at 10 months of age) for evaluation of the persistence of immune response after primary vaccination and one month after the administration of the polysaccharide booster (i.e. at 11 months of age) for evaluation of immune memory induced by primary vaccination. At each time point: Geometric Mean antibody Concentrations or Titres (GMCs or GMTs) with 95% confidence intervals (CIs) were tabulated for serum bactericidal assay (SBA)-MenC, SBA-MenA, anti-PSC, anti-PSA and anti-PRP. Seropositivity or seroprotection rates with exact 95% CIs were calculated for each antibody. Antibody concentrations or titres prior to polysaccharide booster & one month post-polysaccharide booster were investigated using reverse cumulative curves (RCCs) for each antigen and serotype.
Results
Demography Results:
The mean age of the total enrolled cohort was 43.2 weeks with a standard deviation of 6.5 weeks. The male to female ratio was 1.3 (110/83). All subjects belonged to either the East Asian or South-East Asian race.
Immunogenicity Results:
The immunogenicity results for the total enrolled cohort are presented in the table 4.












TABLE 4a





Antibody
Group
Timing
95% CI (LL, UL)
GMC/ GMT
95% CI (LL, UL)























Anti-PRP
2.5/2.5/2.5
PIII(M3)
100.0
91.6
100.0
17.872
11.358
28.123


(% ≧ 0.15 μg/ml)

PRE-PS
97.5
86.8
99.9
6.940
4.402
10.941




POST-PS
100.0
91.6
100.0
66.510
38.690
114.334



5/5/5
PIII(M3)
100.0
91.0
100.0
17.306
11.477
26.095




PRE-PS
94.9
82.7
99.4
4.520
2.946
6.937




POST-PS
100.0
91.0
100.0
44.418
26.595
74.186



2.5/5/5
PIII(M3)
100.0
90.5
100.0
22.484
15.217
33.223




PRE-PS
100.0
89.7
100.0
5.092
3.290
7.883




POST-PS
100.0
90.5
100.0
54.244
32.251
91.234



Hiberix TM
PIII(M3)
100.0
90.3
100.0
30.106
18.316
49.485




PRE-PS
100.0
90.3
100.0
5.105
3.238
8.049




POST-PS
100.0
90.3
100.0
37.049
21.335
64.336



Meningitec TM
PIII(M3)
100.0
91.0
100.0
12.257
8.234
18.246




PRE-PS
100.0
91.0
100.0
4.227
2.804
6.372




POST-PS
100.0
91.0
100.0
24.354
15.308
38.747


SBA-MenA
2.5/2.5/2.5
PIII(M3)
97.1
84.7
99.9
342.3
230.7
507.9


(% ≧ 1:8)

PRE-PS
91.7
77.5
98.2
161.9
93.9
279.1




POST-PS
100.0
88.4
100.0
737.2
577.3
941.4



5/5/5
PIII(M3)
100.0
90.0
100.0
394.6
297.8
523.0




PRE-PS
94.3
80.8
99.3
193.2
126.7
294.7




POST-PS
96.7
82.8
99.9
720.8
479.8
1082.7



2.5/5/5
PIII(M3)
100.0
90.0
100.0
385.8
285.9
520.5




PRE-PS
88.2
72.5
96.7
162.7
95.8
276.2




POST-PS
100.0
88.4
100.0
929.9
718.4
1203.6



Hiberix TM
PIII(M3)
10.0
2.1
26.5
6.6
3.7
11.7




PRE-PS
72.7
54.5
86.7
96.9
46.0
204.1




POST-PS
100.0
89.4
100.0
631.8
475.5
839.4



Meningitec TM
PIII(M3)
6.9
0.8
22.8
4.8
3.6
6.4




PRE-PS
80.0
63.1
91.6
119.7
62.7
228.3




POST-PS
92.1
78.6
98.3
449.9
271.7
745.0


SBA-MenC
2.5/2.5/2.5
PIII(M3)
100.0
91.6
100.0
3342.3
2466.9
4528.3


(% ≧ 1:8)

PRE-PS
90.5
77.4
97.3
322.3
190.2
546.1




POST-PS
100.0
91.6
100.0
2713.5
1909.4
3856.2



5/5/5
PIII(M3)
100.0
91.0
100.0
3863.1
3025.9
4932.1




PRE-PS
97.3
85.8
99.9
463.9
292.9
734.7




POST-PS
100.0
91.0
100.0
2377.3
1665.4
3393.4



2.5/5/5
PIII(M3)
100.0
90.5
100.0
5339.0
3829.4
7443.6




PRE-PS
94.6
81.8
99.3
451.4
281.7
723.5




POST-PS
100.0
90.3
100.0
2824.7
2048.1
3895.8



Hiberix TM
PIII(M3)
2.8
0.1
14.5
4.5
3.6
5.7




PRE-PS
5.7
0.7
19.2
4.8
3.6
6.4




POST-PS
17.6
6.8
34.5
9.8
4.8
19.7



Meningitec TM
PIII(M3)
100.0
91.0
100.0
4557.8
3539.3
5869.5




PRE-PS
97.4
86.5
99.9
347.7
221.6
545.4




POST-PS
100.0
91.0
100.0
1557.7
1090.8
2224.4





95% CI: 95% confidence interval; LL: Lower Limit; UL: Upper Limit; GMC/GMT: Geometric mean concentration/Geometric mean titre


