Hiberix Kit
FDA Label NDC 58160-726

HIBERIX^® is indicated for active immunization for the prevention of invasive disease caused by Haemophilus influenzae type b. HIBERIX is approved for use in children 6 weeks through 4 years of age (prior to fifth birthday).

The evaluation of effectiveness of HIBERIX was based on immune responses in children using serological endpoints that predict protection from invasive disease due to H. influenzae type b [see Clinical Pharmacology (12.1), Clinical Studies (14.1)]. These protective antibody levels have not been evaluated in clinical trials in which a booster dose of HIBERIX is compared to a booster dose of a US-licensed Haemophilus b Conjugate Vaccine in children who previously received a primary series with a US-licensed Haemophilus b Conjugate Vaccine [see Clinical Studies (14.1)].

HIBERIX is to be reconstituted only with the accompanying saline diluent. The reconstituted vaccine should be a clear and colorless solution. Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. If either of these conditions exists, the vaccine should not be administered.

Figure 1 (Hiberix Spl Graphic 01)	Figure 2 (Hiberix Spl Graphic 02)	Figure 3 (Hiberix Spl Graphic 03)	Figure 4 (Hiberix Spl Graphic 04)
Figure 1. Cleanse both vial stoppers. Withdraw 0.6 mL of saline diluent from accompanying vial.	Figure 2. Transfer 0.6 mL saline diluent into lyophilized vaccine vial.	Figure 3. Shake the vial well.	Figure 4. After reconstitution, withdraw 0.5 mL of reconstituted vaccine and administer intramuscularly.

Use a separate sterile needle and sterile syringe for each individual.

After reconstitution, administer HIBERIX immediately or store refrigerated between 2° and 8°C (36° and 46°F) and administer within 24 hours. If the vaccine is not administered immediately, shake the solution well again before administration.

For intramuscular use only.

HIBERIX is administered as a single dose (0.5 mL) by intramuscular injection into the anterolateral aspect of the thigh or deltoid.

Do not administer this product intravenously, intradermally, or subcutaneously.

HIBERIX is administered as a 4-dose series (0.5-mL each dose) given by intramuscular injection. The series consists of a primary immunization course of 3 doses administered at 2, 4, and 6 months of age, followed by a booster dose administered at 15 through 18 months of age. The first dose may be given as early as 6 weeks of age.

HIBERIX is a solution for injection supplied as a single-dose vial of lyophilized vaccine to be reconstituted with the accompanying vial of saline diluent. A single dose, after reconstitution, is 0.5 mL.

Severe allergic reaction (e.g., anaphylaxis) after a previous dose of any H. influenzae type b- or tetanus toxoid-containing vaccine or any component of the vaccine is a contraindication to administration of HIBERIX [see Description (11)].

If Guillain-Barré syndrome has occurred within 6 weeks of receipt of a prior vaccine containing tetanus toxoid, the decision to give any tetanus toxoid-containing vaccine, including HIBERIX, should be based on careful consideration of the potential benefits and possible risks.

Syncope (fainting) can occur in association with administration of injectable vaccines, including HIBERIX. Syncope can be accompanied by transient neurological signs such as visual disturbance, paresthesia, and tonic-clonic limb movements. Procedures should be in place to avoid falling injury and to restore cerebral perfusion following syncope.

Apnea following intramuscular vaccination has been observed in some infants born prematurely. Decisions about when to administer an intramuscular vaccine, including HIBERIX, to infants born prematurely should be based on consideration of the individual infant’s medical status, and the potential benefits and possible risks of vaccination.

Prior to administration, the healthcare provider should review the patient's immunization history for possible vaccine hypersensitivity. Epinephrine and other appropriate agents used for the control of immediate allergic reactions must be immediately available should an acute anaphylactic reaction occur.

Safety and effectiveness of HIBERIX in immunosuppressed children have not been evaluated. If HIBERIX is administered to immunosuppressed children, including children receiving immunosuppressive therapy, the expected immune response may not be obtained.

Urine antigen detection may not have a diagnostic value in suspected disease due to H. influenzae type b within 1 to 2 weeks after receipt of a H. influenzae type b-containing vaccine, including HIBERIX [see Drug Interactions (7.1)].

Immunization with HIBERIX does not substitute for routine tetanus immunization.

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a vaccine cannot be directly compared with rates in the clinical trials of another vaccine, and may not reflect the rates observed in practice. There is the possibility that broad use of HIBERIX could reveal adverse reactions not observed in clinical trials.

Across clinical trials, common solicited adverse events (≥20%) were pain and redness at the injection site, irritability, drowsiness, fever, loss of appetite, fussiness, and restlessness.

Study 1: In a randomized, controlled clinical trial conducted in the US, children were vaccinated with HIBERIX (N = 2,963), a US-licensed monovalent Haemophilus b Conjugate Vaccine (Control PRP-T) (Sanofi Pasteur SA) (N = 520), or a US-licensed combined Diphtheria and Tetanus Toxoids and Acellular Pertussis Adsorbed, Inactivated Poliovirus and Haemophilus b Conjugate Vaccine (DTaP-IPV/Hib) (Sanofi Pasteur Ltd.) (N = 520) at 2, 4, and 6 months of age. HIBERIX and Control PRP-T (Sanofi Pasteur SA) were administered concomitantly with PEDIARIX^® (DTaP-HBV-IPV) [Diphtheria and Tetanus Toxoids and Acellular Pertussis Adsorbed, Hepatitis B (Recombinant) and Inactivated Poliovirus Vaccine] and Pneumococcal 13-valent Conjugate Vaccine (PCV13) (Wyeth Pharmaceuticals Inc.) with Doses 1, 2, and 3 and ROTARIX^® [Rotavirus Vaccine, Live, Oral] with Doses 1 and 2. DTaP-IPV/Hib was administered concomitantly with PCV13 and ENGERIX-B^® [Hepatitis B Vaccine (Recombinant)] with Doses 1, 2, and 3 and ROTARIX with Doses 1 and 2. If a birth dose of hepatitis B vaccine was received, ENGERIX-B was given with Doses 1 and 3. In the total population, 51.2% were male; 61% were white, 8% were Asian, 9% were black, and 22% were other racial/ethnic groups.

In 7 additional clinical studies, 1,008 children received HIBERIX as a booster dose following primary vaccination with either HIBERIX (N = 530), Haemophilus b Conjugate Vaccine (Control PRP-T) (Sanofi Pasteur SA) (N = 235), Haemophilus b Conjugate Vaccine (Merck & Co., Inc.) (N = 26), or Haemophilus b Conjugate Vaccine (Wyeth Pharmaceuticals Inc.) (no longer licensed in the US, N = 217). None of the studies included a comparator group that received a booster dose with a US-licensed Haemophilus b Conjugate Vaccine. Studies were conducted in Europe, Canada, and Latin America. Across these studies, the mean age of subjects at the time of booster vaccination with HIBERIX ranged from 16 to 19 months. At the time of vaccination, 172 (17.1%) subjects were 11 to 14 months of age, 642 (63.7%) subjects were 15 to 18 months of age, and 194 (19.2%) subjects were 19 to 25 months of age. Approximately half of the subjects were male. Among subjects for whom information on race/ethnicity was available, nearly all subjects were white.

In these 7 studies, HIBERIX was administered concomitantly with non-US formulations (containing 2.5 mg 2-phenoxyethanol per dose as preservative) of one of the following US-licensed vaccines: INFANRIX^® (DTaP) [Diphtheria and Tetanus Toxoids and Acellular Pertussis Vaccine Adsorbed], KINRIX^® (DTaP-IPV) [Diphtheria and Tetanus Toxoids and Acellular Pertussis Adsorbed and Inactivated Poliovirus Vaccine], or PEDIARIX (DTaP-HBV-IPV). In the studies, DTaP-IPV and DTaP-HBV-IPV were administered in dosing regimens not approved in the US. Some subjects received DTaP-HBV (GlaxoSmithKline Biologicals, not licensed in US) concomitantly with HIBERIX.

Solicited Adverse Events

The reported frequencies of solicited local and general adverse events from Study 1 are presented in Table 1.

