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NISH (NITAG Support Hub) 12: Whole-cell (wP) Hexavalent vaccine: Scientific articles

This Library Guide is a collection of useful documents & evidence on the safety, efficacy, effectiveness and impact of the whole-cell (wP) Hexavalent vaccine and (wP) Pentavalent vaccine to support NITAG members and other policy makers throughout Africa w

PICO used for search terms

P:  child OR children OR baby OR babies OR infant OR newborn OR neonates OR preschool

I:  4 doses wP Hexavalent vaccine OR DwPT-HepB-Hib-IPV vaccine OR whole cell hexavalent vaccine OR whole-    cell vaccine OR 6-in-1    vaccine

C: 3 doses wP Pentavalent vaccine OR DwPT-HepB-Hib vaccine OR  whole cell pentavalent vaccine OR whole-cell vaccine OR 5-in-1 vaccine

O: safety OR immunogenicity OR cost effectiveness

PubMed search

Akinola, F., Muloiwa, R., Gregory, D. H., Dirix, V., Kagina, B., & Amponsah-Dacosta, E. (2019). Assessment of humoral and cell-mediated immune responses to pertussis vaccination: a systematic review protocol. BMJ open9(6), e028109.https://bmjopen.bmj.com/content/bmjopen/9/6/e028109.full.pdf

Aloysia D’Cor, N., Siddaiah, P., Mohapatra, S., Dhaded, S. M., I V, P., Kar, S., V N, T., Muley, P., Chhatwal, J., Patnaik, B. N., Vidor, E., Moureau, A., Patel, D. M., Midde, V. J., Jagga, S. R., Peesapati, S., & Noriega, F. (2023). Safety and immunogenicity of a new formulation of a pentavalent DTwP-HepB-Hib vaccine in healthy Indian infants-A randomized study. PloS One, 18(8), e0284898. https://doi.org/10.1371/journal.pone.0284898

Araújo, O. O., Forleo-Neto, E., Vespa, G. N., Puccini, R. F., Weckx, L. W., Carvalho, E. S., & Farhat, C. K. (2000). Associated or combined vaccination of Brazilian infants with a conjugate Haemophilus influenzae type b (Hib) vaccine, a diphtheria-tetanus-whole-cell  pertussis vaccine and IPV or OPV elicits protective levels of antibodies against  Hib. Vaccine, 19(2–3), 367–375. https://doi.org/10.1016/s0264-410x(00)00093-1

Bavdekar, A., Malshe, N., Ravichandran, L., Sapru, A., Kawade, A., Lalwani, S., Palkar, S., Hanumante, N., Gunale, B., Kapse, D., Chaudhari, A., Miller, T., Saganic, L., Jarrahian, C., McGray, S., Zehrung, D., & Kulkarni, P. S. (2019). Clinical study of safety and immunogenicity of pentavalent DTP-HB-Hib vaccine administered by disposable-syringe jet injector in India. Contemporary Clinical Trials Communications, 14, 100321. https://doi.org/10.1016/j.conctc.2019.100321

Botet Asensi, F. I., Veronese, A., Del Carmen Otero, M., Desamparados Tamarit Pérez, M., Hontangas Lopez, J. L., & Viviani, S. (2003). Immunogenicity and safety in infants of a DTwPHib full liquid vaccine. Acta Paediatrica (Oslo, Norway : 1992), 92(5), 541–545. https://doi.org/10.1080/08035320310001581

Capeding, M. R. Z., Jica, C., Macura-Biegun, A., Rauscher, M., & Alberto, E. (2014). Interchangeability of Quinvaxem during primary vaccination schedules: Results from a phase IV, single-blind, randomized, controlled, single-center,  non-inferiority study. Vaccine, 32(7), 888–894. https://doi.org/10.1016/j.vaccine.2013.10.059

Chiu, H. H., Huang, L. M., Lee, P. I., Safary, A., & Lee, C. Y. (1998). Diphtheria, tetanus and whole cell pertussis vaccine combined with hepatitis B vaccines: A comparison of two doses (10 microg and 5 microg). The Pediatric Infectious Disease Journal, 17(3), 206–211. https://doi.org/10.1097/00006454-199803000-00007

