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Haemophilus b Vaccine

Class: Vaccines
ATC Class: J07AG51
VA Class: IM100
Brands: ActHIB, Hiberix, PedvaxHIB, Pentacel (combination)

Introduction

Inactivated (polysaccharide) vaccine. Commercially available in US as 2 different vaccine types: Haemophilus b (Hib) conjugate vaccine (meningococcal protein conjugate) (PRP-OMP; PedvaxHIB) and Hib conjugate vaccine (tetanus toxoid conjugate) (PRP-T; ActHIB, Hiberix). PRP-T also commercially available in a combination vaccine containing diphtheria, tetanus, pertussis, poliovirus, and Hib antigens (DTaP-IPV/Hib; Pentacel).

Uses for Haemophilus b Vaccine

Prevention of Haemophilus influenzae type b (Hib) Infection

Prevention of Hib infection in infants and children 2 through 59 months of age. Also recommended in certain individuals ≥5 years of age at increased risk for invasive Hib disease because of certain medical conditions.

Hib is a gram-negative bacterium that causes meningitis and other serious infections (e.g., pneumonia, epiglottitis, sepsis, cellulitis, septic arthritis, osteomyelitis, endocarditis, purulent pericarditis), principally in infants and children <5 years of age. Prior to availability of Hib vaccine, Hib was the most common cause of bacterial meningitis and other invasive bacterial disease in young children worldwide; case fatality rate was 3–6% despite appropriate anti-infective treatment and 15–30% of meningitis survivors had hearing loss or neurologic sequelae.

Incidence of invasive Hib in the US decreased 99% after Hib conjugate vaccines became available. Most cases now occur in unvaccinated or incompletely vaccinated infants and children, including infants <6 months of age who are too young to have received a complete vaccination series. During 2012, there were 30 cases of invasive Hib disease reported in US children <5 years of age. Nonencapsulated (nontypeable) H. influenzae now the leading cause of invasive H. influenzae disease in all age groups.

USPHS Advisory Committee on Immunization Practices (ACIP), AAP, and others recommend routine vaccination against Hib in all infants using an appropriate vaccine regimen initiated in early infancy at 2 months of age (minimum age 6 weeks).

Catch-up vaccination recommended by ACIP, AAP, and others for all children <5 years of age who are unvaccinated or incompletely vaccinated against Hib. Unvaccinated children <5 years of age are at increased risk of invasive Hib disease, especially if in prolonged close contact (e.g., household contact) with a child with invasive Hib disease.

Individuals at increased risk of invasive Hib infection because of certain medical conditions include those with functional or anatomic asplenia, sickle cell disease, immunoglobulin deficiency (including IgG2 deficiency), early component complement deficiency, or HIV infection and those who have undergone hematopoietic stem cell transplantation (HSCT) or are receiving chemotherapy or radiation therapy for malignant neoplasms. Historically, invasive Hib was more common in American Indians (e.g., Apache and Navajo tribes), Alaskan natives, Hispanics, blacks; boys; daycare attendees; children living in crowded conditions; and children who were not breastfed.

PRP-OMP (PedvaxHIB) and PRP-T (ActHIB) are labeled by FDA for use in children through 5 years of age (prior to sixth birthday); PRP-T (Hiberix) is labeled by FDA for use in children through 4 years of age (prior to fifth birthday). Although efficacy and safety not established in older children or adults, ACIP, AAP, and others recommend a single dose of Hib vaccine in certain immunocompromised adults and children ≥5 years of age at increased risk for invasive Hib disease. Consider that immune response to the vaccine may be reduced in immunocompromised individuals. (See Individuals with Altered Immunocompetence under Cautions.)

Hib vaccine will not provide protection against other types of H. influenzae (e.g., nonencapsulated [nontypeable] strains or against other pathogens that cause meningitis, septicemia, or other invasive infections.

Depending on age and vaccination status, Hib vaccine may be given as a monovalent vaccine containing PRP-OMP (PedvaxHIB), monovalent vaccine containing PRP-T (ActHIB, Hiberix), or combination vaccine containing PRP-T (DTaP-IPV/Hib; Pentacel).

ACIP and AAP state that PRP-OMP (PedvaxHIB) is preferred for primary immunization against invasive Hib disease in American Indian and Alaskan native children ≥6 weeks of age. Peak incidence of Hib meningitis in these populations occurs at a younger age (4–6 months) than in other US infants and there is evidence that PRP-OMP can induce protective antibody levels after first dose and provide earlier protection than vaccines containing PRP-T. These experts state that any available age-appropriate monovalent or combination Hib vaccine can be used in other individuals.

DTaP-IPV/Hib (Pentacel) may be used in infants and children 6 weeks through 4 years of age when doses of DTaP, IPV, and Hib indicated and there are no contraindications to any of the individual components. For prevention of Hib, ACIP states that DTaP-IPV/Hib may be used for primary immunization doses and the booster dose at 12 through 15 months of age.

