Haemophilus influenzae type b (Hib)

Haemophilus influenzae type b (Hib)

Symptoms and Causative Agent

Haemophilus Influenzae type b, commonly known as Hib, is a bacterium that can cause severe infections, particularly in young children. Despite its name, it is unrelated to the influenza virus: Hib was found in a group of patients during an influenza outbreak in 1892, before scientists discovered that the flu was caused by a virus. Hib was thus proposed as the cause of influenza. Its now-confusing name was kept in spite of its initial, though incorrect, association with the flu.

Hib bacteria can cause many types of invasive disease, including meningitis, pneumonia, cellulitis (skin infection), septic arthritis (joint infection) and epiglottitis (infection of the epiglottis, causing obstruction or closing of the windpipe). Thus, although it’s sometimes said that the Haemophilus influenzae type b vaccine is given to “protect against Hib,” this phrasing is not technically correct. The vaccine protects against the diseases caused by Hib, which are numerous and can be severe. Collectively, these Hib-caused infections are referred to generally as “Hib disease.”

Before the Hib vaccine was introduced, meningitis—infection of the membranes that cover the brain—was the most common Hib-induced invasive disease. Symptoms include fever, stiff neck, and impaired mental status. Meningitis results in permanent hearing impairment or other neurological conditions in 15-30% of patients who survive it.

Transmission

Haemophilus influenzae type b bacteria can’t survive on surfaces or in the environment. The bacterium’s only known reservoir is humans, who may carry it without becoming ill.

It is thought to be spread through the air by respiratory droplets from sick individuals. Fortunately, its ability to spread is considered limited in most cases, although close contact with an infected patient can lead to outbreaks.

Treatment and Care

Antibiotics may be used to treat Hib infections, but the bacteria have developed resistance to some antibiotics. Hospitalization is often required.

Complications

Because the spectrum of Hib disease ranges from meningitis to pneumonia, the types of complications vary depending on the type of Hib infection. Many of these are forms of neurologic damage, including blindness, deafness, and mental retardation.

As with the complications associated with various forms of Hib disease, the risk of death from the different types varies. For Hib meningitis (the most common form of invasive Hib disease), the case fatality rate is 2-5%.

Before Hib vaccination, about 20,000 children younger than five developed severe Hib disease in the United States each year, and about 1,000 died. By 2006, the number of reported Hib cases was down to only 29 for the year. Now, while the majority of fatalities from Hib disease are reported in developing countries where the Hib vaccine is not widely used, fatalities still occur in developed nations when vaccination rates drop. Seven cases of invasive Hib disease were reported in Pennsylvania during a six-month period starting in October 2008. Only one of the children had received a Hib vaccination (and had received only one of the recommended doses). Three of the children died.

Available Vaccines and Vaccination Campaigns

The first vaccine to protect against Hib diseases was introduced in the United States in 1985; an improved vaccine was licensed two years later. Several preparations of Hib vaccine are now available, both as single vaccinations for Hib and in combined shots (Hepatitis B and Hib vaccines, for example, are available in a combined shot). All of the vaccines against Hib disease are inactivated vaccines and contain only a part of the Hib bacterium.

U.S. Vaccination Recommendations

Vaccination against Hib disease is included on the U.S. childhood immunization schedule. Either three or four doses are recommended depending on which Hib vaccine is being used. For all Hib vaccines, however, the first dose is recommended at two months of age, and is not generally recommended beyond five years of age.

Globally, as of 2013, 98% of World Health Organization member countries had adopted Hib vaccine in their immunization programs. Coverage of infants worldwide was estimated at 52% in 2013.


Sources

Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preventable Diseases. Haemophilus Influenzae type b. Atkinson W, Wolfe S, Hamborsky J, McIntyre L, eds. 13th ed. Washington DC: Public Health Foundation, 2015. http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/hib.pdf. (524 KB). Accessed 2/5/2016.

Centers for Disease Control and Prevention. Hib Vaccination. http://www.cdc.gov/vaccines/vpd-vac/hib/default.htm Accessed 2/5/2016.

World Health Organization. Global immunization data. (215 KB) July 2014. Accessed 05 Oct 2016.

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Last update 5 Oct 2016

Timeline Entry: 1985

First Vaccine Against Hib

The first vaccine against Haemophilus influenzae type b (Hib) disease was licensed in the United States in 1985. The HbPV polysaccharide vaccine was used until 1988. Porter W. Anderson, Jr, PhD, and David H. Smith, MD (1932-1999), had begun working in 1968 on extracting and purifying the polysaccharide outer coating of the bacteria. A 1975 trial of the vaccine in Finland showed that toddlers, but not infants, mounted a protective response to the bacteria. Unable to interest pharmaceutical companies in manufacturing the vaccine, Smith founded a company to produce it.

Before the Hib vaccine was introduced in the United States, severe Hib disease (which includes meningitis, pneumonia, joint infections, bone infections, skin infections, and epiglottitis – an infection and swelling in the throat that can block the airway) affected about 20,000 children younger than five each year, and killed nearly 1,000. Among Hib meningitis cases, 2%-5% are fatal, while 15%-30% of patients who survive have permanent neurological damage such as blindness or deafness.

By 2006, with widespread use of the vaccine, the number of reported Hib cases in the United States was down to only 29 for the year.

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Timeline Entry: 1987

Conjugate Hib Vaccine Licensed

Work by American scientists John Robbins, MD, and Rachel Schneerson, MD, led to the first conjugate vaccine against Haemophilus influenzae (Hib) disease being licensed in the United States. Conjugate vaccines are better able to induce an immune response than polysaccharide vaccines in infants and young children, the age group most at risk from Hib. This vaccine replaced a previous polysaccharide Hib disease vaccine.

Today there are three conjugate Hib disease vaccines available in the United States, as well as two combination vaccines that provide protection against multiple diseases, including Hib disease. For optimal protection, children need 3-4 doses of the vaccine starting around 2 months of age.

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Assessment Questions

Haemophilus influenzae type B is a kind of __________.

  • bacterium
  • fungus
  • virus
  • none of the above

Haemophilus influenzae type B can cause __________.

  • influenza
  • the flu
  • infections of many different body tissues and organs
  • none of the above

Those most at risk of severe disease from Haemophilus influenzae type B are __________.

  • adults
  • teenagers
  • young children
  • pregnant women
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