Clemens, S. C., Azevedo, T., & Homma, A. (2003). Feasibility study of the immunogenicity and safety of a novel DTPw/Hib (PRP-T) Brazilian combination compared to a licensed vaccine in healthy children at 2, 4,  and 6 months of age. Revista Da Sociedade Brasileira de Medicina Tropical, 36(3), 321–330. https://doi.org/10.1590/s0037-86822003000300002

Cox, M., Adetifa, J. U., Noho-Konteh, F., Njie-Jobe, J., Sanyang, L. C., Drammeh, A., Plebanski, M., Whittle, H. C., Rowland-Jones, S. L., Robertson, I., & Flanagan, K. L. (2020). Limited Impact of Human Cytomegalovirus Infection in African Infants on Vaccine-Specific Responses Following Diphtheria-Tetanus-Pertussis and Measles  Vaccination. Frontiers in Immunology, 11, 1083. https://doi.org/10.3389/fimmu.2020.01083

Davis, R. L., & Barlow, W. (2003). Placing the risk of seizures with pediatric vaccines in a clinical context. Paediatric Drugs, 5(11), 717–722. https://doi.org/10.2165/00148581-200305110-00001

Dolan, S. B., Patel, M., Hampton, L. M., Burnett, E., Ehlman, D. C., Garon, J., Cloessner, E., Chmielewski, E., Hyde, T. B., Mantel, C., & Wallace, A. S. (2017). Administering Multiple Injectable Vaccines During a Single Visit-Summary of Findings From the Accelerated Introduction of Inactivated Polio Vaccine Globally. The Journal of Infectious Diseases, 216(suppl_1), S152–S160. https://doi.org/10.1093/infdis/jix054

Espinoza, F., Tregnaghi, M., Gentile, A., Abarca, K., Casellas, J., Collard, A., Lefevre, I., & Jacquet, J.-M. (2010). Primary and booster vaccination in Latin American children with a DTPw-HBV/Hib combination: A randomized controlled trial. BMC Infectious Diseases, 10, 297. https://doi.org/10.1186/1471-2334-10-297

Evdokimov, K., Sayasinh, K., Nouanthong, P., Vilivong, K., Samountry, B., Phonekeo, D., Strobel, M., Haegeman, F., Heimann, P., Muller, C. P., & Black, A. P. (2017). Low and disparate seroprotection after pentavalent childhood vaccination in the Lao People’s Democratic Republic: A cross-sectional study. Clinical Microbiology and Infection : The Official Publication of the European Society of Clinical Microbiology and Infectious Diseases, 23(3), 197–202. https://doi.org/10.1016/j.cmi.2016.10.007

Gandhi, D. J., Dhaded, S. M., Ravi, M. D., Dubey, A. P., Kundu, R., Lalwani, S. K., Chhatwal, J., Mathew, L. G., Gupta, M., Sharma, S. D., Bavdekar, S. B., Jayanth, M. V., Ravinuthala, S., Sil, A., & Dhingra, M. S. (2016). Safety, immune lot-to-lot consistency and non-inferiority of a fully liquid pentavalent DTwp-HepB-Hib vaccine in healthy Indian toddlers and infants. Human Vaccines & Immunotherapeutics, 12(4), 946–954. https://doi.org/10.1080/21645515.2015.1100779

Gatchalian, S. R., Ramakrishnan, G., Bock, H. L., Lefevre, I., & Jacquet, J. M. (2010). Immunogenicity, reactogenicity and safety of three-dose primary and booster vaccination with combined diphtheria-tetanus-whole-cell pertussis-hepatitis  B-reduced antigen content Haemophilus influenzae type b vaccine in Filipino  children. Human Vaccines, 6(8), 664–672. https://doi.org/10.4161/hv.6.8.12155

Gatchalian, S., Reyes, M., Bermal, N., Chandrasekaran, V., Han, H. H., Bock, H. L., & Lefevre, I. (2008). A new DTPw-HBV/Hib vaccine: Immune memory after primary vaccination and booster dosing in the second year of life. Human Vaccines, 4(1), 60–66. https://doi.org/10.4161/hv.4.1.5069

Gatchalian, S., Reyes, M., Bernal, N., Lefevre, I., David, M.-P., Han, H. H., Bock, H. L., Wolter, J., & Schuerman, L. (2005). A new DTPw-HBV/Hib vaccine is immunogenic and safe when administered according to the EPI (Expanded Programme for Immunization) schedule and following hepatitis B  vaccination at birth. Human Vaccines, 1(5), 198–203. https://doi.org/10.4161/hv.1.5.2163