PIII(M3): Post-vaccination blood sample obtained one month after the third dose of the three-dose primary vaccination


PRE-PS: Blood sample obtained prior to plain polysaccharide booster at Month 10


POST-PS: Blood sample obtained one month after the plain polysaccharide booster


















TABLE 4b





Antibody
Group
Timing
95% CI (LL, UL)
CMC/GMT
95% CI (LL, UL)























Anti-PSA
2.5/2.5/2.5
PIII(M3)
100.0
91.2
100.0
17.64
13.52
23.02


(% ≧ 0.3 μg/

PRE-PS
92.5
79.6
98.4
1.79
1.22
2.62


ml)

POST-PS
100.0
91.6
100.0
23.58
16.76
33.17



5/5/5
PIII(M3)
100.0
91.0
100.0
26.06
20.30
33.45




PRE-PS
97.4
86.5
99.9
2.25
1.60
3.18




POST-PS
100.0
91.0
100.0
24.13
17.64
33.01



2.5/5/5
PIII(M3)
100.0
90.3
100.0
24.03
18.84
30.65




PRE-PS
91.2
76.3
98.1
1.47
0.99
2.19




POST-PS
100.0
90.5
100.0
22.68
15.81
32.54



Hiberix TM
PIII(M3)
0.0
0.0
10.3
0.15
0.15
0.15




PRE-PS
5.6
0.7
18.7
0.16
0.15
0.17




POST-PS
75.8
57.7
88.9
1.03
0.55
1.93



Meningitec TM
PIII(M3)
2.6
0.1
13.8
0.16
0.14
0.17




PRE-PS
7.7
1.6
20.9
0.16
0.15
0.18




POST-PS
66.7
49.8
80.9
0.84
0.49
1.42


Anti-PSC
2.5/2.5/2.5
PIII(M3)
100.0
91.6
100.0
48.45
39.65
59.20


(% ≧ 0.3 μg/

PRE-PS
100.0
91.2
100.0
7.11
5.69
8.89


ml)

POST-PS
100.0
91.2
100.0
21.55
17.24
26.94



5/5/5
PIII(M3)
100.0
91.0
100.0
56.42
48.16
66.11




PRE-PS
100.0
91.0
100.0
8.32
6.74
10.28




POST-PS
100.0
90.0
100.0
22.32
18.21
27.36



2.5/5/5
PIII(M3)
100.0
90.3
100.0
76.98
62.69
94.53




PRE-PS
100.0
89.7
100.0
8.64
6.93
10.77




POST-PS
100.0
90.5
100.0
24.75
19.37
31.61



Hiberix TM
PIII(M3)
6.1
0.7
20.2
0.16
0.15
0.18




PRE-PS
0.0
0.0
9.7
0.15
0.15
0.15




POST-PS
100.0
90.3
100.0
8.05
5.73
11.30



Meningitec TM
PIII(M3)
100.0
91.0
100.0
59.05
48.16
72.41




PRE-PS
100.0
91.0
100.0
7.33
5.51
9.75




POST-PS
100.0
90.7
100.0
17.13
13.38
21.94





95% CI: 95% confidence interval; LL: Lower Limit; UL: Upper Limit; GMC/GMT: Geometric mean concentration/Geometric mean titre


PIII(M3): Post-vaccination blood sample obtained one month after the third dose of the three-dose primary vaccination


PRE-PS: Blood sample obtained prior to plain polysaccharide booster at Month 10


POST-PS: Blood sample obtained one month after the plain polysaccharide booster






CONCLUSION
The HibMenAC 2.5/5/5 conjugate vaccine formulation containing a lower amount of Hib tended to give a better immune memory response to MenA and MenC in SBA assays than the vaccine formulations containing equal amounts of all three conjugates. This can be seen from a comparison of the POST-PS readings. Therefore the use of the 2.5/5/5 formulation in priming results in a superior immune memory response.
Looking at the PIII(M3) data, higher readings were seen for the 2.5/5/5 formulation for Hib (22.5 v 17) and MenC (76 v 48 or 56 and 5339 v 3342 or 3863 by SBA).
Example 5a
Clinical Trial Using HibMenCY Given Concomitantly with Infanrix Penta and Prevenar in Infants at 2, 4 and 6 Months
Study Design:
Phase II, open (partially double-blind*), randomized (1:1:1:1:1), controlled, multicentric study with five parallel groups who received concomitant vaccines as follows as a 3-dose primary vaccination course at age 2, 4 and 6 months:

    
    
        Group Hib-MenCY 2.5/5/5: Hib-MenCY (2.5/5/5)+Infanrix® penta+Prevenar®
        Group Hib-MenCY 5/10/10: Hib-MenCY (5/10/10)+Infanrix® penta+Prevenar®
        Group Hib-MenCY 5/5/5: Hib-MenCY (5/5/5)+Infanrix® penta+Prevenar®
        Group Menjugate: Menjugate®+Act HIB®+Infanrix® penta**
        Group ActHIB: ActHIB®+Infanrix® penta+Prevenar®
    
    


