Haemophilus influenzae type b (Hib)
Information about Haemophilus influenzae type b (Hib) disease, vaccines and recommendations for vaccination from the Australian Immunisation Handbook.
Recently added
This page was added on 06 June 2018.
Updates made
This page was updated on 07 December 2022. View history of updates
Vaccination for certain groups of people is funded under the National Immunisation Program.
Overview
What
Haemophilus influenzae is a bacterium that is a normal part of the upper respiratory tract flora. H. influenzae type b (Hib) can cause invasive diseases in children and in people who are immunocompromised. These diseases include bacterial meningitis, pneumonia, epiglottitis, septic arthritis and cellulitis.
Who
Hib-containing vaccine is recommended for:
- routine vaccination in infants and children
- infants and children <5 years of age who have missed a dose of Hib-containing vaccine
- people who are immunocompromised, including people with asplenia and people who have received a haematopoietic stem cell transplant
How
Infants and children are recommended to receive Hib-containing vaccine at 2, 4, 6 and 18 months of age.
People who have functional or anatomical asplenia are recommended to receive 1 dose of Hib vaccine.
People who have received an allogeneic or autologous haematopoietic stem cell transplant are recommended to receive 3 doses of Hib vaccine at 6, 8 and 12 months after the transplant.
Why
Hib can cause invasive diseases in young children and people who are immunocompromised. The case-fatality rate for Hib meningitis is between 3% and 6%. Up to 30% of individuals who survive Hib disease have permanent neurological sequelae.
Recommendations
Infants and children
Hib-containing vaccine is recommended in a 4-dose schedule for infants at 2, 4, 6 and 18 months of age.
Infants can have their 1st dose as early as 6 weeks of age. If the 1st dose is given at 6 weeks of age, infants should still receive their next scheduled doses at 4 months and 6 months of age.
The vaccines usually received at each schedule point are:
- 2, 4 and 6 months of age — (DTPa-hepB-IPV-Hib diphtheria-tetanus-acellular pertussis, hepatitis B, inactivated poliovirus, Hib)
- 18 months of age — monovalent Hib
The recommended number of doses and intervals for catch-up Hib vaccines vary with the child’s age. For catch-up recommendations, see Table. Catch-up schedule for Haemophilus influenzae type b (Hib) vaccination for children <5 years of age in Catch-up vaccination.
View recommendation detailsPeople who are immunocompromised
People who have received an allogeneic or autologous haematopoietic stem cell transplant are recommended to receive 3 doses of Hib vaccine at 6, 8 and 12 months after the transplant.
View recommendation detailsA single dose of Hib vaccine is recommended for people with functional or anatomical asplenia who were not fully vaccinated in early childhood according to the recommendations for infants and children. This is because Hib can cause post-splenectomy sepsis in adults and children.1
See Table. Catch-up schedule for Haemophilus influenzae type b (Hib) vaccination for children <5 years of age in Catch-up vaccination. This is because Hib can cause post-splenectomy sepsis in adults and children.1
Where possible, these people should receive the vaccine either:
- 2 weeks before a planned splenectomy, or
- about 1 week after an emergency splenectomy
These people do not need subsequent booster doses of Hib vaccine.1
See also Table. Recommendations for vaccination in people with functional or anatomical asplenia in Vaccination for people who are immunocompromised for all recommendations.
View recommendation detailsVaccines, dosage and administration
Hib vaccines available in Australia
The Therapeutic Goods Administration website provides product information for each vaccine.
See also Vaccine information and Variations from product information for more details.
Monovalent vaccines
Registered for use in infants and children aged 2 months to 5 years.
Monovalent Haemophilus influenzae type b (Hib) vaccine
Lyophilised powder in a monodose vial with a pre-filled diluent syringe.
Each 0.5 mL reconstituted dose contains:
- 10 µg Hib capsular polysaccharide (polyribosyl-ribitol-phosphate) conjugated to 18–30 µg tetanus protein (PRP-T)
For Product Information and Consumer Medicine Information about Act-HIB visit the Therapeutic Goods Administration website.
