Hib Vaccine : Booster Dose,Delayed Dose,Side Effects

4th Pediatric Infectious Diseases Conference

ISSN 0973 - 0958

Immunization and Vaccination

Hib Vaccine

Immunization and Vaccination

BCG Vaccine

Chickenpox or Varicella Vaccine

DPT Vaccine

Frequently asked questions on immunization

Hepatitis A Vaccine

Hepatitis B Vaccine

Hib Vaccine

Human Papillomavirus vaccine

Immunization Schedule

Influenza vaccine

Measles Vaccine

Meningococcal vaccine

Polio Vaccine

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Get the Vaccine Schedule for your child."

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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 if a dose is delayed or missed?
A. There is no need to restart the schedule if a dose is delayed or missed. One should just complete the age appropriate schedule of remaining vaccines. However, one is not protected well till one has completed the recommended schedule. Hence, delay in vaccination is not desirable

Q. Why is a booster of Hib required?
A. As we have seen before,> 90% of vaccinees achieve a titre of>1.0 mcg/ml after 3 primary doses giving long term protection till 15-18 months of age. In 10-50% of them, the titre falls to <0.15 mcg/ml or less than the minimum protective level by 18 months. If a booster is given at 15 -18 months of age the titre rises by 30-90 fold in all of them and reaches levels as high as 40 mcg/ml. Hence a booster is recommended at 15-18 months of age.

Q. Can you use the vaccines interchangeably?
A. Studies have shown that sero-response is same when the same vaccine is used all throughout or when they are interchanged to complete the course. In fact, some studies have shown better sero-response when different vaccines were used one after another. As we saw before, PRP- OMP leads to protective antibody titre after first dose itself so that protection starts early. This, when followed by 2nd and 3rd dose of PRP-T/HbOC, leads to a better and long term protection at the end of 3 doses. Hence, these studies recommend using PRP-OMP as first dose and PRP-T/ HbOC for the 2nd and 3rd doses.

Again studies have shown equal if not better response when another vaccine is used as booster as compared to original vaccine used for primary doses.

In short, the vaccines can be used interchangeably both for primary as well as booster doses.

Q. What are the side effects of Hib vaccine?
A. Local reactions can occur like redness (16%), swelling (16%), pain (27%), etc. They are more common with first dose than with subsequent doses. Systemic side effects seen include fever (5-10%), which is mild and lasts for 24 hours, excessive crying, fussiness, irritability (30%), vomiting (5%), drowsiness, anorexia (20%), diarrhea etc. Rarely anaphylaxis can occur like with any other vaccine

Q.Can you use other vaccines together with Hib vaccine?
A. With need to use so many vaccines during early infancy, one has to use more than two vaccines together. Hib can be given along with other vaccines such as OPV/DPT/HBV at 6, 10 and 14 weeks of age. However they should be given at different sites using separate syringes.

Some studies have been carried out including in India, where Hib and DPT have been mixed in the same syringe and given, with the same or better response to Hib than when given at individual sites. The response to DPT especially anti-tetanus toxoid antibodies and the pertussis agglutinins have been shown to be less when the vaccines are mixed but still the levels are above protective levels.

Of late combination vaccines containing DPT plus Hib are available. DPT+HbOC is available as ready to use solution (Tetramune). DPT + PRP-T is available separately as DPT liquid in ampoule and PRP-T as lyophilized powder in a bulb. One has to dissolve the PRP-T powder in the DPT liquid to make PRP-T + DPT vaccine, just before the injection (TetraHibest). The studies have shown that such combination vaccines produce same if not better anti PRP antibody titres than when given simultaneously but at different sites. Even anti Tetanus, anti Pertussis and anti Diphtheria antibody titres are same with combination vaccine as when given separately. The side effects are also not more with combination vaccines. The advantage of combination vaccines are many like timely completion of schedule, less number of visits to the doctor, less number of pricks to the child, less space & cost of transportation & storage and better compliance from parents. Hence, whenever available such combinations should be used.

In western world, combinations like IPV+DPT+Hep B or IPV+DPT+Hib or even IPV+DPT+Hib+Hep B are available as penta or hexavalent vaccines. They have shown similar efficacy and side effects as when given separately.

Studies are done on such combination containing acellular pertussis instead of whole cell pertussis in DPT combined with Hib, Hepatitis B or both with/without IPV. Initial studies showed poor anti PRP and anti Tetanus response when such combinations of acellular DPT were used as primary doses. Later studies have shown equally good response with DPaT as with DPwT containing combination vaccines used for primary vaccination. As booster, DPaT containing combination vaccines are as good if not better as DPwT containing combination vaccines.

One word of caution while using the combination vaccines- One should use the same brand of DPT and Hib recommended by the manufacturer in combination and not any DPT with any Hib

Q. What are the reasons for vaccine failure?
A. Poor cold chain maintenance can be one of the reasons for poor response. True failure is seen in <3-5% of cases. The cases include poor choice of vaccine (e.g. PRP-D), immune compromised host or breakthrough infection occurring before the schedule can be completed

Q. Who should be given Hib vaccine?
A. Hib vaccine is recommended and is widely used as a universal vaccine by many western countries. This has almost eliminated Hib disease from these countries.

In India, it is almost a compulsory vaccine but for the cost. Hence, this vaccine is an optional vaccine in India as of today. The option is to be exercised by the parents whether they can afford the vaccine or not. If affordable, the vaccine should be given to all such babies.

Last created on 23-02-2001
Last updated on 01-12-2004

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Dr.Shah N.Hib Vaccine.Pediatric Oncall [serial online] 2004 [cited 2004 December 1];1. Available from: