Vaccines and Preventable Diseases:

Hib Vaccine - Q&A for Providers about Hib Vaccine Supply and Hib Vaccination Coverage

1. Should a provider give Pentacel (DTaP-IPV/Hib) even if doing so results in receipt of an additional dose of other antigens?

It is very important that all infants complete the primary series of Hib vaccination to assure that they are protected against invasive Hib disease. If Pentacel is the only Hib-containing vaccine available, this combination product should be used to complete the primary series of Hib vaccination, even if the child has already received all the necessary doses of DTaP and IPV. In the situation where infants are receiving Pentacel for their Hib vaccination and are also due for HepB vaccine, the HepB dose should be given as monovalent HepB vaccine. If monovalent HepB vaccine is not available, for infants whose mothers are HBsAg-negative the dose can be temporarily delayed until the monovalent HepB vaccine is available. These children should be tracked and recalled to receive their dose as soon as vaccine becomes available. For infants whose mothers are HBsAg-positive, providers should ensure timely administration of HepB vaccine (the 3-dose series must be completed by age 6-8 months), preferably with monovalent HepB vaccine, or if not available, with whatever HepB-containing product is available.

2. How widespread is the problem of lower coverage for the third Hib dose in the primary vaccination series?

Preliminary information from sentinel immunization information systems (registries) in eight states all show similar lower coverage for the third Hib dose in the primary series, compared to other vaccines (DTaP, PCV7) commonly administered at the same visit. We do not have information from other states that may have looked into this issue, but it is likely that coverage for the third Hib dose in the primary series also may be low in other states. An algorithm was distributed by CDC to all states wishing to use their registry to evaluate Hib coverage.

3. Is there enough Hib-containing vaccine currently available in the United States so that all children can receive the primary series?

Yes, there is enough Hib-containing vaccine for all US children to receive the primary series. All infants should complete the primary series. The two Hib-containing vaccines currently available for the primary series are both sanofi pasteur products given as a 3 dose primary series at 2, 4, and 6 months: ActHib (monovalent Hib) and Pentacel (DTaP-IPV/Hib). Although there is enough Hib-containing vaccine nationally, there may be times when practitioners do not have an adequate supply of vaccine to meet local demand. If Hib vaccine is not available in the office at the time of a visit, children who are unable to receive one of the doses in the primary Hib series should be tracked and recalled to schedule an appointment to receive their dose as soon as vaccine becomes available in the office.

Providers who serve predominantly American Indian/Alaska Native (AI/AN) children living in AI/AN communities should continue to use PRP-OMP (i.e., polyribosylribitol phosphate [PRP] covalently linked to a meningococcal outer membrane protein [OMP] carrier) – containing Hib vaccines (Merck product). This product requires a 2-dose primary series (ages 2 and 4 months) and a 12-15 month booster dose. This vaccine is only available from the VFC Pediatric Vaccine Stockpile through state immunization programs.

4. Which children should be still be receiving Hib booster doses at 12-15 months?

Children at increased risk for Hib disease should continue to receive the primary series and the booster dose. This includes children with asplenia, sickle cell disease, and human immunodeficiency virus infection and certain other immunodeficiency syndromes, and malignant neoplasms. In addition, American Indian/Alaska Native (AI/AN) children should also continue to receive the primary series and the booster dose.

5. What is the recommended schedule for children less than 12 months of age who are not at increased risk of Hib disease and who have not finished the 3-dose Hib primary vaccine series?

If the child is at least 6 weeks of age but less than 12 months of age and has received 0, 1, or 2 Hib doses, schedule him/her for the first or next dose(s) immediately with a minimum of four weeks between the doses. Intervals of 8 weeks between doses are recommended for children who are on schedule; intervals of 4 weeks may be used for children whose primary series is delayed. These children will all need one booster dose when the Hib vaccine shortage is over.

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