*Hib-MenCY (2.5/5/5) and Hib-MenCY (5/10/10) were administered in a double-blind manner. The Hib-MenCY (5/5/5) formulation could not be administered in a double blind as it was prepared by reconstituting a Hib-MenCY (10/10/10) formulation with 1.0 ml diluent (half the solution was discarded and the remaining 0.5 ml was administered), whereas the Hib-MenCY (2.5/5/5) and Hib-MenCY (5/10/10) formulations were administered after reconstitution with 0.5 ml diluent.
**Subjects from this group will be offered two doses of a licensed pneumococcal conjugate vaccine at the end of the booster study 792014/002 according to prescribing information.
Blood samples (4.0 ml) were obtained from all subjects prior to and one month after completion of the primary vaccination course (Study Month 0 and Study Month 5).
The study was planned to be on 400 subjects with 80 subjects in each of the five groups. In study was completed with a total of 398 subjects (Group Hib-MenCY 2.5/5/5: 80 Group Hib-MenCY 5/10/10: 81; Group Hib-MenCY 5/5/5: 78; Group Menjugate: 81; Group ActHIB: 78)
Vaccination Schedule/Site:
Three doses injected intramuscularly at two month intervals, at approximately 2, 4 and 6 months of age as follows:







TABLE 5







Vaccines administered and site









Group
Vaccines administered left thigh
Vaccines administered right thigh





Hib-MenCY 2.5/5/5
Hib-TT (2.5 μg)-MenC-TT (5 μg)-
DTPa-HBV-IPV (Infanrix ®



MenY-TT
penta): upper



(5 μg)
Pneumococcal (Prevenar ®):




lower


Hib-MenCY 5/10/10
Hib-TT (5 μg)-MenC-TT (10 μg)-
DTPa-HBV-IPV (Infanrix ®



MenY-TT
penta): upper



(10 μg)
Pneumococcal (Prevenar ®):




lower


Hib-MenCY 5/5/5
Hib-TT (5 μg)-MenC-TT (5 μg)-
DTPa-HBV-IPV (Infanrix ®



MenY-TT
penta): upper



(5 μg)
Pneumococcal (Prevenar ®):




lower




DTPa-HBV-IPV (Infanrix ®


Menjugate ®
ActHIB ®
penta): upper




MenC (Menjugate ®): lower




DTPa-HBV-IPV (Infanrix ®


ActHIB ®
ActHIB ®
penta): upper




Pneumococcal (Prevenar ®):




lower
















TABLE 6







Candidate vaccine formulation and lot numbers










Vaccine
Formulation: contents/dose
Presentation
Lot no.(diluent lot no.)





Hib-MenCY 2.5/5/5
H. influenzae type b capsular
Lyophilized pellet in
DCYH003A48



polysaccharide polyribosyl ribitol
monodose vial (0.5 ml
(01B20/22A)



(PRP) 2.5 μg conjugated to
after reconstitution




tetanus toxoid (TT);
with saline diluent)




N. meningitidis serogroup C





capsular polysaccharide (PSC)





5 μg conjugated to TT;





N. meningitidis serogroup Y





capsular polysaccharide (PSY)





5 μg conjugated to TT




Hib-MenCY 5/10/10
PRP 5 μg conjugated to TT;
Lyophilized pellet in
DCYH002A48



PSC 10 μg conjugated to TT;
monodose vial (0.5 ml
(01B20/22A)



PSY 10 μg conjugated to TT
after reconstitution





with saline diluent)



Hib-MenCY 5/5/5
PRP 5 μg conjugated to TT;
Lyophilized pellet in
DCYH001A48



PSC 5 μg conjugated to TT;
monodose vial.*
(01B20/22A)



PSY 5 μg conjugated to TT





*The Hib-MenCY 5/5/5 was prepared by dissolving Hib-MenCY 10/10/10 formulation with 1.0 ml diluent; 0.5 ml was administered and the remaining 0.5 ml was discarded.






Criteria for Evaluation:
Immunogenicity:
Measurement of titers/concentrations of antibodies against each vaccine antigen prior to the first dose (Month 0) and approximately one month after the third dose (Month 5) in all subjects. Determination of bactericidal antibody titers against N. meningitidis serogroups C and Y (SBA-MenC and SBA-MenY) by a bactericidal test (assay cut-offs: a dilution of 1:8 and 1:128) and ELISA measurement of antibodies against N. meningitidis serogroups C and Y (anti-PSC and anti-PSY, assay cut-offs≧0.3 μg/ml and ≧2 μg/ml), the Hib polysaccharide PRP (anti-PRP, assay cut-offs≧0.15 μg/ml and ≧1.0 μg/ml), the three pertussis antigens (anti-PT, anti-FHA, anti-PRN, assay cut-off≧5 EL·U/ml), antibodies to hepatitis B surface antigen (anti-HBs, assay cut-off≧10 mIU/mL), diphtheria and tetanus toxoids (anti-diphtheria and anti-tetanus, assay cut-off 0.1 IU/ml); anti-poliovirus types 1, 2 and 3 (assay cut-off 1:8); seven pneumococcal serotypes anti-4, anti-6B, anti-9V, anti-14, anti-18C, anti-19F, anti-23F (assay cut-off 0.05 μg/ml). Primary vaccine response to the pertussis antigens was defined as seropositivity (detectable antibodies) after the third dose in subjects with previously undetectable antibodies or at least maintenance of pre vaccination antibody concentration in subjects who were initially seropositive.
Safety (Criteria for evaluation): 8-day (Days 0 to 7) follow-up, after administration of each vaccine dose, of solicited local (pain, redness, swelling) and general (drowsiness, fever, irritability, and loss of appetite) symptoms reported on diary cards by the parent(s)/guardian(s) of the subjects; 31 day (Days 0 to 30) follow-up, after each vaccine dose, of unsolicited non-serious adverse events; and of serious adverse events (SAES) during the entire study period.
Statistical Methods:
Immunogenicity

