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Hib vaccine

Hib component of Infanrix hexa

Vaccine description

Target Haemophilus influenzae type b

Vaccine type Conjugate

Clinical data

Trade names ActHIB, Hiberix, OmniHIB, others

AHFS/Drugs.com Professional Drug Facts

MedlinePlus a607015

License data US DailyMed: Haemophilus

Pregnancy AU: B2[1]

ATC code J07AG01 (WHO)

Legal status

Legal status US: ℞-only

Identifiers

DrugBank DB10990

DB10342

ChemSpider none

UNII C9R35M8XV6

LUY6P8763W

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Hib vaccine

Identifiers

DrugBank DB10076

UNII FLV5I5W26R

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.[4]

It is recommended by both the World Health Organization (WHO) and the U.S. Centers for Disease Control and
Prevention (CDC).[2][5] Two or three doses should be given before six months of age.[2] In the United States a
fourth dose is recommended between 12 and 15 months of age.[6] The first dose is recommended around six
weeks of age with at least four weeks between doses.[2] If only two doses are used, another dose later in life is
recommended.[2] It is given by injection into a muscle.[2]

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.[7] but was replaced by a more effective conjugated formulations beginning in 1987.[8] As of 2013,
184 countries include it in their routine vaccinations.[2] It is on the World Health Organization's List of Essential
Medicines.[9]

Medical uses[edit]
Hib conjugate vaccines have been shown to be effective against all manifestations of Hib disease, with a
clinical efficacy among fully vaccinated children estimated to be between 95–100%. The vaccine has also been
shown to be immunogenic in patients at high risk of invasive disease. Hib vaccine is not effective against non-
type B Haemophilus influenzae. However, non-type B disease is rare in comparison to pre-vaccine rates
of Haemophilus influenzae type B disease.[10]

Impact[edit]
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[edit]
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[edit]
Clinical trials and ongoing surveillance have shown Hib vaccine to be safe. In general, adverse reactions to the
vaccine are mild. The most common reactions are mild fever, loss of appetite, transient redness, swelling,
or pain at the site of injection, occurring in 5–30% of vaccine recipients. More severe reactions are extremely
rare.[citation needed]

Mechanisms of action[edit]
Polysaccharide vaccine[edit]
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[edit]
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[edit]
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Introduction of Hib vaccine in developing countries l