Haemophilus b Vaccine Dosage and Administration

Administration

IM Administration

Monovalent Hib vaccines (PRP-OMP; PedvaxHIB), (PRP-T; ActHIB, Hiberix): Administer by IM injection.

Combination Hib vaccine (DTaP-IPV/Hib; Pentacel): Administer by IM injection.

Do not administer monovalent or combination Hib vaccines IV, sub-Q, or intradermally.

Depending on patient age, administer IM into anterolateral thigh or deltoid muscle.

Infants <12 months of age: Preferably give IM injection into anterolateral thigh. In certain circumstances (e.g., physical obstruction at other sites and no reasonable indication to defer the vaccine dose), may consider IM injection into gluteal muscle using care to identify anatomical landmarks prior to injection.

Infants and children 1 through 2 years of age: Preferably give IM injection into anterolateral thigh; alternatively, deltoid muscle can be used if muscle mass is adequate.

Adults, adolescents, and children ≥3 years of age: Preferably give IM injection into deltoid muscle; alternatively, anterolateral thigh can be used.

To ensure delivery into muscle, make IM injections at a 90° angle to the skin using a needle length appropriate for the individual’s age and body mass, thickness of adipose tissue and muscle at injection site, and injection technique. Consider anatomic variability, especially in the deltoid; use clinical judgment to avoid inadvertent underpenetration or overpenetration of muscle.

Some manufacturers state avoid injection into gluteal area or into or near blood vessels or nerves.

Syncope (vasovagal or vasodepressor reaction; fainting) may occur following vaccination; may be accompanied by transient neurologic signs (e.g., visual disturbance, paresthesia, tonic-clonic limb movements). Occurs most frequently in adolescents and young adults. Have procedures in place to avoid falling injury and restore cerebral perfusion following syncope. Syncope and secondary injuries may be averted if vaccinees sit or lie down during and for 15 minutes after vaccination. If syncope occurs, observe patient until symptoms resolve.

May be given concurrently with other age-appropriate vaccines. When multiple vaccines are administered during a single health-care visit, give each parenteral vaccine using separate syringes and different injection sites. Separate injection sites by at least 1 inch (if anatomically feasible) to allow appropriate attribution of any local adverse effects that may occur.

PRP-OMP (PedvaxHIB)

Do not dilute.

Shake single-dose vial well before withdrawing dose; thorough agitation necessary to maintain suspension. Should appear as slightly opaque white suspension.

PRP-T (ActHIB)

Reconstitute single-dose vial of lyophilized PRP-T (ActHIB) by adding 0.6 mL of 0.4% sodium chloride diluent supplied by the manufacturer; agitate thoroughly. Should appear clear and colorless. Consult manufacturer’s labeling for additional information regarding reconstitution.

Administer promptly after reconstitution or store at 2–8°C and administer within 24 hours after reconstitution.

Shake well prior to use.

Do not mix with any other vaccine or solution.

PRP-T (Hiberix)

Reconstitute single-dose vial of lyophilized PRP-T (Hiberix) by adding entire amount of 0.9% sodium chloride diluent supplied by the manufacturer; agitate thoroughly. Consult manufacturer’s labeling for additional information regarding reconstitution.

Administer promptly after reconstitution or store at 2–8°C and administer within 24 hours after reconstitution.

Shake well before use.

Do not mix with any other vaccine or solution.

DTaP-IPV/Hib (Pentacel)

DTaP-IPV/Hib (Pentacel) is commercially available as a kit containing single-dose vial of fixed-combination vaccine containing diphtheria, tetanus, pertussis, and poliovirus antigens (DTaP-IPV vaccine) and single-dose vial of lyophilized Hib vaccine (PRP-T; ActHIB).

Prior to administration, reconstitute vial of lyophilized PRP-T (ActHIB) vaccine by adding entire contents of vial of DTaP-IPV vaccine in the kit according to manufacturer’s instructions to provide a combination vaccine containing diphtheria, tetanus, pertussis, IPV, and Hib antigens. Gently swirl until cloudy, uniform, white to off-white (yellow tinge) suspension is obtained.

Administer immediately after reconstitution.

Dosage

Dosing schedule (i.e., number of doses) varies according to specific vaccine administered and age at which vaccination is started. Follow age-appropriate dosage recommendations for the specific preparation used.

PRP-OMP (PedvaxHIB) and PRP-T (ActHIB, Hiberix) monovalent Hib vaccines are considered interchangeable for both primary and booster immunization. If primary vaccination series included both PRP-OMB and PRP-T or if vaccine type previously given unknown, 3 primary doses and a booster dose are needed to complete the series.