    
    
        Geometric Mean antibody Concentrations or Titers (GMC/Ts) with 95% confidence intervals (Cis) were tabulated for each antigen. Calculation of GMC/Ts was performed by taking the anti-logarithm in base 10 (anti-log 10) of the mean of the log 10 concentration or titer transformations. Antibody concentrations or titers below the assay cut-off were given an arbitrary value of half the cut-off for the purpose of GMC/T calculation. Percentages of subjects with antibody concentration/titer above the specified assay cut-offs or with a vaccine response with exact 95% CI were calculated. Antibody concentrations/titers were investigated using reverse cumulative antibody curves for each antigen post-vaccination. The distribution of antibody concentration for the 7 pneumococcal antigens was tabulated.
        The differences between the Hib-MenCY groups, compared with the control group were evaluated in an exploratory manner for each antibody, except for SBA-MenY and anti-PSY, in terms of (1) the difference between the control group (minus) the Hib-MenCY groups for the percentage of subjects above the specified cut-offs or with a vaccine response with their standardized asymptotic 95% CI, (2) the GMC or GMT ratios of the control group over the Hib-MenCY groups with their 95% CI. The control group was Menjugate for SBA-MenC and anti-PSC; the control group for all other antigens was Group ActHIB. The same comparisons were done to evaluate the difference between each pair of Hib-MenCY formulations for anti-PRP, SBA-MenC, anti-PSC, SBA-MenY, anti-PSY and anti-tetanus antibodies.
    
    


Seroprotection/Seropositivity Rates & GMC/Ts (ATP Cohort for Immunogenicity)







TABLE 7a







Anti - PRP (μg/ml)

















Group
N
% ≧ 0.15
LL
UL
≧1
LL
UL
GMC
LL
UL




















Hib MenCY 2.5/5/5
74
100.0
95.1
100.0
97.3
90.6
99.7
6.441
5.315
7.805


Hib MenCY 5/10/10
76
100.0
95.3
100.0
98.7
92.9
100.0
7.324
5.877
9.127


Hib MenCY 5/5/5
70
100.0
94.9
100.0
92.9
84.1
97.6
5.577
4.375
7.110


Menjugate TM
74
98.6
92.7
100.0
89.2
79.8
95.2
4.465
3.399
5.865


ActHIB TM
74
100.0
95.1
100.0
94.6
86.7
98.5
5.714
4.538
7.195
















TABLE 7b







SBA -MenC (1/Dil)

















Group
N
% ≧ 1:8
LL
UL
≧1:128
LL
UL
GMT
LL
UL




















Hib MenCY 2.5/5/5
69
100.0
94.8
100.0
98.6
92.2
100.0
1293.1
1027.7
1627.1


Hib MenCY 5/10/10
76
100.0
95.3
100.0
97.4
90.8
99.7
1065.6
858.8
1322.3


Hib MenCY 5/5/5
72
100.0
95.3
100.0
95.8
88.3
99.1
968.4
770.8
1216.6


Menjugate TM
74
100.0
95.1
100.0
98.6
92.7
100.0
1931.9
1541.2
2421.6


ActHIB TM
76
1.3
0.0
7.1
0.0
0.0
4.7
4.2
3.8
4.5
















TABLE 7c







Anti-PSC (μg/ml)

















Group
N
% ≧ 0.3
LL
UL
≧2
LL
UL
GMC
LL
UL




















Hib MenCY 2.5/5/5
63
100.0
94.3
100.0
98.4
91.5
100.0
12.02
9.90
14.59


Hib MenCY 5/10/10
65
100.0
94.5
100.0
100.0
94.5
100.0
12.09
10.59
13.81


Hib MenCY 5/5/5
61
100.0
94.1
100.0
98.4
91.2
100.0
9.95
8.34
11.87


Menjugate TM
62
100.0
94.2
100.0
100.0
94.2
100.0
15.36
12.67
18.62


ActHIB TM
63
1.6
0.0
8.5
0.0
0.0
5.7
0.15
0.15
0.16
















TABLE 7d







SBA-MenY (1/Dil)

















Group
N
% ≧ 1:8
LL
UL
≧1:128
LL
UL
GMT
LL
UL




















Hib MenCY 2.5/5/5
67
98.5
92.0
100.0
95.5
87.5
99.1
843.5
640.1
1111.7


Hib MenCY 5/10/10
68
100.0
94.7
100.0
97.1
89.8
99.6
1020.0
790.0
1316.8


Hib MenCY 5/5/5
69
98.6
92.2
100.0
89.9
80.2
95.8
741.8
538.0
1022.9


Menjugate TM
68
14.7
7.3
25.4
8.8
3.3
18.2
6.9
5.0
9.5


ActHIB TM
74
16.2
8.7
26.6
9.5
3.9
18.5
7.3
5.2
10.1
















TABLE 7e







Anti - PSY (μg/ml)

















