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Current Epidemiology and Trends in Invasive Haemophilus influenzae Disease-United States, 2009-2015
Does Hib Vaccine Schedule Stop All the Cases?
By Peter A. McCullough, MD, MPH
The rates of invasive Haemophilus influenza b have dropped precipitously since the advent of the Hib antigen-based vaccine introduced in 1985. CDC recommends Hib vaccination (4 shots) for all children younger than 5 years old in the United States. CDC does not recommend Hib vaccination for most people 5 years or older unless they:
Have certain medical conditions and are unvaccinated
Receive a bone marrow transplant
Here is the CDC recommended Hib vaccine schedule:
Soeters et al reported on laboratory-based surveillance for invasive H. influenzae disease conducted as part of Active Bacterial Core surveillance (ABCs). ABC surveillance is supported by the Centers for Disease Control and Prevention (CDC) as part of the Emerging Infections Program Network. Data from 1 January 2009 through 31 December 2015 were included in this analysis representing ~12% of the population. There were 4924 cases of invasive H. influenzae disease were reported; 715 (14.5%) were fatal. However, only 77 (1.8%) were serotype b that could have been theoretically prevented by vaccination.
Only 23 (29.9%) H. influenzae b patients aged <5 years, 22 (95.7%) had available information on clinical syndrome: 9 (40.9%) had meningitis, 6 (27.3%) had bacteremic pneumonia, 3 (13.6%) had bacteremia, and 4 (18.2%) had other presentations. Two (8.7%) were too young to have received Hib vaccine, 6 (26.1%) were unvaccinated, and 10 (43.5%) were undervaccinated (n = 8/10 had received the 3-dose primary series but were missing a booster dose at 12–15 months). Five (21.7%) were age-appropriately vaccinated and had no reported underlying conditions; 2 were 3-month-old infants who had been age-eligible for only the first dose of Hib vaccine.
In summary, a very small fraction of all Haemophilus infections are serotype b that would be covered by Hib vaccination. No vaccine is perfect. Among those under age 5 where the big public health intervention has pushed vaccination since 1985, 73.9% were either fully vaccinated or going through the process of the routine schedule. Parents should understand that that a vaccine schedule is an intervention and as such intent-to-treat principles apply. For Hib with an intent to follow the ACIP schedule, among the small number of invasive Haemophilus type b infections, the majority will be failed by the vaccine schedule. Thus, all the risks incurred for every recipient has to be weighed with these reported benefits from outcomes studies.
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Soeters HM, Blain A, Pondo T, Doman B, Farley MM, Harrison LH, Lynfield R, Miller L, Petit S, Reingold A, Schaffner W, Thomas A, Zansky SM, Wang X, Briere EC. Current Epidemiology and Trends in Invasive Haemophilus influenzae Disease-United States, 2009-2015. Clin Infect Dis. 2018 Aug 31;67(6):881-889. doi: 10.1093/cid/ciy187. PMID: 29509834; PMCID: PMC6181225.