Information for health workers - The introduction of Hib vaccine into the routine childhood immunnisation schedule
Information about the Hib Vaccine prepared by Dr William Lagani
HIB VACCINE
What is Hib, What disease does it cause?
Hib is the abbreviation for Haemophilus influenzae type B, a bacteria that causes severe diseases in young children, including:
• Bacterial meningitis an infection of the protective coverings of the brain and spinal cord;
• Pneumonia an infection of the lungs;
• Septicaemia an infection of the blood; also called blood poisoning;
• Septic arthritis an infection of the joints; and
• Epiglottitis an infection of the throat.
Hib also causes problems with the bones, the heart, and the soft tissue under the skin, but these diseases are less common.
Hib disease is not the same as hepatitis B (HepB) or HIV, which are both caused by viruses.
Why is Hib disease a public health problem?
Hib causes serious diseases that can result in hospitalization or death, including:
Pneumonia
• Major cause of death in children (less than 5yr old) in developing countries;
• Common cause of hospital admission and childhood death in PNG; and
• Hib contributes to about 20% of all pneumonia cases.
· Meningitis
• Top 5 causes of death in PNG;
• Chance of a child dying from meningitis is 50%;
• Hib accounts for about 40% of all bacterial meningitis cases;
• About 1650 children die of Hib meningitis each year in PNG; and
• 20% of those that survive are left with permanent brain damage.
How is Hib spread?
Hib bacteria are passed from child to child in droplets of saliva expelled when an infected child coughs or sneezes or when they share toys or other objects that they have put into their mouths.
Many healthy children carry the bacteria in their nose and throat.
Who is most at risk of Hib disease?
• Children less than 5 years of age.
• Children between 4 12 months of age are most at risk.
• By age 5 years most children develop natural protection to Hib.
• Serious disease is uncommon in older children & adults.
Do antibiotics work against Hib infections?
Yes, but they are not always effective. Even with antibiotics and the best medical care, 5% - 10% of cases die. Some Hib are now resistant to 1st line antibiotics for meningitis treatment in PNG.
HIB IMMUNISATION
How can Hib infections be prevented?
Good news - a new, combination vaccine, DTP-Hib will be used in PNG. It will replace DTP (TA) vaccine in the National childhood immunization programme.
Why is this good news?
A single injection of DTP-Hib at 1, 2 & 3 months of age will protect infants against Hib disease as well as Diphtheria, Tetanus, Pertussis (whooping cough).
When will DTP-Hib be available in PNG? The first shipment is expected in August 2007. It should be available from your PVS/DVS in August/September 2007.
Who should be immunized with DTP-Hib vaccine?
All infants between 1-12 months of age should receive DTP-Hib vaccine.
Presentation, what will it look like?
DTP-Hib combination vaccine is presented like the familiar DTP (TA) vaccine:
• As a liquid vaccine (no mixing required); and
• In a 10 dose vial
How many doses of DTP-Hib are needed?
• 3 doses are needed for full protection
When should DTP-Hib be given?
Begin vaccinating each infant that attends for routine DTP:
• At 4 weeks of age;
• Anytime after 4 weeks, up to 12 months; and
• The interval between each dose should not be less than 4 weeks.
What is the size of the dose?
• Each dose is 0.5mls.
What Injection equipment should be used?
• Auto-disable (AD) 0.5ml syringes are recommended, or
• The same size needles and syringes used for DTP and HepB:
• 23 gauge/25mm needle; and
• O.5ml syringe.
How and where is DTP-Hib given?
DTP-Hib is given by intramuscular injection in:
• Anterolateral aspect of thigh in infants; or
• Deltoid muscle in older children
It can be given at the same time as other childhood vaccinations (OPV, HepB, measles)
What are the side effects of DTP-Hib vaccine?
There are no serious side effects associated with this combination vaccine.
Common, mild side effects can include:
• injection site pain, redness, and/or swelling; and
• Mild fever.
These usually resolve within a few days.
Is there any reason why a child should not be given DTP-Hib vaccine?
• DTP-Hib should not be given to an infant who had a severe reaction following vaccination with DTP.
• If a child develops a severe reaction to DTP-Hib vaccine they should not be given another dose.
• Postpone giving immunisation if child has a high fever (> 38.5°C).
What are the limitations of the Hib Vaccine?
• Hib vaccine in DTP-Hib only protects against diseases caused by the Hib bacteria, and
• After immunization with DTP-Hib, a child may still get pneumonia, meningitis, or flu cause by other bacteria & viruses.
How should DTP-Hib vaccine be stored?
• DTP-Hib vaccine should be stored between +2°C & +8°C;
• DTP-Hib vaccine cannot be frozen; and
• If frozen, do not use, discard frozen vials in safety box.
What records are needed to monitor DTP-Hib vaccine usage, wastage & coverage?
The DTP-Hib vaccine is not listed in the current recording forms (eg tally sheets), Bebi Buk, Immunisation posters, etc. It may be a long time until new forms; posters etc. are updated, printed and distributed. Meanwhile, please replace DTP name on forms, posters with DTP-Hib when you start using the expanded vaccine in your health facility.
What happens to the DTP vaccine when DTP-Hib arrives at our health facility?
Since DTP-Hib will replace TA it is important to stop using TA when it arrives.
You will receive detailed instructions with the 1st consignment of DTP-Hib vaccine.
If you have any questions, please discuss with your supervisor, Provincial or Regional CCL officer or contact the National EPI Unit in POM on phone 301 3752 or 301 3722 or 301 3723, Fax: 323 0177.
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