Gentile, A., Umido, V., Czerniuk, P., Nacul, J., Seigelchifer, M., Hilbert, A. K., Yela, U., Herzog, C., Aeberhard, U., & Spyr, C. (2011). Immunogenicity and reactogenicity of a combined fully liquid DTPw-HepB-Hib pentavalent vaccine in healthy infants: No clinically relevant impact of a birth  dose of hepatitis B vaccine. International Journal of Infectious Diseases : IJID : Official Publication of the International Society for Infectious Diseases, 15(1), e24-29. https://doi.org/10.1016/j.ijid.2010.09.004

Halperin, S. A., Langley, J. M., & Eastwood, B. J. (1996). Effect of inactivated poliovirus vaccine on the antibody response to Bordetella pertussis antigens when combined with diphtheria-pertussis-tetanus vaccine. Clinical Infectious Diseases : An Official Publication of the Infectious Diseases Society of America, 22(1), 59–62. https://doi.org/10.1093/clinids/22.1.59

Hefele, L., Syphan, S., Xayavong, D., Homsana, A., Kleine, D., Chanthavilay, P., Nouanthong, P., Xaydalasouk, K., Phathammavong, O., Billamay, S., Xeuatvongsa, A., Reinharz, D., Muller, C. P., & Black, A. P. (2019). Seroprotection at Different Levels of the Healthcare System After Routine Vaccination With Diphtheria-Tetanus-Pertussis whole cell-Hepatitis B-Haemophilus  influenzae Type B in Lao People’s Democratic Republic. Clinical Infectious Diseases : An Official Publication of the Infectious Diseases Society of America, 69(12), 2136–2144. https://doi.org/10.1093/cid/ciz143

Hla, K. H., Thein, S. A. M., Aye, A., Han, H.-H., Bock, H. L., David, M.-P., & Schuerman, L. (2006). Reactogenicity and immunogenicity profiles of a novel pentavalent diphtheria-tetanus-whole cell pertussis-hepatitis B and Haemophilus influenzae  type B vaccine: A randomized dose-ranging trial of the Hib tetanus-conjugate  content. The Pediatric Infectious Disease Journal, 25(8), 706–712. https://doi.org/10.1097/01.inf.0000223488.80814.df

Hogg, K., & Hogg, G. (2003). The immunogenicity of oral poliomyelitis vaccine in a primary vaccination series at 2, 4 and 6 months given concurrently with Hib, hepatitis B and diphtheria,  tetanus and whole-cell pertussis vaccines administered as three separate  injections or as a combination pentavalent vaccine. Vaccine, 21(21–22), 2906–2910. https://doi.org/10.1016/s0264-410x(03)00133-6

Hoppenbrouwers, K., Roelants, M., Ethevenaux, C., Vandermeulen, C., Knops, J., & Desmyter, J. (1999). The effect of reconstitution of an Haemophilus influenzae type b-tentanus toxoid conjugate (PRP-T) vaccine on the immune responses to a diphtheria-tetanus-whole  cell pertussis (DTwP) vaccine: A five-year follow-up. Vaccine, 17(20–21), 2588–2598. https://doi.org/10.1016/s0264-410x(99)00047-x

Huu, T. N., Phuong, N. T. M., Toan, N. T., & Thang, H. V. (2015). IMMUNOGENICITY AND SAFETY OF QUINVAXEM® (DIPHTHERIA, TETANUS, WHOLE-CELL PERTUSSIS, HEPATITIS B AND HAEMOPHILUS INFLUENZAE TYPE B VACCINE) GIVEN TO  VIETNAMESE INFANTS AT 2 TO 4 MONTHS OF AGE. The Southeast Asian Journal of Tropical Medicine and Public Health, 46(4), 753–763.