Table 1. Percentage of Children with Solicited Local and General Adverse Events within 4 Days of Primary Series Vaccination^a (at 2, 4, and 6 Months of Age) with HIBERIX^b, Control PRP-T^b, or DTaP-IPV/Hib^c, Total Vaccinated Cohort^d

•  N = All subjects for whom safety data were available.
•  ^a Within 4 days of vaccination defined as day of vaccination and the next 3 days.
•  ^b Each dose (Doses 1, 2, and 3) of HIBERIX or Control PRP-T (Sanofi Pasteur SA) was concomitantly administered with PEDIARIX (DTaP-HBV-IPV) and PCV13. Doses 1 and 2 were concomitantly administered with ROTARIX.
•  ^c Each dose (Doses 1, 2, and 3) of DTaP-IPV/Hib was concomitantly administered with PCV13 and ENGERIX-B with Doses 1, 2, and 3 and ROTARIX with Doses 1 and 2. If a birth dose of hepatitis B vaccine was received, ENGERIX-B was given with Doses 1 and 3.
•  ^d Study 1: NCT01000974.
•  ^e Local reactions at the injection site for HIBERIX, Control PRP-T, or DTaP-IPV/Hib.
•  ^f Grade 3 pain defined as cried when limb was moved/spontaneously painful.
•  ^g Grade 3 irritability defined as crying that could not be comforted/prevented normal activity.
•  ^h Grade 3 drowsiness defined as prevented normal daily activity.
•  ⁱ Grade 3 loss of appetite defined as did not eat at all.
•  ^j Fever defined as ≥100.4°F (≥38.0°C) rectally; Grade 3 fever defined as >103.1°F (>39.5°C) rectally.

In an open-label, multicenter study conducted in Germany (Study 2), 371 children received a booster dose of HIBERIX administered concomitantly with DTaP-HBV-IPV. The mean age at the time of vaccination was 16 months. Subjects in this study had previously received a primary series with either HIBERIX (N = 92), Control PRP-T (Sanofi Pasteur SA) (N = 96), or Haemophilus b Conjugate Vaccine (Wyeth Pharmaceuticals Inc.) (no longer licensed in the US) (N = 183). All subjects previously received 3 doses of DTaP-HBV-IPV. The reported frequencies of solicited local and general adverse events are presented in Table 2.

Table 2. Percentage of Children with Solicited Local and General Adverse Events within 4 Days of Booster Vaccination^a (Dose 4) with HIBERIX^b Coadministered with DTaP-HBV-IPV^c, Intent-to-Treat Cohort (N = 371)

Adverse Events	% Any	% Grade 3
Locald
Redness	24.5	2.4e
Pain	20.5	1.1f
Swelling	14.8	2.2e
General
Feverg	34.8	3.8
Fussiness	25.9	0.8h
Loss of appetite	22.9	0.8i
Restlessness	21.8	0.5i
Sleepiness	19.9	1.1i
Diarrhea	14.6	0.8i
Vomiting	4.9	0.5i

•  N = All subjects for whom safety data were available.
•  ^a Within 4 days of vaccination defined as day of vaccination and the next 3 days.
•  ^b In this study, 92 subjects previously received 3 doses of HIBERIX, 96 subjects previously received 3 doses of a Control PRP-T (Sanofi Pasteur SA), and 183 subjects previously received 3 doses of a Haemophilus b Conjugate Vaccine that is no longer licensed in the US.
•  ^c In this study, DTaP-HBV-IPV was given to subjects who previously received 3 doses of DTaP-HBV-IPV. In the US, PEDIARIX is approved for use as a 3-dose primary series; use as a fourth consecutive dose is not approved in the US.
•  ^d Local reactions at the injection site for HIBERIX.
•  ^e Grade 3 redness or swelling defined as >20 mm.
•  ^f Grade 3 pain defined as causing crying when limb moved.
•  ^g Fever defined as ≥100.4°F (≥38.0°C) rectally or ≥99.5°F (≥37.5°C) axillary, oral, or tympanic; Grade 3 fever defined as >103.1°F (>39.5°C) rectally or >102.2°F (>39.0°C) axillary, oral, or tympanic.
•  ^h Grade 3 fussiness defined as persistent crying and could not be comforted.
•  ⁱ Grade 3 for these symptoms defined as preventing normal daily activity.