View vaccine detailsRegistered for use in infants and children aged 2 months to 5 years.
Monovalent Haemophilus influenzae type b (Hib) vaccine.
Lyophilised pellet in a monodose vial with separate diluent.
Each 0.5 mL reconstituted dose contains:
- 10 µg Hib capsular polysaccharide (polyribosyl-ribitol-phosphate) conjugated to approximately 25 µg tetanus toxoid (PRP-T)
For Product Information and Consumer Medicine Information about Hiberix visit the Therapeutic Goods Administration website.
View vaccine detailsCombination vaccines
Registered for use in infants and children aged ≥6 weeks.
DTPa-hepB-IPV-Hib — diphtheria-tetanus-acellular pertussis-hepatitis B-inactivated poliovirus-Haemophilus influenzae type b combination vaccine
Each 0.5 mL monodose pre-filled syringe contains:
- ≥20 IU diphtheria toxoid
- ≥40 IU tetanus toxoid
- 25 µg pertussis toxoid
- 25 µg filamentous haemagglutinin
- 10 µg recombinant hepatitis B surface antigen (HBsAg)
- 40 D-antigen units inactivated poliovirus type 1 (Mahoney)
- 8 D-antigen units inactivated poliovirus type 2 (MEF-1)
- 32 D-antigen units inactivated poliovirus type 3 (Saukett)
- 12 µg purified Hib capsular polysaccharide conjugated to 22–36 µg tetanus toxoid
Adsorbed onto 0.6 mg aluminium as aluminium hydroxide.
May contain traces of:
- glutaraldehyde
- formaldehyde
- neomycin
- streptomycin
- polymyxin B
For Product Information and Consumer Medicine Information about Hexaxim visit the Therapeutic Goods Administration website.
View vaccine detailsRegistered for use in infants and children aged ≥6 weeks.
DTPa-hepB-IPV-Hib — diphtheria-tetanus-acellular pertussis-hepatitis B-inactivated poliovirus-Haemophilus influenzae type b combination vaccine
The vaccine consists of both a 0.5 mL monodose pre-filled syringe and a vial containing a lyophilised pellet.
The pre-filled syringe contains:
- ≥30 IU diphtheria toxoid
- ≥40 IU tetanus toxoid
- 25 µg pertussis toxoid
- 25 µg filamentous haemagglutinin
- 8 µg pertactin
- 10 µg recombinant hepatitis B surface antigen (HBsAg)
- 40 D-antigen units inactivated poliovirus type 1 (Mahoney)
- 8 D-antigen units inactivated poliovirus type 2 (MEF-1)
- 32 D-antigen units inactivated poliovirus type 3 (Saukett)
Adsorbed onto aluminium hydroxide/phosphate.
Also contains traces of:
- formaldehyde
- polysorbate 80
- polysorbate 20
- polymyxin
- neomycin
The vial containing a lyophilised pellet contains:
- 10 µg purified Hib capsular polysaccharide conjugated to 20–40 µg tetanus toxoid
May contain yeast proteins.
For Product Information and Consumer Medicine Information about Infanrix Hexa visit the Therapeutic Goods Administration website.
View vaccine detailsDose and route
The dose of all Hib-containing vaccines is 0.5 mL given by intramuscular injection.
Co-administration with other vaccines
People can receive Hib-containing vaccines at any time before or after, or with, most other vaccines.
Interchangeability of Hib vaccines
If possible, use the same brand of Hib-containing vaccine for all primary doses.
Overseas born children who have received different Hib-containing vaccines (such as PRP-OMP [polyribosylribitol phosphate-outer membrane protein conjugate] and PRP-T [PRP conjugated to tetanus toxoid] vaccines) should complete their course according to the recommended routine or catch-up schedule, to receive a total of 4 doses of Hib-containing vaccine at appropriate intervals. However, if a child has received 2 primary PRP-OMP doses, a 3rd primary dose is not required. A booster dose should still be given.
