Hib Vaccine : Antibody Response,Antibody Level,Schedule

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HIB VACCINE - LATEST UPDATES

Related topics

Hib Vaccine Overview

Disease Spectrum of Hib and H. Influenzae Infection

Severity and Incidence of Hib Infection

Generations of Hib Vaccines

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

Q. What is the antibody response to Hib vaccine?
A. As discussed before, unconjugated PRP vaccine leads to IgM type anti-PRP antibody and conjugate vaccine leads to IgG type anti- PRP antibody. These can be detected by Farr type RIA or ELISA.

Anti-PRP antibody levels> 0.15 mcg/ml are protective against Hib for short period and level> 1.0 mcg/ml suggest long term protection.

Q. Of the vaccines available which one should be used?
A. Primary vaccination: Only conjugate vaccines should be used for primary vaccination. PRP -T or HbOC are both equally effective and safe and any one of them can be used. The efficacy at the end of 3 doses is>95%. Protective antibody levels are achieved with 2 doses of PRP- T and 3 doses of HbOC. However, chances of breakthrough infection before completion of 3 doses have been found to be higher with HbOC than PRP-T in some studies.

PRP- D is the least immunogenic vaccine and is not licensed in USA for use in primary vaccination. PRP-OMP vaccine was found to have batch to batch variability. In addition, the antibody titres at the end of 3 doses were not as good as with PRP- T or HbOC as only 40% children develop titre> 1.0 mcg/ml. The advantage of PRP-OMP is that the antibody titers> 0.15 mcg/ml are achieved after first dose itself in 90% of vaccinees giving immediate protection and reducing the chances of breakthrough infection. Hence many studies have suggested using PRP-OMP as first dose so that immediate protection starts. This has to be followed by 2nd and 3rd dose of PRP-T or HbOC so as to achieve good titres at the end of the schedule.

Booster dose: Any of the 4 Vaccines can be used for booster dose.

Q.What is the antibody level following each vaccine?
A. The comparative studies show the following results :-

	Anti PRP antibody levels in mcg/ml
After	PRP-T >0.15 >1.0	HbOC >0.15 >1.0	PRP-OMP >0.15 >1.0	PRP-D >0.15 >1.0
1^st dose	82% 19%	82% 10%	98% 40%	-
2^nd dose	91% 90%	85% 17%	100% 45%	-
3^rd dose	98% 90%	92% 63%	92% 48%	58% 29%

Q. What is the effect of universal Hib immunization on the community?
A. Efficacy of Hib vaccine in reducing Hib infection is>95% with general acceptance of vaccine by>90% of target population. In fact, by decreasing carrier rate even unimmunized children are indirectly protected. Many western countries have shown 99-100% disappearance of invasive Hib disease following mass immunization programs.

Q.Are there any Indian studies on efficacy of Hib vaccine?
A. Both PRP-T and HbOC vaccines have undergone efficacy trials in India. Trials conducted in infants have shown near 100% seroconversion to above protective levels with 98% of vaccinees having achieved titres of>1.0 mcg/ml after 3 doses. The titre achieved at the end of 3 doses is around 5-9mcg/ml. It gradually falls over the next one year in more than 10-50% of the vaccinees. The titres fall <0.15mcg/ml by 15-18 months and hence a booster is given around 15-18 months of age.

Q. What is the schedule of Hib vaccination?
A. For a child less than 6 months, 3 primary doses are necessary. The first dose can be given at 6 weeks along with OPV/DPT and subsequent 2 doses at 4 weeks interval along with subsequent OPV/DPT. One can also keep 2 months gap between the doses. But giving the 3 doses at 6, 10and 14 weeks will complete the vaccination faster and protect earlier. One booster will be necessary between 15-18 months of age.

For children between 6 months to 12 months: 2 primary doses at 4-8 weeks interval are given followed by a booster at 15-18 months of age. For children between 12-15 months only single primary dose is given followed by a booster at 15-18 months of age. If a child present beyond 15 months till 15 years of age, only one dose is given straight as the booster dose. It is usually not given after 5 years of age

Next : Hib Vaccine Frequently Asked Questions(Contd.)

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