|Target disease||Haemophilus influenzae type b|
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Haemophilus influenzae type B vaccine (Hib janan or PRP vaccine) is a conjugate vaccine developed for the prevention of invasive disease caused by Haemophilus influenzae type b bacteria. The Centers for Disease Control and Prevention (CDC) has recommended the use of the Hib vaccine. Due to routine use of the Hib vaccine in the U.S. from 1980 to 1990, the incidence of invasive Hib disease has decreased from 40–100 per 100,000 children down to 1.3 per 100,000. Vaccinations against Haemophilus influenzae (Hib) have decreased early childhood meningitis significantly in developed countries and recently in developing countries.
History and vaccine composition
The first Hib vaccine licensed was a pure polysaccharide vaccine, first marketed in the US in 1985. Similar to other polysaccharide vaccines, immune response to the vaccine was highly age-dependent. Children under 18 months of age did not produce a positive response for this vaccine. As a result, the age group with the highest incidence of Hib disease was unprotected, limiting the usefulness of the vaccine. The vaccine was withdrawn from the market in 1988.
The shortcomings of the polysaccharide vaccine led to the production of the Hib polysaccharide-protein conjugate vaccine. Attaching Hib polysaccharide to a protein carrier greatly increased the ability of the immune system of young children to recognize the polysaccharide and develop immunity. There are currently three types of conjugate vaccine, utilizing different carrier proteins for the conjugation process, all of which are highly effective and safe: inactivated tetanospasmin (also called tetanus toxoid), mutant diphtheria protein, and meningococcal group B outer membrane protein.
Multiple combinations of Hib and other vaccines have been licensed in the United States, reducing the number of shots necessary to vaccinate a child. Hib vaccine combined with diphtheria-tetanus-pertussis–polio vaccines and Hepatitis B vaccines are available in the US. The World Health Organization (WHO) has certified several Hib vaccine combinations, including a pentavalent diphtheria-pertussis-tetanus-hepatitis B-Hib, for use in developing countries. There is not yet sufficient evidence on how effective this combined pentavalent vaccine is in relation to the individual vaccines.
Hib conjugate vaccines have been shown to be universally effective against all manifestations of Hib disease, with a clinical efficacy among fully vaccinated children estimated to be between 95–100%. The vaccine has also been shown to be immunogenic in patients at high risk of invasive disease. Hib vaccine is not effective against non-type B Haemophilus influenzae. However, non-type B disease is rare in comparison to pre-vaccine Haemophilus influenzae type B disease.
Clinical trials and ongoing surveillance have shown Hib vaccine to be safe. In general, adverse reactions to the vaccine are mild. The most common reactions are mild fever, loss of appetite, transient redness, swelling, or pain at the site of injection, occurring in 5–30% of vaccine recipients. More severe reactions are extremely rare.[quantify] ActHIB (Sanofi-Pasteur) vaccine was withdrawn in Japan after four child deaths from anaphylaxis in March 2010. The anaphylaxis was attributed to "a contaminant." Act HIB was the first foreign made vaccine approved in Japan (The Japan Times: Sunday, March 6, 2011). In apparent defiance of the FDA's 1996 "Final Rule," the diluent for the ActHIB vaccine was and, apparently, still is in contact with natural rubber (Reference 1). In 1990, Lancet readers worldwide were warned that natural rubber in disposable syringes, ampoule seals and in unit-dose syringes could release a toxic/allergenic contaminant, MBT (mercaptobenzothiazole) into injected pharmaceuticals, causing anaphylaxis (Reference 3).