Contraindications and precautions
Contraindications
The only absolute contraindications to Hib-containing vaccines are:
- anaphylaxis after a previous dose of any Hib-containing vaccine
- anaphylaxis after any component of a Hib-containing vaccine
Precautions
Women who are pregnant or breastfeeding are not routinely recommended to receive Hib vaccine. The exception is for women with functional or anatomical asplenia who were not fully vaccinated against Hib in childhood.
See Table. Vaccines that are not routinely recommended in pregnancy: inactivated bacterial vaccines in Vaccination for women who are planning pregnancy, pregnant or breastfeeding for more details.
People with latex allergy
The product information for Act-HIB states that the tip cap of the syringe contains latex. Consider using an alternative product in people with an allergy or sensitivity to latex.
Adverse events
Swelling and redness at the injection site after the 1st dose are common and have been reported in 5–30% of vaccinated children. Fever in up to 2% has also been reported. These adverse events usually appear within 3–4 hours of vaccination and resolve completely within 24 hours.2
The incidence of these adverse events declines with subsequent doses.
Nature of the disease
Haemophilus influenzae is a gram-negative coccobacillus that is part of the normal flora of the upper respiratory tract.
Hib has a capsular form and a non-capsular form. Strains isolated from respiratory tract specimens, such as sputum, or middle ear or sinus fluid usually do not have a capsule. These are known as non-typeable H. influenzae (NTHi).
There are 6 capsular types (a to f). Before Hib vaccination started, almost all H. influenzae isolates from sterile sites (blood, cerebrospinal fluid, joint or pleural fluid) were type b. 2
Pathogenesis
The incubation period of Hib disease is not definitively known, but is estimated to be 2–4 days.
Transmission
Hib can be transmitted from symptomatic or asymptomatic carriers by direct contact with respiratory droplets or nasal discharge.3 An infected person can transmit Hib disease for as long as the bacteria are present, which may be several months.
Laboratory diagnosis
Identification of gram-negative coccobacilli in body fluid suggests Hib disease. Culturing Hib from body fluids can be difficult because the organism needs specific growth media and culturing conditions.
Newer non-culture diagnostic methods, such as PCR, are more sensitive and rapid.
It is important that all isolates of Hib are serotyped because only type b is vaccine-preventable.
Clinical features
Clinical categories of invasive disease caused by Hib include:4
- meningitis
- epiglottitis
- septic arthritis
- cellulitis
- pneumonia
Non-typeable Haemophilus influenzae strains are a common cause of otitis media in children and bronchitis in adults. They occasionally cause invasive disease.2 Hib vaccines do not prevent non-typeable H. influenzae infections.
Meningitis
Hib is rarely isolated from the blood without a focal infection being evident or developing subsequently. Focal infections due to Hib do not have any specific clinical features that can differentiate them from those due to other organisms.
Infants often do not present with classical clinical signs of meningitis (neck stiffness and photophobia). Instead, they may present with drowsiness, poor feeding, high fever or irritability.3
Epiglottitis
Epiglottitis presents with respiratory obstruction, associated with soft stridor and often drooling. Children with epiglottitis are pale, febrile and anxious. They should remain upright to open up their airway as much as possible.
Before Hib vaccines were introduced, Hib caused >95% of epiglottitis cases.5
Complications
Meningitis and epiglottitis are almost always fatal without appropriate treatment. The case-fatality rate for Hib meningitis in developed countries is at least 3%, even with treatment. 15–30% of survivors have permanent neurological sequelae.3
Epidemiology
Hib disease in Australia
Since Hib vaccines were included in the routine vaccination schedule in 1993, the number of notified cases of Hib disease in Australia has decreased by more than 95%. 6
In 1992 alone, 549 Hib cases were reported. In contrast, during 2014, 21 Hib infections were notified in Australia. This gives an average annual notification rate of 0.19 per 100,000 population. 7-10
Australia has one of the lowest incidence rates of Hib worldwide. The reduction in Hib incidence after routine vaccination was introduced has been particularly marked in Aboriginal and Torres Strait Islander children. However, absolute rates in these children remain substantially higher than in the non-Indigenous population.11,12
Epiglottitis and Hib
Since Hib disease has become relatively rare, cases of epiglottitis can no longer be assumed to be due to Hib. Also, even if Haemophilus influenzae is isolated from a normally sterile site, it may not be type b. This means that health professionals should always seek laboratory confirmation of H. influenzae infection and serotype before considering vaccination failure.13,14
Changes to immunisation programs
Previously, children received a booster dose of Hib vaccine in combination with meningococcal C vaccine (Hib-MenC) at 12 months of age. This dose has been moved to 18 months of age as monovalent Hib vaccine.
