Healthcare providers should refer to the catch-up schedule which is approved and published each year by the ACIP, AAP, and AAFP (available at www.cdc.gov/vaccines/schedules/hcp/imz/catchup.html). The catch-up schedule will help determine the number of additional doses needed and the minimum intervals between doses. However, if a healthy child receives a dose of Hib vaccine at age 15 months or older, he or she does not need any further doses regardless of the number of doses received before age 15 months. Some high-risk children between the age of 15 months and 59 months will be recommended for two doses of Hib vaccine based on previous history of incomplete vaccination.
Ask the Experts: Hib (Haemophilus Influenzae Type B): Scheduling & Administration
No. If a healthy child receives a dose of Hib vaccine at 15 months of age or older, he or she does not need any further doses regardless of the number of doses received before 15 months of age.
If the child received a primary series (2 or 3 doses) of Hib vaccine in the first year of life, then the final (booster) dose of the series may be given as early as 12 months, provided at least 2 months have passed since the last dose. An unvaccinated 12–14-month-old child should receive one dose as a primary series, and a booster dose 2 months later. Unvaccinated healthy children 15–59 months of age need only a single dose of any licensed conjugate Hib vaccine. Some high-risk children 15–59 months of age are recommended for two doses of Hib vaccine based on previous history of incomplete vaccination.
Yes. All children less than 5 years old need at least one dose of Hib vaccine on or after the first birthday. The last dose should be separated from the previous dose by at least 8 weeks.
Use of DTaP-IPV solution as the diluent for the Hib component is specifically written both on the Pentacel box AND on the DTaP-IPV vial label. The DTaP-IPV component will count as valid doses of DTaP and IPV vaccines, but take measures to prevent this error in the future. You cannot mix the Hib component with sterile water. ActHib must ONLY be reconstituted with either the DTaP-IPV solution supplied with Pentacel, or with a specific ActHib saline diluent. If you have a vial of lyophilized ActHib but neither diluent, you must contact the manufacturer (Sanofi) and obtain ActHib diluent.
ACIP does not recommend routine Hib vaccination of healthy children 59 months of age or older, even if they have no prior history of Hib vaccination.
Limited data suggest that Hib vaccine given before 6 weeks of age may induce immunologic tolerance to Hib antigen and reduce the response to subsequent doses. As a result, Hib vaccine should not be given earlier than 6 weeks of age. However, if a dose was administered before 6 weeks of age, it should not be counted as part of the Hib series. A full series of 3 or 4 doses, depending on the product used, should be started at 2 months of age as usual. No special protocol or testing is recommended for children who received a dose of Hib vaccine before 6 weeks of age.
Hib vaccine is not routinely recommended for healthy adults 19 years and older, even if the person did not receive Hib vaccine as a child. However, ACIP recommends that one dose of Hib vaccine should be administered to persons who have anatomical or functional asplenia or sickle cell disease or are undergoing elective splenectomy if they have not previously received Hib vaccine. Hib vaccine should be administered 14 or more days before splenectomy if possible. Recipients of a hematopoietic stem cell transplant should be vaccinated with a 3-dose series of Hib vaccine 6 to 12 months after a successful transplant, regardless of vaccination history; at least 4 weeks should separate doses. Hib vaccine is not recommended for adults with HIV infection since their risk for Hib disease is low.
When elective splenectomy is planned, vaccination with pneumococcal, meningococcal, and Hib vaccines should precede surgery by at least 2 weeks, if possible. If vaccines are not administered before surgery, they should be administered as soon as the person’s condition stabilizes after surgery.
You are interpreting the recommendations correctly, and age is an important factor in this issue. The recommendation for Hib vaccination for asplenia applies to persons of all ages. The recommendation for Hib vaccination for immunoglobulin deficiency applies only to children 12 through 59 months of age.
Yes. If different brands of Hib vaccine are given at 2 and 4 months of age then the child should receive a third primary dose of either vaccine at 6 months of age. A 2-dose primary schedule (that is, doses at age 2 and 4 months) is only appropriate when both doses are PedvaxHIB.
Hib invasive disease does not always result in development of protective antibody levels. Children younger than 24 months of age who develop invasive Hib disease should be considered susceptible and should receive Hib vaccine. Vaccination of these children should start as soon as possible during the convalescent phase of the illness. A complete series as recommended for the child’s age should be administered.
Hib meningitis incidence historically peaked at a younger age (4–6 months) among AI/AN infants than among other U.S. infant populations (6–7 months). Vaccination with a primary series of PedvaxHib (PRP-OMP, Merck) is preferred for AI/AN infants because this vaccine can produce a protective antibody response after the first dose.
At the current time, it is unknown whether Vaxelis (DTaP-IPV-Hib-HepB), which contains a smaller quantity of PRP-OMP than PedvaxHib, produces a similar protective antibody response after the first dose. Therefore, Vaxelis is not preferred for AI/AN infants at this time.
All Hib-containing vaccines should be administered by the intramuscular route.
The third dose of Vaxelis vaccine administered at age 5 months (less than 24 weeks of age) is not considered a valid dose of the HepB component, because the last dose of HepB vaccine should be given at 24 weeks of age or older. The child will need an additional dose of HepB vaccine at age 24 weeks or older, and at least 4 weeks after the inadvertent dose of Vaxelis. The DTaP and IPV components of the Vaxelis dose erroneously administered at age 5 months are considered valid doses and do not need to be repeated, as long as there was a minimum 4-week interval between the second and third doses of either component.