In anticipation of the successful eradication of wild
polio virus, alternative vaccination strategies for public-sector markets of low-resource countries are extremely important, but are still under development. Following
polio eradication, inactivated
polio vaccine (IPV) would be the only
polio vaccine available, and would be needed for early childhood immunization for several years, as maintenance of herd immunity will be important for sustaining
polio eradication. Low-cost
combination vaccines containing IPV could provide reliable and continuous immunization in the post-
polio eradication period.
Combination vaccines can potentially simplify complex pediatric routine immunization schedules, improve compliance, and reduce costs.
Hexavalent vaccines containing
Diphtheria (D),
Tetanus (T), whole cell
pertussis (wP),
Hepatitis B (HBV), Haemophilus b (Hib) and the three IPV serotype
antigens have been considered as the ultimate combination
vaccine for routine immunization. This product review evaluates potential
hexavalent vaccine candidates by composition, probable time to market, expected cost of goods, presentation, and technical feasibility and offers suggestions for development of low-cost hexavalent
combination vaccines. Because there are significant technical challenges facing wP-based
hexavalent vaccine development, this review also discusses other alternative approaches to hexavalent that could also ensure a timely and reliable supply of low-cost IPV based
combination vaccines.