TicoVac

• 1 through 15 years of age: each dose 0.25 mL
• 16 years of age and older: each dose 0.5 mL

Bring the vaccine to room temperature before administration. Shake well prior to administration to thoroughly mix the vaccine suspension. After shaking, the vaccine should be a homogenous off-white, opalescent suspension. Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. Do not administer if particulate matter or discoloration remains after shaking. Administer vaccine by intramuscular injection.

Appropriate medical treatment and supervision must be available to manage possible anaphylactic reactions following administration of TICOVAC.

Some individuals with altered immunocompetence may have reduced immune responses to TICOVAC.

TICOVAC contains albumin, a derivative of human blood. Based on effective donor screening and product manufacturing processes, it carries an extremely remote risk for transmission of viral diseases and variant Creutzfeldt-Jakob disease (vCJD). There is a theoretical risk for transmission of Creutzfeldt-Jakob disease (CJD), but if that risk actually exists, the risk of transmission would also be considered extremely remote. No cases of transmission of viral diseases, CJD or vCJD have ever been identified for licensed albumin or albumin contained in other licensed products.

Vaccination with TICOVAC may not protect all individuals.

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a vaccine cannot be directly compared to rates in the clinical trials of another vaccine and may not reflect the rates observed in practice.

Among a total of 10 clinical trials, 3240 healthy children 1 through 15 years of age received at least one dose of TICOVAC. A total of 4427 healthy adults 16 years of age and older received at least one dose of TICOVAC in 10 clinical trials.

Study 209 was a multicenter, open-label study to investigate the safety of TICOVAC in 2,417 healthy children 1 through 15 years of age who received three vaccinations (Day 0, 1 and 6 months after the first vaccination). The incidence rates for local and systemic solicited adverse reactions within 4 days after each dose are presented in Table 2.

Incidence rates of fever reported within 4 days after each dose of TICOVAC, by age group, in Study 209 are presented in Table 3.

The following additional adverse reactions to the vaccine have been reported in <1% of subjects 1 through 15 years of age who received TICOVAC in clinical trials (N=3240): vertigo, dizziness, sensory abnormalities, abdominal pain, diarrhea, dyspepsia, injection site pruritus, and urticaria.

Study 208 was a randomized, comparative, single-blind study that assessed the safety of TICOVAC. Healthy subjects 16 through <65 years of age (N=3966) were randomized 3:1 to receive two vaccinations with either TICOVAC or a non-US licensed TBE vaccine comparator administered 21 to 35 days apart. Study 213 was an open-label follow-up study to Study 208; all subjects who had received two vaccinations in Study 208 (regardless of which vaccine they had received) were eligible and received a third vaccination with TICOVAC 6 months after the first vaccination in Study 208 (N=3705).

Incidence rates of solicited local and systemic adverse reactions reported in Study 208 (Doses 1 and 2) and Study 213 (Dose 3) are presented in Table 4.

The following additional adverse reactions have been reported in <1% of subjects 16 through <65 years of age who received TICOVAC in clinical trials (N=4427): hypersensitivity, somnolence, vertigo, diarrhea, abdominal pain, injection site pruritus, and injection site warmth.

Subjects who were seropositive either by ELISA or NT 1 month after the third dose in Studies 209 and 208/213, were invited to participate in follow-up Studies 700401 and 223 (studies assessing antibody persistence and response to a booster dose at 3 years), respectively. A total of 156 subjects received a fourth dose of TICOVAC (0.25 mL), and 240 subjects received a fourth dose of TICOVAC (0.5 mL) in these clinical trials.

Incidence rates of solicited local and systemic adverse reactions reported in Study 223 and 700401 after the booster are presented in Table 5.

Among 3240 subjects who received TICOVAC (0.25 mL) in clinical trials, serious adverse events (SAEs) and death were reported in 62 subjects and 1 subject, respectively. Among 4427 subjects who received TICOVAC (0.5 mL) in clinical trials, SAEs and deaths were reported in 54 subjects and 2 subjects, respectively. None of these events was considered related to the vaccine. Only one SAE in TICOVAC (0.25 mL) was considered possibly related to vaccine (febrile convulsion reported in a 12-month old male two days after vaccination in Study 197, a postmarketing safety surveillance study).