ACIP and AAP recommend use of PRP-OMP (PedvaxHIB) for primary immunization in American Indian and Alaskan native children. (See Limitations of Vaccine Effectiveness under Cautions.)

Medically stable preterm infants should be vaccinated at the usual chronologic age using usual dosage. (See Pediatric Use under Cautions.)

If interruptions or delays result in an interval between doses longer than recommended, there is no need to administer additional doses or start the vaccination series over.

Pediatric Patients

Prevention of Haemophilus influenzae Type b (Hib) Infection
Infants and Children 2 Months through 71 Months of Age (PRP-OMP; PedvaxHIB)
IM

Each dose is 0.5 mL.

Routine primary immunization in early infancy consists of a series of 2 doses and a booster dose. Manufacturer, ACIP, AAP, and others recommend that doses be given at 2, 4, and 12 through 15 months of age. Initial dose may be given as early as 6 weeks of age. Minimum interval between first and second dose is 2 months (8 weeks). Give third dose (booster dose) no earlier than 2 months after second dose; third dose necessary only if second dose was given before 12 months of age.

Catch-up immunization in infants who receive first dose at 7 through 11 months of age: Give second dose at least 4 weeks after first dose and give third dose at 12 through 15 months of age or 8 weeks after second dose, whichever is later.

Catch-up immunization in previously unvaccinated infants 12 through 14 months of age: Give first dose immediately and give second dose 8 weeks after first dose. Third dose not needed.

Previously unvaccinated infants and children 15 through 59 months of age: Give single dose.

Infants and Children 2 Months through 5 years of Age (PRP-T; ActHIB)
IM

Each dose is 0.5 mL.

Routine primary immunization in early infancy consists of a series of 3 doses and a booster dose. ACIP, AAP, and others recommend that doses be given at 2, 4, 6, and 12 through 15 months of age. Manufacturer recommends that doses be given at 2, 4, 6, and 15 through 18 months of age. Initial dose may be given as early as 6 weeks of age.

Catch-up immunization in infants who receive first dose at 7 through 11 months of age: Give second dose at least 4 weeks after first dose and give third dose at 12 through 15 months of age or 8 weeks after second dose, whichever is later.

Catch-up immunization in previously unvaccinated infants 12 through 14 months of age: Give first dose immediately and give second dose 8 weeks after first dose. Third dose not needed.

Previously unvaccinated infants and children 15 through 59 months of age: Give single dose.

Infants and Children 6 Weeks through 4 Years of Age (PRP-T; Hiberix)
IM

Each dose is 0.5 mL.

Routine primary immunization in early infancy consists of a series of 3 doses and a booster dose. ACIP, AAP, and others recommend that doses be given at 2, 4, 6, and 12 through 15 months of age. Manufacturer recommends that doses be given at 2, 4, 6, and 15 through 18 months of age. Initial dose may be given as early as 6 weeks of age.

Catch-up immunization in infants who receive first dose at 7 through 11 months of age: Give second dose at least 4 weeks after first dose and give third dose at 12 through 15 months of age or 8 weeks after second dose, whichever is later.

Catch-up immunization in previously unvaccinated infants 12 through 14 months of age: Give first dose immediately and give second dose 8 weeks after first dose. Third dose not needed.

Previously unvaccinated infants and children 15 through 59 months of age: Give single dose.

Infants and Children 6 Weeks through 4 Years of Age (DTaP-IPV/Hib; Pentacel)
IM

Each dose is 0.5 mL.

May be used when immunization against diphtheria, tetanus, pertussis, poliovirus, and Hib is indicated in children 6 weeks through 4 years of age.

Previously unvaccinated: Use a series of 4 doses. ACIP, AAP, and others recommend that doses be given at 2, 4, 6, and 12 through 15 months of age. Manufacturer recommends that doses be given at 2, 4, 6, and 15 through 18 months of age. Initial dose usually given at 2 months of age, but may be given as early as 6 weeks of age.

Previously received ≥1 dose of Hib vaccine: Can be used to complete the Hib vaccination series when doses of IPV and DTaP also are indicated and there are no contraindications to any of the individual components.

To complete recommended primary and booster vaccination series against diphtheria, tetanus, and pertussis in children who received the 4-dose series of DTaP-IPV/Hib (Pentacel): Give a fifth dose of DTaP (Daptacel) at 4 through 6 years of age. Do not use DTaP-IPV/Hib (Pentacel) for booster dose of DTaP indicated at 4 through 6 years of age; however, if dose of DTaP-IPV/Hib (Pentacel) is inadvertently given to a child ≥5 years of age or older, ACIP states the dose may be counted as a valid dose.

To complete recommended vaccination against poliovirus in children who received the 4-dose series of DTaP-IPV/Hib (Pentacel): Give additional booster dose of age-appropriate vaccine containing IPV (IPOL or Kinrix) at 4 through 6 years of age.

