Medicines for Haemophilus influenzae type b (Hib)

What it is

Haemophilus influenzae type b (Hib) is a type of bacteria that can cause serious infections, particularly in young children. Despite its name, it is not related to the flu (influenza) virus — it is a bacterium. Before a vaccine was introduced, Hib was an important cause of serious, life-threatening infections in young children, including meningitis (inflammation of the lining of the brain and spinal cord), and other severe illnesses. The infections Hib can cause include: meningitis (which can be life-threatening and cause long-term complications); epiglottitis (a dangerous swelling at the back of the throat that can obstruct breathing); blood infection (sepsis); pneumonia (lung infection); and infections of the joints, bones, and other areas. These infections can be serious and rapidly progressive, and were a significant cause of illness, disability, and death in young children before vaccination. The very important and reassuring point is that Hib infection is now rare in countries with routine Hib vaccination, because the Hib vaccine is highly effective and has dramatically reduced these infections. The Hib vaccine is included in the routine childhood immunisation programme (given as part of combined vaccines in infancy, with a booster), which protects young children — who are most at risk — during the years when they are most vulnerable. So the key to preventing Hib disease is vaccination, and ensuring children receive their routine immunisations on schedule. Although Hib is now rare, it has not disappeared, so it remains important to keep up vaccination, and to recognise and seek urgent help for the serious infections it (and other causes) can produce — particularly meningitis and epiglottitis, which are emergencies. The key messages are that Hib is a bacterium that can cause serious infections (such as meningitis) especially in young children, that it is now rare thanks to the highly effective Hib vaccine, and that vaccination is the key protection.

How it is treated

The approach to Hib centres on prevention through the highly effective Hib vaccine, and, for any infection that does occur, prompt medical treatment; recognising the serious infections it can cause is important. Prevention is the key and most important aspect: the Hib vaccine is highly effective and is part of the routine childhood immunisation programme — it is given to babies (as part of combined vaccines) in the first months of life, with a booster later, which protects young children during the years when they are most at risk. Because of this vaccination, Hib disease has become rare. Ensuring children receive their routine immunisations on schedule is therefore the central measure to prevent Hib disease, and keeping vaccination coverage high protects both individual children and the community. In some situations, additional measures may be advised — for example, close contacts of a case may sometimes be offered preventive antibiotics or vaccination, guided by public health advice, and certain people at higher risk may be offered vaccination. If a Hib infection does occur, it needs prompt medical treatment: the serious infections Hib can cause — such as meningitis, epiglottitis, sepsis, and others — are medical emergencies or need urgent hospital treatment, usually with antibiotics given into a vein and supportive care, and prompt treatment is important for the outcome. Recognising the warning signs of these serious infections and seeking urgent help is vital: for meningitis, warning signs include a high temperature, being very unwell, a severe headache, a stiff neck, dislike of bright lights, drowsiness or confusion, and a rash that does not fade under pressure (though a rash is not always present) — and in babies, signs such as being floppy or unresponsive, a high-pitched cry, a bulging soft spot, and being difficult to wake; for epiglottitis, difficulty breathing and swallowing and being very unwell — these need emergency help. Because meningitis and other serious infections can also be caused by other germs, these warning signs always warrant urgent attention regardless of the cause. The reassuring messages are that Hib disease is now rare thanks to the highly effective Hib vaccine, that keeping up routine childhood vaccination is the key protection, and that any serious infection is treated promptly in hospital — while recognising and urgently acting on the warning signs of serious infections such as meningitis is important. Ensuring children are up to date with their immunisations is the main action for families.