Haemophilus influenzae type B (HIB) vaccines for Australian Children

Information for immunisation providers

This fact sheet provides information on Hib disease and the available vaccines to assist immunisation providers in the delivery of Hib vaccinations to children.

Disease and epidemiology

  • Pneumococcal disease refers to a range of clinical diseases caused by bacterium Streptococcus pneumoniae (also called pneumococcus).
  • Diseases where pneumococci are isolated from body sites that are normally sterile are grouped together as ‘invasive pneumococcal disease’ (IPD). IPD would present clinically as pneumonia, bacteraemia and meningitis.
  • The risk of IPD is greatest in very young infants and people aged ˃60 years.
  • Aboriginal and Torres Strait Islander people, particularly young adults, have a substantially higher prevalence of risk factors associated with, and incidence of, IPD compared to non-Indigenous people.
  • Certain underlying medical conditions, including those causing immunocompromise, as well as some behavioural factors, like tobacco smoking and excessive alcohol consumption, are associated with an increased risk of IPD.

Who should be vaccinated?

  • Recommendations for the use of pneumococcal vaccines are based on the different characteristics of the available vaccines and the different risks of IPD depending on age, Indigenous status, the state/territory of residence, the presence and nature of individual risk factors, and previous doses of pneumococcal vaccine received.
  • Routine pneumococcal vaccination is recommended and funded for all Australian children. Key changes to the vaccination schedule for children using 13vPCV come in to effect on 1 July 2018.
  • Pneumococcal vaccines are also available for Aboriginal and Torres Strait Islander adults aged ≥50 years, non-Indigenous adults aged ≥65 years and individuals with condition(s) associated with increased risk of IPD.

Vaccines

  • There are two major types of pneumococcal vaccines – pneumococcal conjugate vaccine (PCV) and pneumococcal polysaccharide vaccine (PPV). Vaccine formulations vary in their ‘valency’, i.e. the number of pneumococcal serotypes included in the vaccine.
  • The vaccines currently used in the National Immunisation Program (NIP) are 13-valent pneumococcal conjugate vaccine (13vPCV) and 23-valent pneumococcal polysaccharide vaccine (23vPPV). 13vPCV is highly effective (over 80–90%) against IPD due to 13vPCV serotypes in children. 23vPPV is around 80% effective against IPD due to 23vPPV serotypes in adults.
  • Common adverse events reported after 13vPCV are mild and transient injection site reactions. Injection site reactions are common in adults after 23vPPV but are mostly non-serious and self-limiting.

The disease

Causative agent

Haemophilus influenzae is a bacterium that has two forms: capsular and non-capsular. Capsular (typable) forms have a polysaccharide covering that is responsible for the organism’s virulence and stimulation of immunity. There are 6 distinct capsular serotypes: a to f. Of these, type ‘b’ is almost always responsible for serious disease in children, such as meningitis, pneumonia and septicaemia (i.e. invasive Hib disease). Non-capsular (non-typable) forms of Haemophilus influenzae mostly colonise the upper respiratory tract without causing illness. However, non-typable Haemophilus influenzae (NTHi) can also cause middle ear infection (otitis media) in young children. Haemophilus influenzae vaccines provide protection specifically against infection by the ‘b’ capsular type (Hib).1-3

Risk
category

Indigenous
Status

Age

Recommended
dose(s) of 13vPCV

Recommended dose(s)
of 23vPPV*

Without
any risk
conditions

Non-Indigenous

>65
years

-

Single dose

Indigenous

>50
years

-

Initial dose, then one
repeat (2nd) dose 5 years

Without
any risk
conditions

Non-Indigenous

>65
years

-

Single dose

Indigenous

>50
years

-

Initial dose, then one
repeat (2nd) dose 5 years

Epidemiology

Hib is mainly a childhood disease with over 80% of cases worldwide occurring in children aged <5 years. Before Hib vaccination started, Hib was one of the most common bacterial causes of pneumonia and meningitis in children aged between 4 and 18 months, with a high case fatality rate the world over.

Before Hib vaccines were introduced, Hib was the most common cause of bacterial meningitis in Australian children. Aboriginal and Torres Strait Islander children, especially in remote and rural areas, had a much higher incidence of Hib infection and presented at a younger age than non-Indigenous children. Hib epiglottitis was particularly rare among Indigenous children.
A similar pattern is described among other indigenous populations, such as American Indians and Alaskan Natives in the USA and Maori and Pacific children in New Zealand.