Children 12 through 59 Months of Age with Medical Conditions Associated with Increased Risk of Invasive Hib Disease
IM

Unvaccinated or previously received 1 dose of Hib vaccine before 12 months of age: Give 2 doses of Hib vaccine 2 months (8 weeks) apart.

Previously received 2 doses of Hib vaccine before 12 months of age: Give 1 additional dose of Hib vaccine at least 8 weeks after last dose.

Previously received complete primary immunization series followed by a booster dose given at ≥12 months of age: No additional doses of Hib vaccine needed.

Children ≥5 Years of Age with Medical Conditions Associated with Increased Risk of Invasive Hib Disease†
IM

Unvaccinated or incompletely vaccinated against Hib: ACIP, AAP, and others recommend a single dose of Hib vaccine in those at increased risk because of anatomic or functional asplenia, sickle cell disease, HIV infection, or IgG2 deficiency.

Undergoing splenectomy: Give a single dose of Hib vaccine at least 14 days before surgery if previously unvaccinated. Some experts recommend a dose regardless of prior vaccination against Hib. If not given before splenectomy, give as soon as possible ≥2 weeks after surgery when patient's condition is stable.

HSCT recipient: Starting 6–12 months after HSCT, give 3 doses of monovalent Hib vaccine at least 4 weeks apart, regardless of prior vaccination against Hib.

Adults

Adults with Medical Conditions Associated with Increased Risk of Invasive Hib Disease†
IM

Anatomic or functional asplenia, sickle cell disease: Give a single dose of Hib vaccine if previously unvaccinated.

Undergoing splenectomy: Give a single dose of Hib vaccine at least 14 days before surgery if previously unvaccinated. Some experts recommend a dose regardless of prior vaccination against Hib. If not given before splenectomy, give as soon as possible ≥2 weeks after surgery when patient's condition is stable.

HIV-infected adults: Hib vaccine not recommended unless patient also has anatomic or functional asplenia.

HSCT recipient: Starting 6–12 months after HSCT, give 3 doses of Hib vaccine at least 4 weeks apart, regardless of prior vaccination against Hib.

Special Populations

Hepatic Impairment

No specific dosage recommendations.

Renal Impairment

No specific dosage recommendations.

Cautions for Haemophilus b Vaccine

Contraindications

  • PRP-OMP (PedvaxHIB): Hypersensitivity to any vaccine component.

  • PRP-T (ActHIB, Hiberix): Severe allergic reaction (e.g., anaphylaxis) after dose of any Hib vaccine, dose of any vaccine containing tetanus toxoid, or any component in PRP-T.

  • DTaP-IPV/Hib (Pentacel): Severe allergic reaction (e.g., anaphylaxis) to any ingredient in the vaccine or after previous dose of the vaccine or any vaccine containing diphtheria, tetanus, pertussis, poliovirus, or Hib antigens. Also contraindicated (because of the pertussis antigen) in individuals who had encephalopathy (e.g., coma, decreased consciousness, prolonged seizures) within 7 days of a dose of pertussis-containing vaccine and in individuals with progressive neurologic disorder, including infantile spasms, uncontrolled epilepsy, or progressive encephalopathy.

Warnings/Precautions

Sensitivity Reactions

Hypersensitivity Reactions

Hypersensitivity reactions (e.g., anaphylaxis, anaphylactoid reaction, angioedema, rash, pruritus, urticaria) reported.

Prior to administration, take all known precautions to prevent adverse reactions, including a review of the patient’s history with respect to possible hypersensitivity to the vaccine or similar vaccines.

Epinephrine and other appropriate agents and equipment should be readily available in case an immediate allergic reaction occurs.

Latex Sensitivity

Stopper on vial of PRP-OMP (PedvaxHIB) contains natural rubber latex, which may cause sensitivity reactions in susceptible individuals.

Delayed-type (cell-mediated) allergic contact dermatitis is most common type of latex hypersensitivity; immediate-type allergic reactions reported rarely.

ACIP states that vaccines supplied in vials or syringes containing dry natural rubber or natural rubber latex may be administered to individuals with a history of contact allergy to latex. Avoid use of such vaccines, if possible, in those with a history of severe (anaphylactic) latex allergy; if used in such individuals, ensure that appropriate agents and equipment are available to treat anaphylaxis or other immediate allergic reaction to latex.

Neomycin and/or Polymyxin B Allergy

DTaP-IPV/Hib (Pentacel) contains trace amounts of neomycin sulfate (≤4 pg) and polymyxin B (≤4 pg).

Neomycin hypersensitivity usually manifests as a delayed-type (cell-mediated) contact dermatitis.

ACIP states that a history of delayed-type allergic reaction to neomycin is not a contraindication for use of vaccines containing trace amounts of neomycin. However, individuals with a history of anaphylactic reaction to neomycin should be evaluated by an allergist before receiving a neomycin-containing vaccine.