References 1) US Centers for Disease Control (CDC): "Latex in vaccine packaging" December 2012 2) Hamilton G: "The Nurses are Innocent – The Digoxin Poisoning Fallacy (Dundurn Press, Toronto, 2011)," Postscript – The Irony: pp 213–214 3) Hamilton G: "Medical rubber anaphylaxis." The Lancet, Volume 336, Issue 8728, Pages 1453 - 1454, 8 Dec., 1990
Prior to introduction of the conjugate vaccine, Hib was a leading cause of childhood meningitis, pneumonia, and epiglottitis in the United States, causing an estimated 20,000 cases a year in the early 1980s, mostly in children under 5 years old. Since routine vaccination began, the incidence of Hib disease has declined by greater than 99%, effectively eliminating Hib as a public health problem. Similar reductions in disease occurred after introduction of the vaccine in Western Europe and developing countries.
Although Hib vaccine is given to children, Hib infections have also decreased in adults. This decrease occurred because of herd immunity; children infected with Hib carry the bacteria in their nasal passages while clearing the infection. These Hib-carrying children would regularly infect adults. The practice of vaccinating children eliminated the source of the bacteria, reducing the rate of Hib in adults.
The CDC and WHO currently recommend that all infants be vaccinated using a polysaccharide-protein conjugate Hib vaccine, starting after the age of 6 weeks. The vaccination is also indicated in asplenic patients.
Vaccination in the developing world
Introduction of Hib vaccine in developing countries lagged behind that in developed countries for several reasons. The expense of the vaccine was large in comparison to the standard EPI vaccines. Poor disease surveillance systems and inadequate hospital laboratories failed to detect the disease, leading many experts to believe that Hib did not exist in their countries. And health systems in many countries were struggling with the current vaccines they were trying to deliver.
GAVI and the Hib Initiative
In order to remedy these issues, the GAVI Alliance took active interest in the vaccine. GAVI offers substantial subsidization of Hib vaccine for countries interested in using the vaccine, as well as financial support for vaccine systems and safe injections. In addition, GAVI created the Hib Initiative to catalyze uptake of the vaccine. The Hib Initiative uses a combination of collecting and disseminating existing data, research, and advocacy to assist countries in the making a decision about using the Hib vaccine. Currently[update], 61 out of 72 low-income countries are planning on introducing the vaccine by the end of 2009.
- Yogev, R.; Arditi, M.; Chadwick, E. G.; Amer, M. D.; Sroka, P. A. (1990). "Haemophilus influenzae type b conjugate vaccine (meningococcal protein conjugate): Immunogenicity and safety at various doses". Pediatrics 85 (4 Pt 2): 690–693. PMID 2107520.
- "Recommendation of the Immunization Practices Advisory Committee (ACIP) Polysaccharide Vaccine for Prevention of Haemophilus influenzae Type b Disease". MMWR Weekly 34 (15): 201–5. 1985-04-19. ISSN 0149-2195. Retrieved 2008-10-03.
- "Haemophilus influenzae Serotype b (Hib) Disease". Disease Listing. Centers for Disease Control and Prevention. 2008-04-04. Retrieved 2008-10-03.
- "Deadly Disease Eliminated in Children under Five Years of Age in Uganda" (Press release). GAVI Alliance. 2008-03-10. Retrieved 2008-10-03.
- Centers for Disease Control and Prevention (2006). Atkinson W, Hamborsky J, McIntyre L, Wolfe S, ed. Epidemiology and Prevention of Vaccine-Preventable Diseases (9th ed.). Washington, D.C.: Public Health Foundation.
- Bar-On, E. S.; Goldberg, E.; Hellmann, S.; Leibovici, L. (2012). Combined DTP-HBV-HIB vaccine versus separately administered DTP-HBV and HIB vaccines for primary prevention of diphtheria, tetanus, pertussis, hepatitis B andHaemophilus influenzaeB (HIB). In Bar-On, Edna S. "Cochrane Database of Systematic Reviews". The Cochrane database of systematic reviews 4: CD005530. doi:10.1002/14651858.CD005530.pub3. PMID 22513932.
- "Hib Initiative". Retrieved 2008-10-03. "61 of 72 GAVI countries have introduced or will introduce Hib vaccine into their routine immunization program [sic] by 2009"