The change in vaccination timing from 12 months to 18 months is not expected to lead to increased Hib breakthrough disease. A booster dose of Hib vaccine in the 2nd year of life can ensure long-term protection against Hib disease and prevent cases of Hib disease later in childhood.
In Australia between 1993 and 2016, 17 cases of Hib occurred in partially vaccinated children aged 6–23 months. Most of these children (n = 15) had not completed the initial 3-dose infant course (usually given at 2, 4 and 6 months of age).12
In the United States, the Hib booster dose was deferred by 18 months in response to a vaccine supply shortage. This deferral did not cause an increase in the incidence of invasive Hib disease.15
A 2017 modelling study assessed the likely impact on carriage and disease of delaying the Hib booster dose for up to 4 years. The study predicted no increase in a population with high (>90%) vaccine coverage.16 Giving a booster dose at an older age may also increase Hib antibody responses and long-term protection.17
Vaccine information
Types of conjugate Hib vaccines
All Hib-containing vaccines in Australia contain the Hib capsular polysaccharide polyribosylribitol phosphate conjugated to tetanus toxoid (PRP-T).
Vaccine efficacy and effectiveness
Vaccine efficacy against invasive Hib disease is estimated to be 97% for 3 doses of Hib-containing vaccine. Vaccine effectiveness against invasive Hib disease in cohort studies has been estimated at 94% for 3 doses of Hib-containing vaccine.18 Several case–control studies have estimated the vaccine effectiveness against Hib meningitis to be:
- 55% for 1 dose
- 96% for 2 doses
- 96% for 3 doses18
Transporting, storing and handling vaccines
Transport according to National Vaccine Storage Guidelines: Strive for 5.19 Store at +2°C to +8°C. Do not freeze. Protect from light.
Act-HIB
Act-HIB vaccine must be reconstituted. Add the entire contents of the diluent syringe to the vial and shake until the powder completely dissolves. Use the reconstituted vaccine immediately.
Hiberix
Hiberix vaccine must be reconstituted. Add the entire contents of the diluent container to the vial and shake until the pellet completely dissolves. Use the reconstituted vaccine as soon as practicable. If storage is needed, store at +2°C to +8°C for no more than 24 hours.
Infanrix hexa
Infanrix hexa vaccine must be reconstituted. Add the entire contents of the syringe to the vial and shake until the pellet completely dissolves. Use the reconstituted vaccine as soon as practicable. If storage is needed, store at room temperature for no more than 8 hours.
Public health management
Hib is a notifiable disease in all states and territories in Australia. The Communicable Diseases Network Australia national guidelines for Hib invasive infection20 have details about the management of Hib cases and contacts.
State and territory public health authorities can provide further advice about the public health management of Hib.
Variations from product information
Infanrix hexa
The product information for Infanrix hexa states that this vaccine is for:
- primary immunisation of infants from the age of 6 weeks
- booster dose in children 18 months of age if they need boosting for all antigens
The Australian Technical Advisory Group on Immunisation (ATAGI) recommends that Infanrix hexa may also be used for catch-up of the primary schedule or as a booster dose in children <10 years of age.