Group
N
% ≧ 0.3
LL
UL
≧2
LL
UL
GMC
LL
UL




















Hib MenCY 2.5/5/5
67
100.0
94.6
100.0
100.0
94.6
100.0
19.22
15.42
23.95


Hib MenCY 5/10/10
70
100.0
94.9
100.0
98.6
92.3
100.0
19.09
15.44
23.59


Hib MenCY 5/5/5
72
100.0
95.0
100.0
97.2
90.3
99.7
15.83
12.64
19.82


Menjugate TM
66
3.0
0.4
10.5
0.0
0.0
5.4
0.16
0.15
0.17


ActHIB TM
69
0.0
0.0
5.2
0.0
0.0
5.2
0.15
0.15
0.15









CONCLUSION
The 2.5/5/5 and 5/10/10 formulations resulted in higher titres against Hib, MenC and MenY in terms of immunogenicity and SBA results. Therefore the inclusion of lower doses of Hib conjugate in a combined conjugate vaccine gave superior results.
Co-administration of Hib-MenCY with Infanrix penta and PrevenarTM gave satisfactory results
Example 5b
Effect of Co-Administration of HibMenCY with PrevenarTM on the Response to Pneumococcal Polysaccharides
A further aspect of the study of example 3 was to investigate the level of antibodies raised against the 7 pneumococcal polysaccharides present in the PrevenarTM vaccine in order to assess the effect of co-administration of HibMenCY on the antibody titre raised against pneumococcal polysaccharides.
The GMCs and percentages of subjects with antibodies for the 7 pneumococcal serotypes≧0.05 μg/ml and ≧0.2 μg/ml are shown in Table 8. Except for the 6B serotype, seropositivity rates for the 7vPn components ranged from 95.5-100% (antibody concentrations≧0.05 μg/ml) and 93.9-100% (antibody concentrations≧0.2 μg/ml) across groups. For the 6B serotype, seropositivity rates ranged from 88.4-98.6% (antibody concentrations≧0.05 μg/ml) and 81.2-91.4% (antibody concentrations≧0.2 μg/ml) across groups (ActHIB group: 92.3%≧0.05 μg/ml; 86.2%≧0.2 μg/ml).







TABLE 8a







Anti-4












No. in 





Group
group
% ≧ 0.05 μg/ml
% ≧ 0.2 μg/ml
GMC (μg/ml)





Hib-MenCY
69
100%
100%
2.101


2.5/5/5






Hib-MenCY
70
100%
100%
2.049


5/10/10






Hib-MenCY
69
100%
100%
2.023


5/5/5






Menjugate TM
58
 3.4%
 1.7%
0.024


ActHib TM
66
100%
100%
2.062
















TABLE 8b







Anti-6B












No. in 





Group
group
% ≧ 0.05 μg/ml
% ≧ 0.2 μg/ml
GMC (μg/ml)





Hib-MenCY
68
95.6%
85.3%
1.060


2.5/5/5






Hib-MenCY
70
98.6%
91.4%
1.079


5/10/10






Hib-MenCY
69
88.4%
81.2%
0.834


5/5/5






Menjugate TM
63
 4.8%
 1.6%
0.027


ActHib TM
65
92.3%
86.2%
0.879
















TABLE 8c







Anti-9V












No. in 





Group
group
% ≧ 0.05 μg/ml
% ≧ 0.2 μg/ml
GMC (μg/ml)





Hib-MenCY
68
 100%
 100%
3.102


2.5/5/5






Hib-MenCY
71
98.6%
97.2%
2.363


5/10/10






Hib-MenCY
71
 100%
 100%
2.823


5/5/5






Menjugate TM
62
 4.8%
 1.6%
0.028


ActHib TM
67
98.5%
98.5%
2.651
















TABLE 8d







Anti-14












No. in 





Group
group
% ≧ 0.05 μg/ml
% ≧ 0.2 μg/ml
GMC (μg/ml)





Hib-MenCY
65
100%
98.5%
4.095


2.5/5/5






Hib-MenCY
65
100%
 100%
5.592


5/10/10






Hib-MenCY
68
100%
 100%
4.309


5/5/5






Menjugate TM
49
 49%
14.3%
0.062


ActHib TM
65
100%
98.5%
4.372
















TABLE 8e







Anti-18C












No. in 





Group
group
% ≧ 0.05 μg/ml
% ≧ 0.2 μg/ml
GMC (μg/ml)





Hib-MenCY
67
98.5%
98.5%
3.518


2.5/5/5






Hib-MenCY
71
 100%
98.6%
2.969


5/10/10






Hib-MenCY
72
 100%
 100%
2.936


5/5/5






Menjugate TM
65
 7.7%
 3.1%
0.029


ActHib TM
67
98.5%
  97%
3.326
















TABLE 8f







Anti-19F












No. in 





Group
group
% ≧ 0.05 μg/ml
% ≧ 0.2 μg/ml
GMC (μg/ml)





Hib-MenCY
65
 100%
 100%
2.303


2.5/5/5






Hib-MenCY
67
98.5%
98.5%
1.846


5/10/10






Hib-MenCY
66
 100%
 100%
2.061


5/5/5






Menjugate TM
56
12.5%
 3.6%
0.030


ActHib TM
65
 100%
96.9%
1.881
















TABLE 8g







Anti-23F












No. in 





Group
group
% ≧ 0.05 μg/ml
% ≧ 0.2 μg/ml
GMC (μg/ml)





