Hib Vaccine : Severity,Hib Carrier state,Incidence,Drug resistant

4th Pediatric Infectious Diseases Conference

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HIB VACCINE - LATEST UPDATES

Related topics

Hib Vaccine Overview

Disease Spectrum of Hib and H. Influenzae Infection

Generations of Hib Vaccines

Hib Vaccines Frequently Asked Questions

Dr Nitin Shah
Hon. Pediatrician, UHC, LTMG Hospital, Mumbai.
Treasurer, Indian Academy of Pediatrics, 1998-2001

Q. What is the severity of Hib infection?
A. Hib leads to very severe infections at a very young age. The case fatality rate of Hib meningitis in developed countries is 2-4% but that in developing countries is as high as 30 -40% or even nearly 100% depending on drug resistance and type of drug used primarily.

The long-term sequelae of meningitis and epiglottitis are also high. Post meningitis sequelae are seen in 15- 30% of cases in the form of deafness or blindness or severe neurological damage etc.

Q. What is the Hib carrier state?
A. Newborns are protected against Hib by maternal antibodies for first few months of life. After that the child coming in contact with Hib develops nasopharyngeal carrier state from where it can spread and lead to invasive Hib disease or spread to other susceptible hosts in community.

The carrier state in developed countries is estimated to be 2-3 % and in developing countries 5- 10 %. In day care centers it can reach as high 20-30%. In family contacts of index case it is 10-12%.

After effective immunization, the carrier rate has decreased from 6 % to 1.5 % in some studies.

Q. What is the incidence of Hib in India?
A. Exact incidence of Hib in Indian community is not known. Looking at the world experience it is likely to be as high as the other developing countries. There are two problems in our country. First is lack of community based data and second is lack of laboratory facilities to culture Hib as Hib is a fastidious organism to grow.

In a study from Pune, Maharashtra it was shown that protective levels of anti PRP antibodies (>0.15 mcg/ml) were present in 20% of children by 1 year of age, 35% by 3 years and 80% by 5 years. It suggests the pattern of natural, clinical or subclinical infection and immunity acquired at different ages. Yet, majority of them are not protected in the early months or years of life.

Q.What is the scene of Hib disease in India?
A. Again there are only hospital- based data available, which suggest that 15-40 % of cases of pyogenic meningitis and 7-15% of cases of lobar pneumonia in children are due to Hib infection. There are reports of occasional cases of invasive H. influenzae disease caused by type a or other non-typeable strains. In children, more then 95% of cases of invasive H.influenza disease are due to Hib. The data from India shows similar pattern as seen in Europe before mass vaccination there. In such case, extrapolation of their data to India, estimates the incidence of Hib meningitis to be 60-80/100,000 children <5 years of age in India.

Q. What about drug resistant Hib in India?
A. Before 1984, studies suggested almost 100% sensitivity of Hib to common antibiotics. Since then many reports have shown emergence of multi-drug resistant strains to the tune of 40-60% of total Hib cases. However, all of them appear to be sensitive to 3rd generation cephalosporins at present. The drug resistance appears to be mediated by R plasmid. It appears to be uniform all over the country.

Next : Generations of Hib Vaccine

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