Ibrahim, R., Ali, S. A., Kazi, A. M., Rizvi, A., Guterman, L. B., Bednarczyk, R. A., Kim, E., Park, S., Paulos, S., Jeyachandran, A., Patel, D., Gorantla, Y., Wong, E., Rajam, G., Schiffer, J., & Omer, S. B. (2018). Impact of maternally derived pertussis antibody titers on infant whole-cell pertussis vaccine response in a low income setting. Vaccine, 36(46), 7048–7053. https://doi.org/10.1016/j.vaccine.2018.09.045

Jones, I. G., Tyrrell, H., Hill, A., Horobin, J. M., & Taylor, B. (1998). Randomised controlled trial of combined diphtheria, tetanus, whole-cell pertussis vaccine administered in the same syringe and separately with Haemophilus  influenzae type b vaccine at two, three and four months of age. Vaccine, 16(1), 109–113. https://doi.org/10.1016/s0264-410x(97)00161-8

Kosalaraksa, P., Thisyakorn, U., Benjaponpitak, S., Chokephaibulkit, K., & Santos-Lima, E. (2011). Immunogenicity and safety study of a new DTaP–IPV–Hep B–PRP-T combined vaccine compared to a licensed DTaP–IPV–Hep B//PRP-T comparator, both concomitantly administered with a 7-valent pneumococcal conjugate vaccine at 2, 4, and 6 months of age in Thai infants. International Journal of Infectious Diseases15(4), e249-e256. https://doi.org/10.1016/j.ijid.2010.12.004

Kulkarni, P. S., Sapru, A., Bavdekar, A., Naik, S. S., Patwardhan, M., Barde, P., & Pandit, A. N. (2011). Immunogenicity of two diphtheria-tetanus-whole cell pertussis-hepatitis B vaccines in infants: A comparative trial. Human Vaccines, 7(9), 941–944. https://doi.org/10.4161/hv.7.9.15994

Langue, J., Ethevenaux, C., Champsaur, A., Fritzell, B., Bégué, P., & Saliou, P. (1999). Safety and immunogenicity of Haemophilus influenzae type b-tetanus toxoid conjugate, presented in a dual-chamber syringe with diphtheria-tetanus-pertussis  and inactivated poliomyelitis combination vaccine. European Journal of Pediatrics, 158(9), 717–722. https://doi.org/10.1007/s004310051186

Liljeqvist, S., & Ståhl, S. (1999). Production of recombinant subunit vaccines: Protein immunogens, live delivery systems and nucleic acid vaccines. Journal of Biotechnology, 73(1), 1–33. https://doi.org/10.1016/s0168-1656(99)00107-8

Mangarule, S., Palkar, S., Mitra, M., Ravi, M. D., Dubey, A. P., Moureau, A., Jayanth, M. V., Patel, D. M., Ravinuthala, S., Jagga, S. R., Patnaik, B. N., Jordanov, E., & Noriega, F. (2022). Safety and immunogenicity of a hexavalent DTwP-IPV-HB-PRP∼T vaccine versus separate DTwP-HB-PRP∼T and IPV vaccines in healthy infants in India. Vaccine: X, 10, 100137. https://doi.org/10.1016/j.jvacx.2021.100137

Mangarule, S., Siddaiah, P., Kawade, A., Dhati, R. M., Padmavathi, I. V., Palkar, S., Tripathi, V., Singh, R., Palvi, K., Mitra, M., Shetty, R., Leclercq, J., Midde, V. J., Varghese, K., Kandukuri, S. R., Kukian, D., & Noriega, F. (2023). Antibody Persistence Following Administration of a Hexavalent DTwP-IPV-HB-PRP~T Vaccine Versus Separate DTwP-HB-PRP~T and IPV Vaccines and Safety and  Immunogenicity of a Booster Dose of DTwP-IPV-HB-PRP~T Administered With an MMR  Vaccine in Healthy Infants in India. The Pediatric Infectious Disease Journal, 42(12), 1128–1135. https://doi.org/10.1097/INF.0000000000004118

Mills, E., Gold, R., Thipphawong, J., Barreto, L., Guasparini, R., Meekison, W., Cunning, L., Russell, M., Harrison, D., Boyd, M., & Xie, F. (1998). Safety and immunogenicity of a combined five-component pertussis-diphtheria-tetanus-inactivated poliomyelitis-Haemophilus B conjugate  vaccine administered to infants at two, four and six months of age. Vaccine, 16(6), 576–585. https://doi.org/10.1016/s0264-410x(97)00241-7