Hib-MenCY
66
98.5%
  97%
2.581


2.5/5/5






Hib-MenCY
68
97.1%
94.1%
2.112


5/10/10






Hib-MenCY
70
95.7%
95.7%
2.098


5/5/5






Menjugate TM
59
 5.1%
 0.0%
0.027


ActHib TM
66
95.5%
93.9%
1.988









CONCLUSION
Co-administration of all three formulations of HibMenCY with Prevnar led to satisfactory immune responses against the seven pneumococcal serotypes. Serotype 6B is a difficult immunogen to raise a response against. In the case of 6B, a higher GMC and percentage of subjects achieving the two threshold levels was achieved using the lower Hib dose formulations of HibMenC. Therefore the uses of lower dose Hib conjugate vaccines for co-administration with pneumococcal polysaccharide conjugates leads to a better response against the 6B antigen.
Example 6
Phase II Clinical Trial Administering Hib MenCY Concomitantly with Infanrix Penta According to a 2, 3 and 4 Month Schedule
Study Design:
A Phase II, open (partially double-blind*) randomized controlled multi-center study with 5 groups receiving a three-dose primary schedule with vaccines as follows:
Group Hib-MenCY 2.5/5/5: Hib-MenCY (2.5/5/5)+InfanrixTM penta
Group Hib-MenCY 5/10/10: Hib-MenCY (5/10/10)+InfanrixTM penta
Group Hib-MenCY 5/5/5: Hib-MenCY (5/5/5)+InfanrixTM penta
Group Hib-MenC: Hib-MenC (5/5)+InfanrixTM penta
Group Menjugate: MenjugateTM**+InfanrixTM hexa (control).
*Hib-MenCY 2.5/5/5, Hib-MenCY 5/10/10 and Hib-MenC were administered in a double-blind manner while the Hib-MenCY 5/5/5 group and the Menjugate group were open.
**MenjugateTM was the vaccine that was administered to all subjects in the group. Vaccination at +/−2, 3, 4 months of age (StudyMonth 0, Month 1 and Month 2), and blood samples (3.5 ml) from all subjects prior to and one month post primary vaccination (StudyMonth 0 and Month 3).
Study Vaccine, Dose, Mode of Administration, Lot Number:
Three doses injected intramuscularly at one month intervals, at approximately 2, 3 and 4 months of age as follows:







TABLE 8







Vaccines administered (study and control), group, schedule/site and dose












Vaccine dose
Concomitant vaccine



Schedule
administered
administered


Group
(months of age)
Site- Left upper thigh
Site Right upper thigh





Hib-MenCY 2.5/5/5
2, 3, and 4
Hib (2.5 μg)- MenC-TT
DTPa-HBV-IPV




(5 μg)-MenY-TT (5 μg)
(Infanrix TM penta)


Hib-MenCY 5/10/10
2, 3, and 4
Hib (5 μg)-MenC-TT
DTPa-HBV-IPV




(10 μg)-MenY-TT (10 μg)
(Infanrix TM penta)


Hib-MenCY 5/5/5
2, 3, and 4
Hib (5 μg)-MenC-TT 
DTPa-HBV-IPV




(5 μg)-MenY-TT (5 μg)
(Infanrix TM penta)


Hib-MenC
2, 3, and 4
Hib (5 μg)-Men C (5 μg)
DTPa-HBV-IPV





(Infanrix TM penta)


Menjugate TM
2, 3, and 4
Menjugate TM
DTPa-HBV-IPV/Hib





(Infanrix TM hexa)









Immunogenicity:
Measurement of Antibody Titres/Concentrations against Each Vaccine Antigen:
Prior to the first dose (Month 0) and approximately one month after the third dose (Month 3) in all subjects for: SBA-MenC and SBA-MenY, anti-PSC and anti-PSY, anti-PRP, anti-T, anti-FHA, anti-PRN and anti-PT. Using serum bactericidal activity against N. meningitidis serogroups C and Y (SBA-MenC and SBA-MenY cut-off: 1:8 and 1:128); ELISA assays with cut-offs: ≧0.3 μg/ml and ≧2 μg/ml for anti-N. meningitidis serogroups C and Y polysaccharides (anti-PSC IgG and anti-PSY IgG); ≧0.15 μg/ml and ≧1.0 μg/ml for Hib polysaccharide polyribosil-ribitol-phosphate (anti-PRP IgG); 5 EL·U/ml for anti-FHA, anti-PRN, anti-PT; ≦0.1 IU/ml anti-tetanus toxoid (anti-TT). Only at one month after the third dose (Month 3) in all subjects for: anti-D, anti-HBs and anti-polio 1, 2 and 3. Using ELISA assays with cut-offs: 0.1 IU/ml for anti-diphtheria (anti-D); ≧10 mIU/ml for antihepatitis B (anti-HBs); and microneutralization test cut-off: 1:8 for anti-polio type 1, 2 and 3 (anti-polio 1, 2 and 3).
Statistical Methods:
The seroprotection/seropositivity rates and geometric mean concentrations/titres (GMCs/GMTs) with 95% confidence intervals (95% CI) were computed per group, for SBA-MenC, anti-PSC, SBA-MenY, anti-PSY, anti-PRP, anti-Tetanus, anti-PT, anti-FHA and anti-PRN prior to and one month after vaccination; for anti-Diphtheria, anti-HBs, anti-Polio 1, anti-Polio 2 and anti-Polio 3 one month after vaccination. Vaccine response (appearance of antibodies in subjects initially seronegative or at least maintenance of antibody concentrations in subjects initially seropositive) with 95% CI for anti-PT, anti-PRN and anti-FHA were also computed one month after vaccination. Reverse cumulative curves for each antibody at Month 3 are also presented. The differences between the Hib-MenCY and the Hib-MenC groups, compared with the MenjugateTM control group were evaluated in an exploratory manner for each antibody, except for SBA-MenY and anti-PSY, in terms of (1) the difference between the MenjugateTM group (minus) the Hib-MenCY and Hib-MenC groups for the percentage of subjects above the specified cut-offs or with a vaccine response with their standardized asymptotic 95% CI, (2) the GMC or GMT ratios of the MenjugateTM group over the Hib-MenCY and Hib-MenC groups with their 95% CI. The same comparisons were done to evaluate the difference between each pair of Hib-MenCY formulations for anti-PRP, SBA-MenC, anti-PSC, SBA-MenY, anti-PSY and anti-TT antibodies.
The overall incidences of local and general solicited symptoms were computed by group according to the type of symptom, their intensity and relationship to vaccination (as percentages of subjects reporting general, local, and any solicited symptoms within the 8 days following vaccination and their exact 95% CI). Incidences of unsolicited symptoms were computed per group. For Grade 3 symptoms, onset ≦48 hours, medical attention, duration, relationship to vaccination and outcomes were provided. Serious Adverse Events were fully described.
Seroprotection/Seropositivity Rates & GMC/Ts (ATP Cohort for Immunogenicity)







