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Hib shortage did not lead to spikes in disease incidence
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The Haemophilus influenzae type b vaccine deferral did not increase disease incidence, according to study results published online this week.
Elizabeth C. Briere, MD, MPH, of the CDC’s Division of Bacterial Diseases in the National Center for Immunization and Respiratory Diseases, and colleagues looked at surveillance data from both before the Hib vaccine deferral recommendation (1998 to 2007) and the 18-month deferral after (2008 to 2009). Officials with Merck halted production of its Hib-containing vaccines in December 2007 to address manufacturing issues, which resulted in a national shortage of Hib vaccine and a subsequent recommendation by the CDC to suspend booster doses in children except in those at higher risk.
Elizabeth C. Briere
The researchers said in those two time periods, the incidence of Hib disease “per 100,000 population was 0.2 and 0.18, respectively.” In both time frames, Hib occurred more commonly in unvaccinated children or children behind in their immunization schedule.
Stepped up production by Sanofi-Pasteur of its monovalent Hib vaccine (ActHIB) and Pentacel (DTaP-IPV/Hib) led to a reinstatement in July 2009 of the booster dose for all children aged 12 to 15 months and a recommendation to recall children who may have missed their booster. Also, Hiberix (GlaxoSmithKline) was licensed in August 2009.
However, the researchers said that Hib booster deferral is a reasonable short-term approach if a Hib vaccine shortage were to occur again.
“Our findings highlight the importance of full vaccination in preventing Hib disease and the need for continued H. influenzae surveillance to identify Hib cases and provide appropriate chemoprophylaxis measures,” Briere told Infectious Diseases in Children.
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Jon S. Abramson, MD
This study did a good job of answering the question of whether we can do without a Hib booster dose in the event of another vaccine shortage. The answer is yes, as long as it is short-term. As this study demonstrates, there was probably little impact on the prevalence of Hib disease during the time when the Hib vaccine shortage occurred.
However, my concern is that this information will be misused in a way that people will conclude the immunization can always be delayed or is unnecessary.
It is easy to assume you could skip the Hib booster dose because Hib disease has always been rare in children after the age of 4 years. However, there is evidence that skipping the booster dose does lead to a higher incidence of Hib disease. For example, the initial UK Hib vaccine program used three Hib doses during infancy, but no booster dose. During the early years of this program, there was a marked decrease in Hib disease. Later on, the incidence of Hib disease started to increase in those children aged 2 to 4 years. Thus, elimination of the booster dose in a population for a prolonged time would likely result in an increase in Hib disease, and therefore result in an in increase in serious diseases due to Hib, such as bacterial meningitis.
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