Hib vaccine
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Vaccine description | |
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Target | Haemophilus influenzae type b |
Vaccine type | Conjugate |
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Trade names | ActHIB, Hiberix, OmniHIB, others |
AHFS/Drugs.com | Professional Drug Facts |
MedlinePlus | a607015 |
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Routes of administration | IM |
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The Haemophilus influenzae type B vaccine, also known as Hib vaccine, is a vaccine used to prevent Haemophilus influenzae type b (Hib) infection.[2][3] In countries that include it as a routine vaccine, rates of severe Hib infections have decreased more than 90%.[2] It has therefore resulted in a decrease in the rate of meningitis, pneumonia, and epiglottitis.[2]
It is recommended by both the
Severe side effects are extremely rare.[2] About 20 to 25% of people develop pain at the site of injection while about 2% develop a fever.[2] There is no clear association with severe allergic reactions.[2] The Hib vaccine is available by itself, in combination with the diphtheria/tetanus/pertussis vaccine, and in combination with the hepatitis B vaccine, among others.[2] All Hib vaccines that are currently used are conjugate vaccine.[2]
An initial Hib vaccine consisting of plain (unconjugated) type b polysaccharide, was introduced in the United States in 1985.[6] but was replaced by a more effective conjugated formulations beginning in 1987.[7] As of 2013[update], 184 countries include it in their routine vaccinations.[2] It is on the World Health Organization's List of Essential Medicines.[8][9]
Medical uses
Hib conjugate vaccines have been shown to be effective against all manifestations of Hib disease, with a clinical
Impact
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. Nearly all disease was in children under five years old.[11] After routine use of Hib conjugate vaccines in the United States, the rate of invasive Hib disease decreased from 40–100 per 100,000 children down to fewer than 1 per 100,000.[12] Similar reductions in Hib disease occurred after introduction of the vaccine in Western Europe[13] and developing countries.[14] However, in recent years. Haemophilus influenzae strains with other encapsulated serotypes such as a or f, or non-encapsulated strains, have been recognized to cause invasive disease, particularly in high risk populations.[14]
Recommendations
The CDC and the WHO recommend that all infants be vaccinated using a polysaccharide-protein conjugate Hib vaccine, starting after the age of six weeks. The vaccination is also indicated in people without a spleen.[15]
Side effects
Mechanisms of action
Polysaccharide vaccine
Haemophilus influenzae type b is a bacterium with a polysaccharide capsule; the main component of this capsule is polyribosyl ribitol phosphate (PRP). Anti-PRP antibodies have a protective effect against Hib infections. However, the antibody response to PRP was quite variable in young children, and diminished rapidly after administration. This problem was due to recognition of the PRP antigen by B cells, but not T cells. In other words, even though B cell recognition was taking place, T cell recruitment (via MHC class II) was not, which compromised the immune response. This interaction with only B cells is termed T-independent (TI). This process also inhibits the formation of memory B cells, thus compromising long term immune system memory.[16][17]
Conjugate vaccine
PRP covalently linked to a protein carrier was found to elicit a greater immune response than the polysaccharide form of the vaccine. This is due to the protein carrier being highly immunogenic in nature. The conjugate formulations show responses which are consistent with T-cell recruitment (namely a much stronger immune response). A memory effect (priming of the immune system against future attack by Hib) is also observed after administration; indicative that memory B cell formation is also improved over that of the unconjugated polysaccharide form. Since optimal contact between B cells and T cells is required (via MHC II) to maximize antibody production, it is reasoned that the conjugate vaccine allows B cells to properly recruit T cells, this is in contrast to the polysaccharide form in which it is speculated that B cells do not interact optimally with T cells leading to the TI interaction.[16][17]
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
GAVI and the Hib Initiative
In order to remedy these issues, the
History
Polysaccharide vaccine
The first Hib vaccine licensed was a unconjugated polysaccharide vaccine, called PRP. This vaccine was first marketed in the United States in 1985.[19] Similar to other unconjugated polysaccharide vaccines, serum antibody responses to PPP vaccine were 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. Also, post-licensure studies by Michael Osterholm [20] and his colleagues, and Dan Granoff et al.[21] suggested that the PRP vaccine was largely ineffective in preventing invasive Hib disease in children 18 to 59 months, the age group recommended for vaccination . The vaccine was withdrawn from the market in 1988.[22]
Conjugate vaccine
The shortcomings of the polysaccharide vaccine led to the production of the Hib polysaccharide-
There are currently three types of conjugate vaccine, utilizing different carrier proteins for the conjugation process: inactivated tetanospasmin (also called tetanus toxoid); mutant diphtheria protein; and meningococcal group B outer membrane protein.[27]
Combination vaccines
Multiple combinations of Hib and other vaccines have been licensed in the United States, reducing the number of injections necessary to vaccinate a child. Hib vaccine combined with diphtheria-tetanus-pertussis–polio vaccines and hepatitis B vaccines are available in the United States. 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.[28]
References
- ^ Professional Drug Facts
- ^ PMID 24143842.