Serious Adverse Events

In Study 1, one of 2,963 subjects who received HIBERIX and coadministered vaccines given at 2, 4, and 6 months of age experienced a SAE which was in temporal association with vaccination and had no alternative plausible causes (convulsion on Day 14 after Dose 1).

In the 7 additional studies, two of 1,008 subjects reported a serious adverse event that occurred in the 31-day period following booster immunization with HIBERIX. One subject developed bilateral pneumonia 9 days post-vaccination and one subject experienced asthenia following accidental drug ingestion 18 days post-vaccination.

In addition to reports in clinical trials, worldwide voluntary reports of adverse events received for HIBERIX since market introduction (1996) of this vaccine are listed below. This list includes serious events and/or events which have a plausible causal connection to HIBERIX. Because these events are reported voluntarily from a population of uncertain size, it is not possible to reliably estimate their frequency or establish a causal relationship to vaccination.

General Disorders and Administration Site Conditions

Extensive swelling of the vaccinated limb, injection site induration.

Immune System Disorders

Allergic reactions (including anaphylactic and anaphylactoid reactions), angioedema.

Nervous System Disorders

Convulsions (with or without fever), hypotonic-hyporesponsive episode (i.e., sudden onset of hypotonia, hyporesponsiveness, and pallor or cyanosis), somnolence, syncope, or vasovagal responses to injection.

Respiratory, Thoracic, and Mediastinal Disorders

Apnea [see Warnings and Precautions (5.3)].

Skin and Subcutaneous Tissue Disorders

Rash, urticaria.

Haemophilus b capsular polysaccharide derived from Haemophilus b Conjugate Vaccines has been detected in the urine of some vaccinees.¹ Urine antigen detection may not have a diagnostic value in suspected disease due to H. influenzae type b within 1 to 2 weeks after receipt of a H. influenzae type b-containing vaccine, including HIBERIX [see Warnings and Precautions (5.6)].

In Study 1, HIBERIX was administered concomitantly with PEDIARIX (DTaP-HBV-IPV), PCV13, and ROTARIX [see Adverse Reactions (6.1), Clinical Studies (14.2)].

In the 7 additional studies, a booster dose of HIBERIX was administered concomitantly with 1 of the following vaccines: DTaP, DTaP-IPV, DTaP-HBV-IPV, or DTaP-HBV (GlaxoSmithKline Biologicals, not licensed in the US). The formulations of DTaP, DTaP-IPV, and DTaP-HBV-IPV were non-US formulations (containing 2.5 mg 2-phenoxyethanol per dose as preservative) of the following US-licensed vaccines: INFANRIX, KINRIX, and PEDIARIX, respectively. In these studies, DTaP-IPV and DTaP-HBV-IPV were administered in dosing regimens that are not approved in the US. [See Adverse Reactions (6.1), Clinical Studies (14.1).]

If HIBERIX is administered concomitantly with other injectable vaccines, they should be given with separate syringes and at different injection sites. HIBERIX should not be mixed with any other vaccine in the same syringe or vial.

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

Pregnancy Category C

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

Safety and effectiveness of HIBERIX in children younger than 6 weeks of age and in children 5 to 16 years of age have not been established.

HIBERIX [Haemophilus b Conjugate Vaccine (Tetanus Toxoid Conjugate)] is a solution for intramuscular injection, supplied as a sterile, lyophilized powder which is reconstituted at the time of use with the accompanying saline diluent. HIBERIX contains Haemophilus b capsular polysaccharide (polyribosyl-ribitol-phosphate [PRP]), a high molecular weight polymer prepared from the Haemophilus influenzae type b strain 20,752 grown in a synthetic medium that undergoes heat inactivation and purification. The tetanus toxin, prepared from Clostridium tetani grown in a semi-synthetic medium, is detoxified with formaldehyde and purified. The capsular polysaccharide is covalently bound to the tetanus toxoid. After purification, the conjugate is lyophilized in the presence of lactose as a stabilizer. The diluent for HIBERIX is a sterile saline solution (0.9% sodium chloride) supplied in vials.