Individuals with Altered Immunocompetence

May be administered to individuals immunosuppressed as the result of disease or immunosuppressive therapy. Consider possibility that immune responses to the vaccine and efficacy may be reduced in these individuals.

Manufacturer of PRP-T (Hiberix) states safety and efficacy not evaluated in immunosuppressed children.

Immune responses have been obtained following administration of Hib vaccine in patients with sickle cell disease, leukemia, or HIV infection, and in those who have undergone splenectomies; immune responses in HIV-infected individuals vary with the degree of immunocompromise.

ACIP, AAP, CDC, NIH, HIV Medicine Association of the IDSA, and others state that recommendations for use of Hib vaccine in HIV-infected children are the same as those for children not infected with HIV.

AAP states children who have received the usual age-appropriate regimen of Hib vaccine (primary and booster doses) and have decreased or absent splenic function do not need additional doses of the vaccine; however, those scheduled for splenectomy (e.g., for Hodgkin’s disease, spherocytosis, immune thrombocytopenia, hypersplenism) may benefit from an additional dose of a Hib vaccine given ≥14 days before surgery.

Generally, administer prior to initiation of immunosuppressive therapy or defer until immunosuppressive therapy discontinued. (See Immunosuppressive Agents under Interactions.)

Concomitant Illness

Base decision to administer or delay vaccination in an individual with a current or recent acute illness on severity of symptoms and etiology of the illness.

ACIP states that mild acute illness generally does not preclude vaccination.

ACIP states that moderate or severe acute illness (with or without fever) is a precaution for vaccination; defer vaccines until individual has recovered from the acute phase of the illness. This avoids superimposing vaccine adverse effects on the underlying illness or mistakenly concluding that a manifestation of the underlying illness resulted from vaccine administration.

Guillain-Barré Syndrome

If Guillain-Barré syndrome (GBS) occurred within 6 weeks of receipt of a vaccine containing tetanus toxoid, manufacturers state base decision to administer a dose of PRP-T (ActHIB, Hiberix) on careful consideration of potential benefits and possible risks.

Individuals with Bleeding Disorders

Advise individuals who have bleeding disorders or are receiving anticoagulant therapy and/or their family members about the risk of hematoma from IM injections.

ACIP states IM vaccines may be given to such individuals if a clinician familiar with the patient’s bleeding risk determines that the vaccines can be administered IM with reasonable safety. In these cases, use a fine needle (23 gauge or smaller) to administer the vaccine and apply firm pressure to the injection site (without rubbing) for ≥2 minutes. In individuals receiving therapy for hemophilia, IM vaccines can be scheduled for shortly after a dose of such therapy.

Use of Combination Vaccines

When combination vaccine containing Hib and other antigens (DTaP-IPV/Hib; Pentacel) used, consider cautions, precautions, and contraindications associated with each antigen.

Limitations of Vaccine Effectiveness

May not protect all vaccine recipients against Hib.

Hib vaccines will not provide protection against other types of H. influenzae (e.g., nonencapsulated [nontypeable] strains) or against other pathogens that cause meningitis, septicemia, or other invasive disease.

Hib vaccine does not result in protective antibodies immediately following vaccination.

There is some evidence that vaccines containing PRP-OMP (PedvaxHIB) result in more rapid seroconversion to protective antibody concentrations within the first 6 months of life compared with vaccines containing PRP-T (ActHIB, Hiberix). This is particularly important in American Indian and Alaskan native children because these children are at increased risk for Hib disease during the first 6 months of life.

Although PRP-OMP contains Hib antigen conjugated to outer membrane protein complex (OMPC) of Neisseria meningitidis and antibodies to OMPC have been demonstrated in individuals who received the vaccine, the clinical relevance of these antibodies not established. PRP-OMP is not an immunizing agent against meningococcal disease.

Although PRP-T contains Hib antigen conjugated to tetanus toxoid, PRP-T is not a substitute for routine immunization against tetanus.

Improper Storage and Handling

Improper storage or handling of vaccines may reduce vaccine potency resulting in reduced or inadequate immune responses in vaccinees.

Inspect all vaccines upon delivery and monitor during storage to ensure that the appropriate temperature is maintained. (See Storage under Stability.)

Do not administer monovalent Hib vaccines or combination vaccines containing Hib and other antigens that have been mishandled or have not been stored at the recommended temperature.

If there are concerns about mishandling, contact the manufacturer or state or local immunization or health departments for guidance on whether the vaccine is usable.

Specific Populations

Pregnancy

Not labeled by FDA for use in adolescents or adults; not usually recommended for this age group.

No human or animal data available to assess risks of Hib vaccines during pregnancy.

ACIP states there is no evidence of risk to the fetus if inactivated vaccines are administered during pregnancy.