Nicol, M., Huebner, R., Mothupi, R., Käyhty, H., Mbelle, N., Khomo, E., & Klugman, K. P. (2002). Haemophilus influenzae type b conjugate vaccine diluted tenfold in diphtheria-tetanus-whole cell pertussis vaccine: A randomized trial. The Pediatric Infectious Disease Journal, 21(2), 138–141. https://doi.org/10.1097/00006454-200202000-00010

Nolan, T., Hogg, G., Darcy, M. A., Carlin, J. B., Skeljo, M., & Varigos, J. (1998). Immunogenicity and reactogenicity associated with an 18-month booster dose of a new diphtheria-tetanus-whole cell pertussis vaccine. Journal of Paediatrics and Child Health, 34(4), 346–348. https://doi.org/10.1046/j.1440-1754.1998.00242.x

Nolan, T., Hogg, G., Darcy, M. A., Skeljo, M., & Carlin, J. (1998). A combined liquid Hib (PRP-OMP), hepatitis B, diphtheria, tetanus and whole-cell pertussis vaccine: Uncontrolled preliminary clinical trial of immunogenicity and  reactogenicity. Vaccine, 16(20), 2085–2089. https://doi.org/10.1016/s0264-410x(98)00074-7

Nolan, T., Hogg, G., Darcy, M. A., Varigos, J., & McEwen, J. (1997). Primary course immunogenicity and reactogenicity of a new diphtheria-tetanus-whole cell pertussis vaccine (DTPw). Journal of Paediatrics and Child Health, 33(5), 413–417. https://doi.org/10.1111/j.1440-1754.1997.tb01631.x

Odusanya, O. O., Alufohai, F. E., Meurice, F. P., Wellens, R., Weil, J., & Ahonkhai, V. I. (2005). Prevalence of hepatitis B surface antigen in vaccinated children and controls in rural Nigeria. International Journal of Infectious Diseases : IJID : Official Publication of the International Society for Infectious Diseases, 9(3), 139–143. https://doi.org/10.1016/j.ijid.2004.06.009

Özen, M., Ünüvar, E., Yıldırım, A., Akman, H., Mevlitoğlu, S., & Pehlivan, T. (2024). A worldwide overview for hexavalent vaccines and a glimpse into Turkiye’s perspective. Human Vaccines & Immunotherapeutics20(1), 2345493.doi: 10.1080/21645515.2024.2345493

Raghu, M. B., Latha, R., Bhave, S., Sivananda, A., Pramod, G., Kavita, S., Arulprakash, R., Bhusari, P., Lad, S., & Raman, R. (2005). Immunogenicity and reactogenicity of an indigenous combined diphtheria, tetanus, whole-cell Bordetella pertussis and hepatitis B vaccine in Indian infants. Journal of Tropical Pediatrics, 51(4), 261. https://doi.org/10.1093/tropej/fmh113

Sanchez, L., Rungmaitree, S., Kosalaraksa, P., Jantarabenjakul, W., Leclercq, J., Yaiprayoon, Y., Midde, V. J., Varghese, K., Mangarule, S., & Noriega, F. (2023). Immunogenicity and Safety of a Hexavalent DTwP-IPV-HB-PRP~T Vaccine Versus Separate DTwP-HB-PRP~T, bOPV, and IPV Vaccines Administered at 2, 4, 6 Months of  Age Concomitantly With Rotavirus and Pneumococcal Conjugate Vaccines in Healthy  Infants in Thailand. The Pediatric Infectious Disease Journal, 42(8), 711–718. https://doi.org/10.1097/INF.0000000000003975

Santos, J. I., Martin, A., De Leon, T., Rivera, L., Gaitán, M. E. G., Del Rio, C., Oselka, G., Cervantes, Y., Rubio, P., Clemens, S. A. C., & de Mendonça, J. S. (2002). DTPw-HB and Hib primary and booster vaccination: Combined versus separate administration to Latin American children. Vaccine, 20(13–14), 1887–1893. https://doi.org/10.1016/s0264-410x(01)00512-6

Scheid, A., Borriello, F., Pietrasanta, C., Christou, H., Diray-Arce, J., Pettengill, M. A., Joshi, S., Li, N., Bergelson, I., Kollmann, T., Dowling, D. J., & Levy, O. (2018). Adjuvant Effect of Bacille Calmette-Guérin on Hepatitis B Vaccine Immunogenicity in the Preterm and Term Newborn. Frontiers in Immunology, 9, 29. https://doi.org/10.3389/fimmu.2018.00029

Scheifele, D. W., Bjornson, G., Halperin, S. H., Mitchell, L., & Boraston, S. (1994). Role of whole-cell pertussis vaccine in severe local reactions to the preschool (fifth) dose of diphtheria-pertussis-tetanus vaccine. CMAJ : Canadian Medical Association Journal = Journal de l’Association Medicale Canadienne, 150(1), 29–35.

