One Arm of Two? Concurrent Administration of Meningococcal Conjugate and Hepatitis B Vaccines in Pre-Teens

Category: Public Health Practice, Immunization Programs

Pielak KL, McIntyre CC, Remple VP, Buxton JA, Skowronski DM


The purpose of this study was to (a) compare rates of local reactions from meningococcal C conjugate (Neis Vac-C) and hepatitis B vaccines (Recombivax HB), and (b) compare local reactions when both vaccines are given in one arm versus one vaccine in each arm.


Schools were randomized to receive both vaccines in one arm (Group I), or one vaccine in each arm (Group II). Structured telephone interviews were conducted 48 to 96 hours following immunization. Respondents were asked about local and systemic reactions, interference with school or other activities, need for medical attention, and lost parental work time. Logistic regression modeled the association between explanatory variables of interest and specific reactions. Association between variables was examined using cross-tabulation, chi-squared, Fisher's exact, and t-tests.


202 students participated in Group I and 188 in Group II (51% response rate). Group II reported significantly more local redness> 46 mm (6.5% vx 0.5%, p < 0.001), moderate to severe tenderness (28% vs 18%, p < 0.05), and drowsiness (14% vs 7%, p < 0.05). When adjusted for gender, ethnicity, and town of residence, moderate or severe tenderness was independently associated with Group II (OR 1.4, 95% CI 1.1, 1.85) but not when vaccine product was included in the regression model. There were no significant differences between groups in interference with school attendance or other activities, need for medical attention, or lost parental work time, all of which were low for both groups. There was more redness (6.4% vs 1.6%, p < 0.05) and tenderness (55.7% vs 32.4%, p < 0.001) experienced with Neis Vac-C than with Recombivax HB.


Vaccinating in one arm did not cause more local reaction than in separate arms and remains an option for those who prefer it for logistic reasons. If vaccinating in two arms, Neis Vac-C should preferentially be given in the non-dominant arm.

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