- ^ "WHO position on Haemophilus influenzae type b (Hib) vaccination-July 2013" (PDF). who.int. 27 October 2013. Archived from the original (PDF) on 19 January 2022. Retrieved 30 March 2016.
- PMID 1899280.
- ^ "Hib (Haemophilus Influenzae Type B)". Archived from the original on 8 April 2016. Retrieved 30 March 2016.
- PMID 3490784.
- PMID 3050001.
- hdl:10665/325771. WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
- hdl:10665/345533. WHO/MHP/HPS/EML/2021.02.
- S2CID 229695991.
- PMID 3313240.
- ^ "Haemophilus influenzae Disease (Including Hib)". U.S. Centers for Disease Control and Prevention (CDC). 25 September 2012. Archived from the original on 30 January 2014. Retrieved 31 January 2014.
- PMID 28220749.
- ^ PMID 34076491.
- ^ "Asplenia and Adult Vaccination". U.S. Centers for Disease Control and Prevention (CDC). 14 February 2019. Retrieved 29 March 2019.
- ^ PMID 15379976.
- ^ PMID 15339854.
- ^ "Hib Initiative". Archived from the original on 5 September 2008. Retrieved 3 October 2008.
61 of 72 GAVI countries have introduced or will introduce Hib vaccine into their routine immunization program [sic] by 2009
- ^ a b Centers for Disease Control and Prevention (2006). Atkinson W, Hamborsky J, McIntyre L, Wolfe S (eds.). Epidemiology and Prevention of Vaccine-Preventable Diseases (9th ed.). Washington, D.C.: Public Health Foundation.
- PMID 3261350.
- PMID 3491315.
- PMID 26904695.
- PMID 3259309.
- ^ "Haemophilus influenzae type b (Hib)". historyofvaccines.org. Retrieved 8 May 2023.
- PMID 8417244.
- PMID 8463894.
- PMID 15379976.
- PMID 22513932.
Further reading
- Ramsay M, ed. (2013). "Chapter 16: Haemophilus influenzae type b (Hib)". Immunisation against infectious disease. Public Health England.
- Hall E, Wodi AP, Hamborsky J, Morelli V, Schillie S, eds. (2021). "Chapter 8: Haemophilus influenzae". Epidemiology and Prevention of Vaccine-Preventable Diseases (14th ed.). Washington D.C.: U.S. Centers for Disease Control and Prevention (CDC).
External sources
- "Haemophilus Influenzae Type b (Hib) Vaccine Information Statement". U.S. Centers for Disease Control and Prevention (CDC). August 2021.
- "Haemophilus B Conjugate Vaccine (Meningococcal Protein Conjugate)". U.S. Food and Drug Administration (FDA). 24 April 2019.
- "Haemophilus b Conjugate Vaccine (Tetanus Toxoid Conjugate)". U.S. Food and Drug Administration (FDA). 24 April 2019.
- "Hiberix". U.S. Food and Drug Administration (FDA). 3 October 2019.