The product information for Infanrix hexa states that this vaccine is contraindicated in children with either:
- encephalopathy of unknown aetiology, or
- neurologic complications occurring within 7 days after a vaccine dose
ATAGI recommends that the only contraindications are:
- anaphylaxis after a previous dose of any Hib-containing vaccine
- anaphylaxis after any component of a Hib-containing vaccine
Act-HIB
The product information for Act-HIB states that the antibody response appears to be greater following subcutaneous administration than that after intramuscular administration.
ATAGI does not have preference for either of the two routes of administration for Act-HIB.
Act-HIB and Hiberix
The product information for Act-HIB and Hiberix states that these vaccines are for use in children aged 2 months to 5 years.
ATAGI recommends that the following people can also receive Act-HIB or Hiberix:
- older people with asplenia
- people who have received an allogeneic or autologous haematopoietic stem cell transplant
References
- Davies JM, Lewis MP, Wimperis J, et al. Review of guidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen: prepared on behalf of the British Committee for Standards in Haematology by a working party of the Haemato-Oncology Task Force. British Journal of Haematology 2011;155:308-17.
- Centers for Disease Control and Prevention (CDC). Haemophilus influenzae type b. In: Hamborsky J, Kroger A, Wolfe C, eds. Epidemiology and prevention of vaccine-preventable diseases. 13th ed. Washington, DC: Public Health Foundation; 2015.
- Nanduri SA, Sutherland AR, Gordon LK, Santosham M. Haemophilus influenzae type b vaccines. In: Plotkin SA, Orenstein WA, Offit PA, Edwards KM, eds. Plotkin's vaccines. 7th ed. Philadelphia, PA: Elsevier; 2018.
- Gilbert GL, Johnson PD, Clements DA. Clinical manifestations and outcome of Haemophilus influenzae type b disease. Journal of Paediatrics and Child Health 1995;31:99-104.
- Wood N, Menzies R, McIntyre P. Epiglottitis in Sydney before and after the introduction of vaccination against Haemophilus influenzae type b disease. Internal Medicine Journal 2005;35:530-5.
- Horby P, Gilmour R, Wang H, McIntyre P. Progress towards eliminating Hib in Australia: an evaluation of Haemophilus influenzae type b prevention in Australia, 1 July 1993 to 30 June 2000. Communicable Diseases Intelligence 2003;27:324-41.
- McIntyre P. Invasive Haemophilus influenzae type b disease in Australia: the beginning of the end? Medical Journal of Australia 1992;156:516-8.
- Chiu C, Dey A, Wang H, et al. Vaccine preventable diseases in Australia, 2005 to 2007. Communicable Diseases Intelligence 2010;34 Suppl:ix-S167.
- Herceg A. The decline of Haemophilus influenzae type b disease in Australia. Communicable Diseases Intelligence 1997;21:173-6.
- NNDSS Annual Report Working Group. Australia's notifiable disease status, 2014: annual report of the National Notifiable Diseases Surveillance System. Communicable Diseases Intelligence 2016;40:E48-145.
- Wang H, Deeks S, Glasswell A, McIntyre P. Trends in invasive Haemophilus influenzae type b disease in Australia, 1995–2005. Communicable Diseases Intelligence 2008;32:316-25.
- Menzies RI, Bremner KM, Wang H, Beard FH, McIntyre PB. Long-term trends in invasive Haemophilus influenzae type b disease among Indigenous Australian children following use of PRP-OMP and PRP-T vaccines. Pediatric Infectious Disease Journal 2015;34:621-6.
- Booy R, Heath PT, Slack MP, Begg N, Moxon ER. Vaccine failures after primary immunisation with Haemophilus influenzae type-b conjugate vaccine without booster. [erratum appears in Lancet 1997 May 31;349(9065):1630]. The Lancet 1997;349:1197-202.
- Heath PT, Booy R, Azzopardi HJ, et al. Non-type b Haemophilus influenzae disease: clinical and epidemiologic characteristics in the Haemophilus influenzae type b vaccine era. Pediatric Infectious Disease Journal 2001;20:300-5.