Sharma, H., Parekh, S., Pujari, P., Shewale, S., Desai, S., Kawade, A., Lalwani, S., Ravi, M. D., Ramanan, P. V., Kamath, V., Agarwal, A., Dogar, V., Gautam, M., Jaganathan, K. S., Kumar, R., Sharma, I., & Gairola, S. (2024). A randomized, active-controlled, multi-centric, phase-II clinical study to assess safety and immunogenicity of a fully liquid DTwP-HepB-IPV-Hib hexavalent vaccine  (HEXASIIL®) in Indian toddlers. Vaccine, 42(26), 126380. https://doi.org/10.1016/j.vaccine.2024.126380

Sharma, H., Patil, V., Sharma, D., Kapre, S., Jadhav, S., Ravetkar, S., Kumar, R., Bahl, S., Parekh, S., & Chakravarty, A. (2012). A phase III, randomized controlled study to assess the safety and immunogenicity of a semi-synthetic diphtheria, tetanus and whole-cell pertussis vaccine in  Indian infants. Vaccine, 30(43), 6157–6162. https://doi.org/10.1016/j.vaccine.2012.07.068

Sharma, H., Yadav, S., Lalwani, S., Kapre, S., Jadhav, S., Parekh, S., Palkar, S., Ravetkar, S., Bahl, S., Kumar, R., & Shewale, S. (2013). Antibody persistence of two pentavalent DTwP-HB-Hib vaccines to the age of 15-18 months, and response to the booster dose of quadrivalent DTwP-Hib vaccine. Vaccine, 31(3), 444–447. https://doi.org/10.1016/j.vaccine.2012.11.038

Shin, S., Anh, D. D., Zaman, K., Yunus, M., Mai, L. T. P., Thiem, V. D., Azim, T., Victor, J. C., Dallas, M. J., Steele, A. D., Neuzil, K. M., & Ciarlet, M. (2012). Immunogenicity of the pentavalent rotavirus vaccine among infants in two developing countries in Asia, Bangladesh and Vietnam. Vaccine, 30 Suppl 1, A106-113. https://doi.org/10.1016/j.vaccine.2011.11.091

Tejiokem, M. C., Njamkepo, E., Gouandjika, I., Rousset, D., Béniguel, L., Bilong, C., Tene, G., Penda, I., Ngongueu, C., Gody, J. C., Guiso, N., & Baril, L. (2009). Whole-cell pertussis vaccine induces low antibody levels in human immunodeficiency virus-infected children living in sub-Saharan Africa. Clinical and Vaccine Immunology : CVI, 16(4), 479–483. https://doi.org/10.1128/CVI.00312-08

Usonis, V., Bakasenas, V., Taylor, D., & Vandepapeliere, P. (1996). Immunogenicity and reactogenicity of a combined DTPw-hepatitis B vaccine in Lithuanian infants. European Journal of Pediatrics, 155(3), 189–193. https://doi.org/10.1007/BF01953936

Weckx, L. Y., Thompson, A., Berezin, E. N., de Faria, S. M., da Cunha, C. A., Pride, M., Patterson, S., Gruber, W. C., Emini, E. A., & Scott, D. A. (2012). A phase 3, randomized, double-blind trial comparing the safety and immunogenicity of the 7-valent and 13-valent pneumococcal conjugate vaccines, given with routine  pediatric vaccinations, in healthy infants in Brazil. Vaccine, 30(52), 7566–7572. https://doi.org/10.1016/j.vaccine.2012.10.040

Zarei, S., Jeddi-Tehrani, M., Akhondi, M. M., Zeraati, H., Pourheidari, F., Ostadkarampour, M., Tavangar, B., & Shokri, F. (2009). Primary immunization with a triple diphtheria-tetanus-whole cell pertussis vaccine in Iranian infants: An analysis of antibody response. Iranian Journal of Allergy, Asthma, and Immunology, 8(2), 85–93.