After reconstitution, each 0.5-mL dose is formulated to contain 10 mcg of purified capsular polysaccharide conjugated to approximately 25 mcg of tetanus toxoid, 12.6 mg of lactose, and ≤0.5 mcg of residual formaldehyde.

HIBERIX does not contain a preservative.

The lyophilized vaccine and saline diluent vial stoppers are not made with natural rubber latex.

Haemophilus influenzae is a gram-negative coccobacillus. Most strains of H. influenzae that cause invasive disease are type b. H. influenzae type b can cause invasive disease such as sepsis and meningitis.

Specific levels of antibodies to polyribosyl-ribitol-phosphate (anti-PRP) have been shown to correlate with protection against invasive disease due to H. influenzae type b. Based on data from passive antibody studies² and a clinical efficacy study with unconjugated Haemophilus b polysaccharide vaccine³, an anti-PRP concentration of 0.15 mcg/mL has been accepted as a minimal protective level. Data from an efficacy study with unconjugated Haemophilus b polysaccharide vaccine indicate that an anti-PRP concentration of ≥1.0 mcg/mL predicts protection through at least a 1-year period.^4,5 These antibody levels have been used to evaluate the effectiveness of Haemophilus b Conjugate Vaccines, including HIBERIX.

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

Primary Series Vaccination (Doses 1, 2, and 3)

The immunogenicity of HIBERIX was evaluated in a randomized, controlled trial (Study 1). HIBERIX or control vaccines were administered concomitantly with US-licensed vaccines [see Adverse Reactions (6.1)].

Anti-PRP GMCs and seroprotection rates 1 month following Dose 3 of HIBERIX, Control PRP-T (Sanofi Pasteur SA), or DTaP-IPV/Hib are presented in Table 3.

Table 3. Anti-PRP GMCs and Seroprotection Rates 1 Month following 3 Doses of HIBERIX, Control PRP-T^a, or DTaP-IPV/Hib^b Administered at 2, 4, and 6 Months of Age, ATP Cohort for Immunogenicity^c

•  ^a US-licensed monovalent Haemophilus b Conjugate Vaccine (Control PRP-T) (Sanofi Pasteur SA).
•  ^b US-licensed DTaP-IPV/Hib Vaccine (Sanofi Pasteur Ltd.).
•  ^c Study 1: NCT01000974.
•  ^d HIBERIX was non-inferior to Control PRP-T for percent of subjects achieving anti-PRP ≥0.15 mcg/mL [lower limit of 95% CI on difference of HIBERIX minus Control PRP-T ≥ predefined limit of -5%].
•  ^e The non-inferiority criterion was not met (lower limit of 95% CI for the difference in the percentages of subjects with anti-PRP ≥1.0 mcg/mL between two groups [HIBERIX minus Control PRP-T] was -12.28%, which was lower than the predefined limit of -10%).
•  ^f Analyses of anti-PRP immune responses following DTaP-IPV/Hib vaccination were exploratory.

Booster Vaccination (Dose 4)

In 6 clinical studies, the immune response to HIBERIX administered as a booster dose was evaluated in a total of 415 children 12 to 23 months of age. At the time of vaccination, 30 children were 12 to 14 months of age, 316 children were 15 to 18 months of age, and 69 children were 19 to 23 months of age. Among subjects, 43% to 60% were male. Among subjects for whom information on race/ethnicity was available, nearly all subjects were white. None of the studies included a comparator group that received a booster dose with a US-licensed Haemophilus b Conjugate Vaccine. Characteristics of 3 of these studies are presented in Table 4.

Table 4. Characteristics of 3 Open-Label Booster Immunization Studies of HIBERIX

Study	Country	Per-Protocol Immunogenicity Cohort N	Priming History	Booster Vaccination with HIBERIX
				Age at Vaccination (months)	Concomitantly Administered Vaccinea
3	Canada	42	DTaP-HBV-IPVb + Haemophilus b Conjugate Vaccinec at 2, 4, and 6 months of age	16-18	DTaP-HBV-IPVb
4	Canada	64	DTaP-IPVd + HIBERIX at 2, 4, and 6 months of age	16-19	DTaP-IPVd
5	Germany	108	DTaP-HBVe + HIBERIX at 3, 4, and 5 months of age	16-23	DTaP-HBVe