- Briere EC, Jackson M, Shah SG, et al. Haemophilus influenzae type b disease and vaccine booster dose deferral, United States, 1998–2009. Pediatrics 2012;130:414-20.
- Charania NA, Moghadas SM. Modelling the effects of booster dose vaccination schedules and recommendations for public health immunization programs: the case of Haemophilus influenzae serotype b. BMC Public Health 2017;17:705.
- Southern J, McVernon J, Gelb D, et al. Immunogenicity of a fourth dose of Haemophilus influenzae type b (Hib) conjugate vaccine and antibody persistence in young children from the United Kingdom who were primed with acellular or whole-cell pertussis component-containing Hib combinations in infancy. Clinical and Vaccine Immunology: CVI 2007;14:1328-33.
- Jackson C, Mann A, Mangtani P, Fine P. Effectiveness of Haemophilus influenzae type b vaccines administered according to various schedules: systematic review and meta-analysis of observational data. Pediatric Infectious Disease Journal 2013;32:1261-9.
- National Vaccine Storage Guidelines: Strive for 5: Strive for 5. 3rd ed. Canberra: Australian Government Department of Health and Ageing; 2019. https://www.health.gov.au/resources/publications/national-vaccine-stora…
- Communicable Diseases Network Australia (CDNA). Haemophilus influenzae type b invasive infection: CDNA national guidelines for public health units. Canberra: Australian Government Department of Health; 2014.
Page history
Update to remove guidance on co-administration with MenACWY vaccine.
- Added 'People with latex allergy' section under 'Precautions', to reflect updated product information regarding Adacel.
- Updated guidance on route of administration.
- Removal of Menitorix as vaccine was discontinued in July 2020.
Guidance on co-administration of Hib-containing vaccines with quadrivalent meningococcal vaccines has been added.
The Hib (Haemophilus influenzae type b) booster dose previously given in combination with Hib-MenC (combined Hib and meningococcal C vaccine) at 12 months of age has been replaced with a monovalent Hib dose at 18 months of age.
Changes to 4.3.4 Vaccines, 4.3.7 Recommendations, and 4.3.12 Variations from product information
4.3.4 Vaccines
Addition of text to clarify situations in which vaccine interchangeability will now need to be considered.
4.3.4 Vaccines, 4.3.7 Recommendations, 4.3.12 Variations from product information
Amendment of text due to the discontinuation of the Haemophilus b conjugate (PRP-OMP) vaccine (PedvaxHIB) (Refer also Chapter 2.1 Pre-vaccination).
Amendment of text due to the discontinuation of a vaccine type, Pediacel (Refer also Chapters, 4.2 Diphtheria, 4.12 Pertussis, 4.14 Polio and 4.19 Tetanus).
Update to remove guidance on co-administration with MenACWY vaccine.
- Added 'People with latex allergy' section under 'Precautions', to reflect updated product information regarding Adacel.
- Updated guidance on route of administration.
- Removal of Menitorix as vaccine was discontinued in July 2020.
Guidance on co-administration of Hib-containing vaccines with quadrivalent meningococcal vaccines has been added.
The Hib (Haemophilus influenzae type b) booster dose previously given in combination with Hib-MenC (combined Hib and meningococcal C vaccine) at 12 months of age has been replaced with a monovalent Hib dose at 18 months of age.
Changes to 4.3.4 Vaccines, 4.3.7 Recommendations, and 4.3.12 Variations from product information
4.3.4 Vaccines
Addition of text to clarify situations in which vaccine interchangeability will now need to be considered.
4.3.4 Vaccines, 4.3.7 Recommendations, 4.3.12 Variations from product information
Amendment of text due to the discontinuation of the Haemophilus b conjugate (PRP-OMP) vaccine (PedvaxHIB) (Refer also Chapter 2.1 Pre-vaccination).
Amendment of text due to the discontinuation of a vaccine type, Pediacel (Refer also Chapters, 4.2 Diphtheria, 4.12 Pertussis, 4.14 Polio and 4.19 Tetanus).