Dr Niyaf's Online Clinic

Among the common childhood vaccines that are recommended, Hib vaccine is one that is not currently covered by the Maldivian national vaccination program. I have written about this vaccine before in response to a question. However, I have recently received more questions about Hib that I decided to write a full post on it.

What is Hib vaccine and what does it protect against?
Hib is the short form name given to the bacteria Haemophilus influenza type B. Infection by this bacteria causes meningitis (an infection of the brain and its covering layers), epiglottitis (a disease where a swelling at the upper end of the airway causes severe breathing difficulty) and pneumonia..

Both Hib meningitis and Hib epiglottitis were very common in the western countries about 2 decades ago. They were both associated with significant morbidity. Thankfully, because of the wide use of the vaccine, today both the disease are relatively rare.

Misconception
It has been brought to my attention by several parents that Hib vaccine is being recommended for kids as a means of preventing the common cold! Hib vaccine does provide protection from Hib meningitis, epiglottitis and pneumonia.

However, it has no role in preventing the common cold or common upper respiratory tract infection. Perhaps the confusion arises because of the word “influenza” in it’s name. Hib as said before is a bacteria and is not the same as the Influenza virus (one of the common causative organisms of upper respiratory tract infections).

The influenza vaccine a shot of which is needed annually,  offers some protection from influenza.

Who should get vaccinated?

Hib vaccine is recommended for children below 5 years of age.  The usual recommendation is a dose each at 2 months, 4 months, 6 months and a booster between 12 months and 18 months. 

Hib vaccine is recommended in other special cases such as patients with significant immune suppression, splenectomy and those requiring chemotherapy. In these conditions the risk of infection by Hib is increased and therefore protection is advised.

 If the usual doses were missed, children above 1 year of age need only a single dose of the vaccine. Above 5 years the incidence of Hib infection is so small that the vaccine may not offer as much benefit.

Is Hib vaccine available in Maldives?
As said before the vaccine is not included in the national program. It is however available for purchase from pharmacies. The STO pharmacy and ADK pharmacy sell the vaccine as a prescription only medication. It costs around Mrf 250 per dose. [Likely to be different at a later date].

Who should not get the Hib vaccine?
A very few children may develop significant allergic reaction to the 1st Hib vaccine dose. These children should not be vaccinated with further doses.
Hib vaccine should not be given below 6 weeks of age.

Do children get fever with Hib vaccine?
Some children do get mild to moderate fever following Hib vaccination. If fever develops it can be safely managed with Paracetamol in most cases. It is not recommended that Paracetamol or other fever medications be used as a prophylaxis.

Some children may also develop mild redness and pain at the injection site. It usually clears on its own without any treatment.

If you need further information please contact your doctor or an immunisation center. Alternatively, you could leave a question on this website.

Responses & Commensts:

• A wrote:
  While this is such an important vaccine , why is it not included in the schedule.
  
  
• Niyaf wrote:
  Our national schedule covers the basic vaccines recommended by WHO. DPH has been adding vaccines to the list according to local need. Hep B vaccine was added because of high prevalence of Hepatitis B. Recently MMR was added because of recent mumps and rubella epidemics.
  
  These vaccine are costly. We are likely to need financial assistance to use it in our national program. Donor agencies would require information on local prevalence of the infection to justify them supporting the vaccine in Maldives. Therefore, we need to study Hib prevalence in the Maldives before we make a recommendation to include it in the national program. Such a study is possible through the assistance of agencies. CDC in USA has assisted countries in our neighbourhood to carry out such studies in the past; perhaps we could get such assistance ourselves.
  
  Having said that, in this day and age where traveling across the globe is readily possible, infections predominant to the western hemisphere may quite easily cross over to our side of the world.
  
  Hib bacteria can colonise the nasal passage of individuals who themselves may not be unwell. They can then disseminate the infection to others whom they meet and closely socialise with.
  
  For this reason, as a pediatrician I recommend the vaccine for all kids. I would be happy if it is included in the national program.