•  ^a Administered at a separate site.
•  ^b Non-US formulation equivalent to PEDIARIX with the exception of containing 2.5 mg 2-phenoxyethanol per dose as preservative. In the US, PEDIARIX is approved for use as a 3-dose primary series; use as a fourth consecutive dose is not approved in the US.
•  ^c US-licensed Haemophilus b Conjugate Vaccine (Control PRP-T) (Sanofi Pasteur SA).
•  ^d Non-US formulation equivalent to KINRIX with the exception of containing 2.5 mg 2-phenoxyethanol per dose as preservative. In the US, KINRIX is approved for use as the fifth dose of DTaP and the fourth dose of IPV in children 4 to 6 years of age previously primed with approved dosing regimens of INFANRIX and/or PEDIARIX. The DTaP-IPV dosing regimen is not approved in the US.
•  ^e Manufactured by GlaxoSmithKline Biologicals (not licensed in the US).

Antibodies to PRP were measured in sera obtained immediately prior to and 1 month after booster vaccination with HIBERIX. Geometric mean concentrations and anti-PRP seroprotection rates are presented in Table 5.

Table 5. Anti-PRP GMCs and Seroprotection Rates prior to and 1 Month following a Booster Dose of HIBERIX, Per-protocol Immunogenicity Cohort

Study	N	Anti-PRP GMC (mcg/mL)		% Anti-PRP ≥0.15 mcg/mL		% Anti-PRP ≥1.0 mcg/mL
		Pre-	Post-	Pre-	Post-	Pre-	Post-
3a	42	0.46	59.07	76.2	100	35.7	97.6
4b	63-64	0.25	47.78	71.4	100	12.7	100
5c	108	0.59	96.12	77.8	100	32.4	100

•  GMC = Geometric mean antibody concentration.
•  N = Number of children for whom serological results were available for the pre- and post-dose immunological evaluations.
•  Studies 3, 4, and 5 correspond to Studies 3, 4, and 5, respectively in Table 4.
•  ^a Canadian study in children 16 to 18 months of age who previously received 3 doses of DTaP-HBV-IPV and Haemophilus b Conjugate Vaccine (Control PRP-T) (Sanofi Pasteur SA). The booster dose of HIBERIX was coadministered with DTaP-HBV-IPV (a fourth consecutive dose of PEDIARIX is not approved in the US). In this study, pre-vaccination sera may have been obtained up to 1 week prior to booster vaccination with HIBERIX.
•  ^b Canadian study in children 16 to 19 months of age who previously received 3 doses of DTaP-IPV and HIBERIX. The booster dose of HIBERIX was coadministered with DTaP-IPV. The DTaP-IPV dosing regimen is not approved in the US.
•  ^c German study in children 16 to 23 months of age who previously received 3 doses of DTaP-HBV (GlaxoSmithKline Biologicals, not licensed in the US) and HIBERIX. The booster dose of HIBERIX was coadministered with DTaP-HBV.

Primary Series Vaccination (Doses 1, 2, and 3)

In US Study 1, subjects who received HIBERIX concomitantly with PEDIARIX (DTaP-HBV-IPV) and PCV13 at 2, 4, and 6 months of age had no evidence for reduced antibody responses relative to the response in control subjects administered Control PRP-T (Sanofi Pasteur SA) concomitantly with PEDIARIX (DTaP-HBV-IPV) and PCV13, to pertussis antigens (GMC to pertussis toxin, filamentous hemagglutinin, and pertactin), diphtheria toxoid (antibody levels ≥0.1 IU/mL), tetanus toxoid (antibody levels ≥0.1 IU/mL), poliovirus types 1, 2, and 3 (antibody levels ≥1:8 to each virus), PCV13 (antibody levels ≥0.2 mcg/mL and GMC to each serotype), or hepatitis B (anti-hepatitis B surface antigen ≥10 mIU/mL). The immune responses to PEDIARIX (DTaP-HBV-IPV) and PCV13 were evaluated 1 month following Dose 3. Subjects in both groups received ROTARIX at 2 and 4 months of age.