Lactation

Not labeled by FDA for use in adolescents or adults; not usually recommended for this age group.

Not known whether antigens contained in Hib vaccine are distributed into human milk, affect human milk production, or affect breast-fed infant.

ACIP states that administration of inactivated vaccines to a woman who is breast-feeding does not pose any safety concerns for the woman or her breast-fed infant.

Pediatric Use

PRP-OMP (PedvaxHIB): Safety and efficacy not established in infants <6 weeks of age or in children ≥6 years of age. Manufacturer states administration before 6 weeks of age may result in immunologic tolerance to the vaccine (i.e., impaired ability to respond to subsequent exposure to PRP antigen).

PRP-T (ActHIB): Safety and efficacy not established in infants <6 weeks of age.

PRP-T (Hiberix): Safety and efficacy not established in infants <6 weeks of age or in children and adolescents 5–16 years of age.

DTaP-IPV/Hib (Pentacel): Safety and efficacy not established in infants <6 weeks of age or in children 5–16 years of age.

Do not administer Hib vaccine to infants <6 weeks of age.

Apnea reported following IM administration of vaccines in some infants born prematurely. Base decisions regarding when to administer an IM vaccine in premature infants on consideration of the individual infant's medical status and potential benefits and possible risks of vaccination.

Geriatric Use

Not labeled by FDA for use in adults, including geriatric adults; not usually recommended for this age group.

Common Adverse Effects

PRP-OMP (PedvaxHIB) or PRP-T (ActHIB Hiberix): Injection site reactions (pain, erythema, swelling), fever, irritability, lethargy, drowsiness, restlessness.

DTaP-IPV/Hib (Pentacel): Injection site reactions (tenderness, redness, swelling), systemic effects (fever, decreased activity/lethargy, inconsolable crying, fussiness/irritability).

Interactions for Haemophilus b Vaccine

Immunosuppressive Agents

Immune responses to vaccines, including Hib vaccine, may be reduced in individuals receiving immunosuppressive agents.

Generally, give inactivated vaccines ≥2 weeks prior to initiation of immunosuppressive therapy and, because of possible suboptimal response, do not give during and for certain periods of time after immunosuppressive therapy discontinued. (See Specific Drugs under Interactions.)

Time to restoration of immune competence varies depending on type and intensity of immunosuppressive therapy, underlying disease, and other factors; optimal timing for vaccine administration after discontinuance of immunosuppressive therapy not identified for every situation.

Vaccines

Although specific studies may not be available, concurrent administration with other age-appropriate vaccines, including live virus vaccines, toxoids, or inactivated or recombinant vaccines, during the same health-care visit not expected to affect immunologic responses or adverse reactions to any of the preparations.

Immunization against Hib can be integrated with immunization against diphtheria, tetanus, pertussis, hepatitis A, hepatitis B, influenza, measles, mumps, rubella, meningococcal disease, pneumococcal disease, poliovirus, rotavirus, and varicella. Administer each parenteral vaccine using separate syringes and different injection sites.

Specific Drugs and Laboratory Tests

Drug

Interaction

Comments

Diphtheria and tetanus toxoids and pertussis vaccine adsorbed (DTaP)

PRP-OMP (PedvaxHIB) or PRP-T (ActHIB, Hiberix): Concurrent administration with DTaP at different sites has not resulted in decreased antibody responses or increased adverse reactions

PRP-T (Hiberix): Concurrent administration with DTaP-HepB-IPV (Pediarix) and pneumococcal 13-valent conjugate vaccine (PCV13; Prevnar 13) at different sites in infants 2, 4, and 6 months of age did not reduce antibody responses to DTaP or the other antigens; concurrent administration of booster dose of PRP-T (Hiberix) and DTaP at different injection sites in children 15–18 months of age did not affect antibody responses to DTaP

DTaP and Hib vaccine may be given concurrently (using separate syringes and different injection sites); alternatively, Hib vaccine is commercially available in combination with DTaP and IPV (DTaP-IPV/Hib; Pentacel)

Hepatitis A vaccine (HepA)

HepA (Havrix, Vaqta): Concurrent administration with Hib vaccine at different sites (with or without other concurrent vaccines) resulted in immune responses and adverse effects similar to those reported when the vaccines were administered at different times

HepA and Hib vaccine may be given concurrently (using separate syringes and different injection sites)

Hepatitis B vaccine (HepB)

HepB and Hib vaccine may be given concurrently (using separate syringes and different injection sites)

Do not prepare extemporaneous combinations of HepB and Hib vaccine

Immune globulin (immune globulin IM [IGIM], immune globulin IV [IGIV], immune globulin sub-Q) or specific hyperimmune globulin (hepatitis B immune globulin [HBIG], rabies immune globulin [RIG], tetanus immune globulin [TIG], varicella zoster immune globulin [VZIG])