TABLE 9a







Anti - PRP (μg/ml)

















Group
N
% ≧ 0.15
LL
UL
≧1
LL
UL
GMC
LL
UL




















Hib MenCY 2.5/5/5
67
100.0
94.6
100.0
98.5
92.0
100.0
9.01
7.25
11.21


Hib MenCY 5/10/10
67
100.0
94.6
100.0
98.5
92.0
100.0
9.49
7.72
11.65


Hib MenCY 5/5/5
70
100.0
94.9
100.0
98.6
92.3
100.0
8.08
6.53
9.98


Hib MenC
74
100.0
95.1
100.0
98.6
92.7
100.0
10.44
8.49
12.83


Menjugate TM
71
100.0
94.9
100.0
80.3
69.1
88.8
2.60
1.97
3.43
















TABLE 9b







SBA -MenC (Titre)

















Group
N
% ≧ 1:8
LL
UL
≧1:128
LL
UL
GMT
LL
UL




















Hib MenCY 2.5/5/5
70
100.0
94.9
100.0
95.7
88.0
99.1
1005.8
773.5
1308.0


Hib MenCY 5/10/10
67
100.0
94.6
100.0
94.0
85.4
98.3
1029.8
799.7
1326.0


Hib MenCY 5/5/5
71
100.0
94.9
100.0
94.4
86.2
98.4
906.9
691.3
1189.8


Hib MenC
74
100.0
95.1
100.0
95.9
88.6
99.2
871.0
677.3
1120.0


Menjugate TM
71
100.0
94.9
100.0
100.0
94.9
100.0
3557.6
2978.8
4248.8
















TABLE 9c







Anti-PSC (μg/ml)

















Group
N
% ≧ 0.3
LL
UL
≧2
LL
UL
GMC
LL
UL




















Hib MenCY 2.5/5/5
69
100.0
94.8
100.0
100.0
94.8
100.0
21.70
18.36
25.65


Hib MenCY 5/10/10
66
100.0
94.6
100.0
100.0
94.6
100.0
27.26
23.26
31.95


Hib MenCY 5/5/5
70
100.0
94.9
100.0
100.0
94.9
100.0
19.02
16.49
21.93


Hib MenC
74
100.0
95.1
100.0
100.0
95.1
100.0
21.08
18.24
24.35


Menjugate TM
71
100.0
94.9
100.0
100.0
94.9
100.0
38.49
33.64
44.05
















TABLE 9d







SBA-MenY (Titre)

















Group
N
% ≧ 1:8
LL
UL
≧1:128
LL
UL
GMT
LL
UL




















Hib MenCY 2.5/5/5
69
97.1
89.9
99.6
92.8
83.9
97.6
470.7
351.1
631.2


Hib MenCY 5/10/10
66
97.0
89.5
99.6
86.4
75.7
93.6
437.1
322.0
593.4.8


Hib MenCY 5/5/5
71
98.6
92.4
100.0
95.8
88.1
99.1
635.3
501.5
804.8


Hib MenC
74
21.6
12.9
32.7
13.5
6.7
23.5
9.3
6.3
13.7


Menjugate TM
71
19.7
11.2
30.9
9.9
4.1
19.3
7.5
5.4
10.4
















TABLE 9e







Anti - PSY (μg/ml)

















Group
N
% ≧ 0.3
LL
UL
≧2
LL
UL
GMC
LL
UL




















Hib MenCY 2.5/5/5
69
100.0
94.8
100.0
100.0
94.8
100.0
26.86
22.86
31.56


Hib MenCY 5/10/10
66
100.0
94.6
100.0
100.0
94.6
100.0
37.02
31.84
43.04


Hib MenCY 5/5/5
70
100.0
94.9
100.0
100.0
94.9
100.0
23.57
19.94
27.86


Hib MenC
74
8.1
3.0
16.8
4.1
0.8
11.4
0.19
0.15
0.25


Menjugate TM
71
5.6
1.6
13.8
1.4
0.0
7.6
0.17
0.15
0.19
















TABLE 9e







Anti-tetanus (IU/ml)