Booster Vaccination (Dose 4)

In 7 additional studies, a booster dose of HIBERIX was administered concomitantly with non-US formulations of INFANRIX, KINRIX, and PEDIARIX. Non-US formulations of KINRIX and PEDIARIX were administered in dosing regimens not approved in the US.

Sufficient data are not available to confirm lack of interference in immune responses to vaccines administered concomitantly with a booster dose of HIBERIX.

• Rothstein EP, Madore DV, Girone JAC, et al. Comparison of antigenuria after immunization with three Haemophilus influenzae type b conjugate vaccines. Pediatr Infect Dis J 1991;10:311-314.
• Robbins JB, Parke JC, Schneerson R, et al. Quantitative measurement of “natural” and immunization-induced Haemophilus influenzae type b capsular polysaccharide antibodies. Pediatr Res 1973;7:103-110.
• Peltola H, Käythy H, Sivonen A, et al. Haemophilus influenzae type b capsular polysaccharide vaccine in children: A double-blind field study of 100,000 vaccinees 3 months to 5 years of age in Finland. Pediatrics 1977;60:730-737.
• Käythy H, Peltola H, Karanko V, et al. The protective level of serum antibodies to the capsular polysaccharide of Haemophilus influenzae type b. J Infect Dis 1983;147:1100.
• Anderson P. The protective level of serum antibodies to the capsular polysaccharide of Haemophilus influenzae type b. J Infect Dis 1984;149:1034.

HIBERIX is available in single-dose vials of lyophilized vaccine, accompanied by vials containing 0.85 mL of saline diluent (packaged without syringes or needles).

Supplied as package of 10 doses (NDC 58160-818-11):

NDC 58160-816-01 Vial of lyophilized vaccine in Package of 10: NDC 58160-816-05

NDC 58160-817-01 Vial of saline diluent in Package of 10: NDC 58160-817-05

Lyophilized vaccine vials: Store refrigerated between 2° and 8°C (36° and 46°F). Protect vials from light.

Diluent: Store refrigerated or at controlled room temperature between 2° and 25°C (36° and 77°F). Do not freeze. Discard if the diluent has been frozen.

Administer within 24 hours of reconstitution. After reconstitution, store refrigerated between 2° and 8°C (36° and 46°F). Discard the reconstituted vaccine if not used within 24 hours. Do not freeze. Discard if the vaccine has been frozen.

• Inform parents or guardians of the potential benefits and risks of immunization with HIBERIX.
• Inform parents or guardians about the potential for adverse reactions that have been temporally associated with administration of HIBERIX or other vaccines containing similar components.
• Give parents or guardians the Vaccine Information Statements, which are required by the National Childhood Vaccine Injury Act of 1986 to be given prior to immunization. These materials are available free of charge at the Centers for Disease Control and Prevention (CDC) website (www.cdc.gov/vaccines).

ENGERIX-B, HIBERIX, INFANRIX, KINRIX, PEDIARIX, and ROTARIX are registered trademarks of the GSK group of companies.

Manufactured by GlaxoSmithKline Biologicals

Rixensart, Belgium, US License 1617, and

Distributed by GlaxoSmithKline

Research Triangle Park, NC 27709

©2016 the GSK group of companies. All rights reserved.

HRX:6PI

PRINCIPAL DISPLAY PANEL

NDC 58160-806-05

HIBERIX^®

Haemophilus b Conjugate Vaccine (Tetanus Toxoid Conjugate)

R_x only

For booster dose only; 15 months through 4 years of age.

Contents: 10 Vials each containing one dose of Lyophilized Vaccine

Reconstitute only with the accompanying saline diluent.

©2009, GlaxoSmithKline

429670 Rev. 7/09

Vial Carton (Hiberix Spl Graphic 05)

PRINCIPAL DISPLAY PANEL

NDC 58160-818-11

HIBERIX^®

Haemophilus b Conjugate Vaccine (Tetanus Toxoid Conjugate)

R_x only

Hib

Contents (see back panel for storage instructions):

10 Vials of Lyophilized Vaccine

10 Vials of Sterile Saline Diluent (for reconstitution of Lyophilized Vaccine).

For 6 weeks through 4 years of age

Lyophilized Vaccine Made in Belgium

©2017 the GSK group of companies

Rev. 6/17

490126