No evidence that immune globulin preparations interfere with immune response to Hib vaccine

Hib vaccine may be given concurrently with (using separate syringes and different injection sites) or at any interval before or after immune globulin or specific hyperimmune globulin

Immunosuppressive agents (e.g., alkylating agents, antimetabolites, certain biologic response modifiers, corticosteroids, cytotoxic drugs, radiation)

Potential for decreased immune responses to vaccines

Anti-B-cell antibodies (e.g., rituximab): Optimal time to administer vaccines after such treatment unclear

Corticosteroids: May reduce immune responses to Hib vaccine if given in greater than physiologic doses

Chemotherapy or radiation: Give inactivated vaccines ≥2 weeks before and avoid during such therapy if possible; if Hib vaccine given during or within 14 days of starting chemotherapy or radiation therapy, repeat vaccine doses beginning ≥3 months following completion of such therapy if immune competence restored; revaccination not needed if Hib vaccine given >14 days before such therapy

Anti-B-cell antibodies (e.g., rituximab): Give inactivated vaccines ≥2 weeks before or defer until ≥6 months after such treatment

Certain biologic response modifiers (e.g., colony-stimulating factors, interleukins, tumor necrosis factor-α inhibitors): Give inactivated vaccines ≥2 weeks prior to initiation of such therapy; if inactivated vaccine indicated in patient with chronic inflammatory illness receiving maintenance therapy with a biologic response modifier, some experts state do not withhold the vaccine because of concern about exacerbation of inflammatory illness

Corticosteroids: Some experts state give inactivated vaccines ≥2 weeks prior to initiation of immunosuppressive corticosteroid therapy if feasible, but may be given to those receiving long-term corticosteroid therapy for inflammatory or autoimmune disease; IDSA states, although it may be reasonable to delay inactivated vaccines in patients treated with high-dose corticosteroid therapy, recommendations for use of Hib vaccine in individuals receiving corticosteroid therapy (including high-dose corticosteroid therapy) generally are the same as those for other individuals

Measles, mumps, and rubella vaccine (MMR)

Concurrent administration of MMR and Hib vaccine at different sites does not interfere with immune responses or increase adverse effects

MMR and Hib vaccine may be given concurrently (using separate syringes and different injection sites)

Pneumococcal vaccine

PCV13 (Prevnar 13): Has been given concurrently with Hib vaccine using separate syringes and different injection sites

Hib vaccine may be given concurrently with PCV13 (Prevnar 13) or pneumococcal 23-valent polysaccharide vaccine (PPSV23; Pneumovax) using separate syringes and different injection sites

Poliovirus vaccine (IPV)

IPV may be given concurrently with Hib vaccine (using separate syringes and different injection sites); alternatively, Hib vaccine is commercially available in combination with DTaP and IPV (DTaP-IPV/Hib; Pentacel)

Rotavirus vaccine

Rotavirus vaccine (Rotarix, RotaTeq): Has been administered concurrently with Hib vaccine without decreased immune responses to either vaccine

Tests to diagnose Hib disease

Hib capsular polysaccharide detected in urine following administration of Hib vaccine; may interfere with interpretation of antigen tests used to diagnose Hib disease

Urine antigen detection may not have diagnostic value in evaluating suspected Hib disease in children within 1–2 weeks following administration of Hib vaccine

Antigen testing of urine and serum specimens no longer recommended for diagnosis of Hib infection

Varicella vaccine (VAR)

Concurrent administration of VAR and Hib vaccine at different sites does not increase risk of breakthrough varicella infection

VAR and Hib vaccine may be given concurrently (using different syringes and different injection sites)

Stability

Storage

Parenteral

For Injection, for IM Use

PRP-T (ActHIB) and 0.4% sodium chloride diluent: 2–8°C; do not freeze. Following reconstitution with diluent provided by manufacturer, store at 2–8°C and use within 24 hours.

PRP-T (Hiberix): 2–8°C; protect from light. Store 0.9% sodium chloride diluent supplied by manufacturer at 2–8°C or room temperature <25°C; do not freeze; discard if freezing occurs. Following reconstitution with diluent provided by manufacturer, store at 2–8°C and use within 24 hours; do not freeze. Discard reconstituted vaccine if frozen or if not used within 24 hours.

Kit containing DTaP-IPV and ActHIB (DTaP-IPV/Hib; Pentacel): 2–8°C. Do not freeze; if freezing occurs, discard vaccine. Use immediately after reconstitution.

Suspension, for IM Use

PRP-OMP (PedvaxHIB): 2–8°C; do not freeze.

Actions

  • Commercially available as monovalent PRP-OMP vaccine (PedvaxHIB) and as monovalent PRP-T vaccine (ActHIB, Hiberix). PRP-T also available in a kit used to provide a combination vaccine containing diphtheria, tetanus, pertussis, poliovirus, and Hib antigens (DTaP-IPV/Hib; Pentacel).