Introduction of Hib vaccines led to a remarkable decrease in the incidence of Hib disease in Australia and other countries with vaccine programs.4 Hib vaccine was first added to the National Immunisation Program in Australia in 1993. Introduction of Hib vaccines led to a remarkable decrease in the incidence of Hib disease in Australia and other countries with vaccine programs.4 Hib vaccine was first added to the National Immunisation Program in Australia in 1993.12

Hib is mainly a childhood disease with over 80% of cases worldwide occurring in children aged <5 years. Before Hib vaccination started, Hib was one of the most common bacterial causes of pneumonia and meningitis in children aged between 4 and 18 months, with a high case fatality rate the world over.

Before Hib vaccines were introduced, Hib was the most common cause of bacterial meningitis in Australian children. Aboriginal and Torres Strait Islander children, especially in remote and rural areas, had a much higher incidence of Hib infection and presented at a younger age than non-Indigenous children. Hib epiglottitis was particularly rare among Indigenous children. A similar pattern is described among other indigenous populations, such as American Indians and Alaskan Natives in the USA and Maori and Pacific children in New Zealand.

 

References

  1. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC). Haemophilus influenzae type b. In: Hamborsky J, Kroger A, Wolfe C (editors). Epidemiology and prevention of vaccine-preventable diseases. 13th. Washington DC: Public Health Foundation; 2015. p. 119-32. Available from: https://www.cdc.gov/vaccines/pubs/pinkbook/hib.html.
  2. Nanduri SA, Sutherland AR, Gordon LK, Santosham M. Haemophilus influenzae type b vaccines. In: Plotkin SA, Orenstein WA, Offit PA (editors). Plotkin's vaccines. 7th. Philadelphia, PA: Elsevier; 2018.
  3. Haggard M. Otitis media: prospects for prevention. Vaccine 2008;26 Suppl 7:G20-G4.
  4. Peltola H. Worldwide Haemophilus influenzae type b disease at the beginning of the 21st century: global analysis of the disease burden 25 years after the use of the polysaccharide vaccine and a decade after the advent of conjugates. Clinical Microbiology Reviews 2000;13:302-17.
  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.
  6. Hanna JN, Wild BE. Bacterial meningitis in children under five years of age in Western Australia. Medical Journal of Australia 1991;155:160-4.
  7. McIntyre PB, Leeder SR, Irwig LM. Invasive Haemophilus influenzae type b disease in Sydney children 1985-1987: a population-based study. Medical Journal of Australia 1991;154:832-7.
  8. Bower C, Condon R, Payne J, et al. Measuring the impact of conjugate vaccines on invasive Haemophilus influenzae type b infection in Western
  9. Markey P, Krause V, Boslego JW, et al. The effectiveness of Haemophilus influenzae type b conjugate vaccines in a high-risk population measured using immunization register data. Epidemiology and Infection 2001;126:31-6.
  10. Coulehan JL, Michaels RH, Hallowell C, et al. Epidemiology of Haemophilus influenzae type b disease among Navajo Indians. Public Health Reports 1984;99:404-9.
  11. Ward JI, Lum MK, Hall DB, Silimperi DR, Bender TR. Invasive Haemophilus influenzae type b disease in Alaska: background epidemiology for a vaccine efficacy trial. Journal of Infectious Diseases 1986;153:17-26.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.
  12. Chiu C, Dey A, Wang H, et al. Vaccine preventable diseases in Australia, 2005 to 2007. Communicable Diseases Intelligence 2010;34 Suppl:ix-S167.
  13. Swingler GH, Michaels D, Hussey GG. Conjugate vaccines for preventing Haemophilus influenzae type b infections. [update of Cochrane Database Syst Rev. 2003;(4):CD001729; PMID: 14583937]. Cochrane Database of Systematic Reviews 2007;(2):CD001729. DOI: 10.1002/14651858.CD001729.pub2.
  14. Ward JI, Lum MK, Hall DB, Silimperi DR, Bender TR. Invasive Haemophilus influenzae type b disease in Alaska: background epidemiology for a vaccine efficacy trial. Journal of Infectious Diseases 1986;153:17-26.
  15. 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.
  16. Chiu C, Dey A, Wang H, et al. Vaccine preventable diseases in Australia, 2005 to 2007. Communicable Diseases Intelligence 2010;34 Suppl:ix-S167.
Last updated April 2023