Group
N
% ≧ 0.1
LL
UL
GMC
LL
UL

















Hib MenCY 2.5/5/5
68
100.0
94.7
100.0
3.06
2.63
3.55


Hib MenCY 5/10/10
67
100.0
94.6
100.0
3.25
2.88
3.68


Hib MenCY 5/5/5
70
100.0
94.9
100.0
2.97
2.59
3.41


Hib MenC
74
100.0
95.1
100.0
3.15
2.73
3.64


Menjugate TM
71
100.0
94.9
100.0
1.66
1.39
1.97





Group Hib-MenCY 2.5/5/5: Hib-MenCY (2.5/5/5) + Infanrix TM penta


Group Hib-MenCY 5/10/10: Hib-MenCY (5/10/10) + Infanrix  TM penta


Group Hib-MenCY 5/5/5: Hib-MenCY (5/5/5) + Infanrix TM penta


Group Hib-MenC: Hib-Men (5/5) + Infanrix TM hexa


Group Menjugate: Menjugate TM + Infanrix TM penta


N = number of subjects with available results. % = percentage of subjects with concentration/titre within the specified range


GMC/T: geometric mean concentration/titre 95% CI = 95% confidence interval; LL = Lower Limit; UL = Upper Limit






CONCLUSION
The immune responses against Hib and MenC were superior using the two formulations with reduced doses of Hib. For MenY, an improved SBA response was seen using the 2.5/5/5 and 5/10/10 formulations compared to the 5/5/5 formulation.

## Claims

1. A method of immunising a human host against disease caused by Haemophilus influenza (Hib) comprising administering to the human host an immunoprotective dose of an immunogenic composition, wherein the immunogenic composition comprises: a Hib saccharide conjugate; a Neisseria meningitidis (N. meningitidis) capsular saccharide conjugate derived from a strain selected from the group consisting of serogroup A, serogroup B, serogroup C, serogroup W135 and serogroup Y; and an antigen selected from the group consisting of whole cell pertussis and hepatitis B surface antigen, wherein the saccharide dose of the Hib saccharide conjugate is less than 5 μg and the saccharide dose of the N. meningitidis capsular saccharide conjugate is less than 8 μg, and wherein the Geometric Mean Concentration (GMC) for the antigen achieved with said immunogenic composition is higher than the GMC achieved after immunisation with said immunogenic composition containing a 5 μg saccharide dose of Hib saccharide conjugate and an 8 μg dose of N. meningitidis capsular saccharide conjugate.

2. The method of claim 1 wherein the saccharide dose of the N. meningitidis capsular saccharide conjugate is less than 6 μg.

3. The method of claim 1 wherein the saccharide dose of the N. Meningitidis capsular saccharide conjugate is 1-4 μg.

4. The method of claim 1 wherein the immunogenic composition comprises N. meningitidis serogroup C capsular saccharide (MenC).

5. The method of claim 1 wherein the immunogenic composition comprises N. meningitidis serogroup A capsular saccharide (MenA).

6. The method of claim 1 wherein the immunogenic composition comprises N. meningitidis serogroup Y capsular saccharide (MenY).

7. The method of claim 1 wherein the immunogenic composition comprises N. meningitidis serogroup W135 capsular saccharide (MenW).

8. The method of claim 1 wherein the immunogenic composition comprises diphtheriae toxoid (DT), tetanus toxoid (TT), whole cell pertussis antigen (Pw) and Hepatitis B surface antigen (HepB).

9. The method of claim 1 wherein the immunogenic composition comprises a N. meningitidis serogroup B outer membrane vesicle preparation.

10. The method of claim 1 wherein the immunogenic composition comprises a Streptococcus pneumoniae capsular saccharide derived from a strain selected from the group consisting of serotypes 1, 2, 3, 4, 5, 6A, 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19A, 19F, 20, 22F, 23F and 33F.

11. The method of claim 1 wherein the at least one additional bacterial saccharide conjugate comprises a Salmonella typhi Vi capsular saccharide.

12. The method of claim 1 wherein said N. meningitidis capsular saccharide conjugate is conjugated to the same carrier protein as used in the Hib conjugate.

13. The method of claim 1 wherein the Hib saccharide is conjugated to a carrier protein selected from the group consisting of tetanus toxoid (TT), diphtheria toxoid (DT), cross-reacting material 197 (CRM197), fragment C of tetanus toxoid, protein D, meningococcal outer membrane protein (OMPC) and pneumolysin.

14. The method of claim 1 wherein said N. meningitidis saccharide is conjugated to a carrier protein selected from the group consisting of tetanus toxoid (TT), diphtheria toxoid (DT), cross-reacting material 197 (CRM197), fragment C of tetanus toxoid, protein D, meningococcal outer membrane protein (OMPC) and pneumolysin.

15. The method of claim 1 wherein the ratio of Hib to carrier protein in the Hib saccharide conjugate is between 1:5 and 5:1 weight/weight (w/w).

16. The method of claim 1 wherein the Hib saccharide conjugate and the N. meningitidis saccharide conjugate is not adsorbed onto aluminium salts.

17. The method of claim 1 for immunising a human host against meningitis.

18. The method of claim 2 for immunising a human host against disease caused by Neisseria meningitides.