The following adverse reactions have been reported spontaneously (postmarketing) with the use of TICOVAC in the European Union (EU). Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to vaccine exposure.

• Infections and infestations: herpes zoster (triggered in pre-exposed individuals)
• Immune system disorders: anaphylactic reaction, hypersensitivity, precipitation or aggravation of autoimmune disorders (e.g., multiple sclerosis)
• Nervous system disorders: convulsion, convulsion (including febrile), demyelinating disorders (acute disseminated encephalomyelitis, Guillain-Barré syndrome, myelitis, transverse myelitis), encephalitis, sensory abnormalities and motor dysfunction (hemiparesis, hemiplegia, VIIth nerve paralysis/facial paresis, paralysis, paresis, neuritis, neuralgia, optic neuritis), polyneuropathy, meningism, dizziness, aseptic meningitis
• Eye disorders: visual impairment, photophobia, eye pain
• Ear and labyrinth disorders: tinnitus
• Cardiac disorders: tachycardia
• Respiratory, thoracic and mediastinal disorders: dyspnea
• Skin and subcutaneous tissue disorders: urticaria, rash (erythematous, maculo-papular, vesicular), pruritus, dermatitis, erythema, hyperhidrosis
• Musculoskeletal and connective tissue disorders: back pain, joint swelling, neck pain, musculoskeletal stiffness (including neck stiffness), pain in extremity
• General disorders and administration site conditions: injection site joint movement impairment, injection site joint pain, injection site nodule, injection site inflammation, influenza-like illness, chills, gait disturbance, asthenia, edema

Safety and effectiveness of TICOVAC have not been established in infants below 1 year of age.

Clinical studies of TICOVAC did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. A clinical study (Study 690601, NCT00460486) of TICOVAC enrolled 73 subjects 60 years of age and older, including 31 subjects 65 years of age and older.

Following administration, TICOVAC induces TBEV-neutralizing antibodies, which are believed to confer protection. However, a protective antibody level has not been defined.

TICOVAC has not been evaluated for the potential to cause carcinogenicity, genotoxicity or impairment of fertility.

In Austria, field effectiveness of TBE vaccines was assessed retrospectively for the period from 2000 to 2011. During this period, two TBE vaccines were available in Austria. The market coverage in Austria for TICOVAC was 95%, 90%, and 80%, in 2000, 2006, and 2011, respectively.¹ The calculation of TBE vaccine effectiveness overall is based on (1) the annual numbers of serologically confirmed cases of TBE virus infections with neurological symptoms causing hospitalization (2) their vaccination history, and (3) the proportion of vaccinated and unvaccinated in the Austrian population. During the study period, the recommended vaccination schedule in Austria consisted of 2 vaccinations approximately 4 weeks apart followed by a third vaccination 5–12 months after the second dose, and a booster vaccination ≥3 years after the third dose. The TBE cases were categorized based on their vaccination status. Among the 883 TBE cases in Austria between 2000 and 2011, 45 patients did not have an accurate vaccination history. The best-case and worst-case estimates of vaccine effectiveness were calculated. For the best-case estimate, the 45 patients without an accurate vaccination history were excluded from the calculation. For the worst-case estimate, these 45 patients were assumed to have been vaccinated according to the recommended schedule. The proportions of vaccinated and unvaccinated individuals in the general population were estimated using annual postal surveys sent to 4,000 households (8,500–10,000 household members). Overall, worst-case and best-case TBE vaccine effectiveness for preventing hospitalized TBE was estimated to be 96.3% (95% CI: 95.5, 97.0) and 98.7% (95% CI: 98.2, 99.0), respectively, following at least 3 doses of TBE vaccine administered according to the recommended schedule in Austria.²

TICOVAC is supplied in the following strengths and package configurations:

The tip cap and rubber plunger of the pre-filled syringe are not made with natural rubber latex.

Upon receipt, store refrigerated at 2ºC to 8ºC (36ºF to 46ºF).

Keep the syringe in the outer carton in order to protect from light. Do not freeze. Discard if the vaccine has been frozen.