  • Hib vaccines contain antigenic capsular polysaccharides extracted from Hib. Vaccine capsular polysaccharides are derived from polyribosylribitol phosphate (PRP), a major Hib virulence factor.

  • All currently available Hib vaccines contain Hib antigen conjugated to a T-cell-dependent protein antigen (carrier), either N. meningitidis outer membrane protein complex (OMPC) (PRP-OMP; PedvaxHIB) or tetanus toxoid (PRP-T; ActHIB) (PRP-T; Hiberix) (DTaP-IPV/Hib; Pentacel).

  • Conjugation with a carrier protein results in a T-cell dependent polysaccharide antigen that induces an improved immunologic response compared with unconjugated Hib vaccines previously available.

  • Hib vaccines stimulate active immunity to Hib infection by inducing production of specific antibodies. Hib capsular polysaccharide present in the vaccines promotes production of Hib anticapsular antibody; this antibody provides protection against Hib infection.

  • Studies using unconjugated Hib vaccines (no longer commercially available) indicate that antibody titers to H. influenzae capsular polysaccharide (anti-PRP) of ≥1 mcg/mL after vaccination correlate with long-term protection against invasive Hib disease.

  • In clinical study using PRP-OMP (PedvaxHIB), 80% of infants developed protective antibody levels (anti-PRP >1 mcg/mL) after primary series of 2 doses initiated at 2–3 months of age; 95% had protective antibody levels approximately 1 month after a booster dose given at 12–15 months of age.

  • In clinical studies using PRP-T (ActHIB, Hiberix), 81–97% of infants developed protective antibody levels (anti-PRP ≥1 mcg/mL) after a primary immunization series of 3 doses given at 2, 4, and 6 months of age; 98–100% had protective antibody levels 1 month after a booster dose given at 15–23 months of age.

  • If complete vaccination series administered as recommended, regimens that include PRP-OMP or PRP-T are considered equivalent. However, there is some evidence that vaccines containing PRP-OMP result in more rapid seroconversion to protective antibody concentrations within first 6 months of life compared with vaccines containing PRP-T.

Advice to Patients

  • Prior to administration of each vaccine dose, provide a copy of the appropriate CDC Vaccine Information Statement (VIS) to the patient or patient’s legal representative as required by the National Childhood Vaccine Injury Act (VISs are available at [Web]).

  • Advise patient and/or patient’s parent or guardian of the risks and benefits of vaccination against Hib.

  • Importance of receiving the complete primary vaccination series to ensure the highest level of protection against Hib.

  • Importance of informing clinicians if any severe or unusual adverse reactions occur. Clinicians or individuals can report any adverse reactions that occur following vaccination to Vaccine Adverse Event Reporting System (VAERS) at 800-822-7967 or [Web].

  • Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant illnesses.

  • Importance of informing patients and/or patient’s parent or guardian of other important precautionary information. (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

Haemophilus b Conjugate Vaccine (Meningococcal Protein Conjugate) (PRP-OMP)

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Parenteral

Injectable suspension, for IM use

7.5 mcg of Haemophilus b capsular polysaccharide conjugated to 125 mcg of Neisseria meningitidis OMPC protein carrier per 0.5 mL

PedvaxHIB Liquid

Merck

Haemophilus b Conjugate Vaccine (Tetanus Toxoid Conjugate) (PRP-T)

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Parenteral

For injectable suspension, for IM use

10 mcg of Haemophilus b capsular polysaccharide conjugated to 24 mcg of tetanus toxoid protein carrier per 0.5 mL

ActHIB

Sanofi Pasteur

For injection, for IM use

10 mcg of Haemophilus b capsular polysaccharide conjugated to 25 mcg of tetanus toxoid protein carrier per 0.5 mL

Hiberix

GlaxoSmithKline

Diphtheria and Tetanus Toxoids and Acellular Pertussis Adsorbed, Inactivated Poliovirus and Haemophilus b Conjugate (Tetanus Toxoid Conjugate) Vaccine (DTaP-IPV/Hib)

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Parenteral

Kit, for IM use

Injection, for IM use, Diphtheria Toxoid 15 Lf units, Tetanus Toxoid 5 Lf units, Acellular Pertussis Vaccine 48 mcg (of pertussis antigen), Poliovirus Type 1 40 DU, Poliovirus Type 2 8 DU, and Poliovirus Type 3 32 DU per 0.5 mL

For injectable suspension, for IM use, 10 mcg of Haemophilus b polysaccharide conjugated to 24 mcg of tetanus toxoid protein carrier per 0.5 mL, ActHIB

Pentacel

Sanofi Pasteur

AHFS DI Essentials™. © Copyright 2021, Selected Revisions November 26, 2018. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.

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