Skip to Content

Haemophilus b Vaccine

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

Introduction

Inactivated (polysaccharide) vaccine.134 144 174 223 Commercially available in US as 2 different vaccine types: Haemophilus b (Hib) conjugate vaccine (meningococcal protein conjugate) (PRP-OMP; PedvaxHIB)144 and Hib conjugate vaccine (tetanus toxoid conjugate) (PRP-T; ActHIB, Hiberix).174 223 PRP-T also commercially available in fixed combination with meningococcal groups C and Y antigens (Hib-MenCY; MenHibrix)227 and in a combination vaccine containing diphtheria, tetanus, pertussis, poliovirus, and Hib antigens (DTaP-IPV/Hib; Pentacel).224

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.105 144 159 166 174 199 223 Also recommended in certain individuals ≥5 years of age at increased risk for invasive Hib disease.105 159 199 200

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.105 159 166 Prior to availability of Hib vaccine, Hib was the most common cause of bacterial meningitis and other invasive bacterial disease in young children worldwide;105 166 case fatality rate was 3–6% despite appropriate anti-infective treatment and 15–30% of meningitis survivors had hearing loss or neurologic sequelae.166

Incidence of invasive Hib in the US decreased 99% after Hib conjugate vaccines became available.105 166 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.105 166 During 2012, there were 30 cases of invasive Hib disease reported in US children <5 years of age.166 Nonencapsulated (nontypeable) H. influenzae now the leading cause of invasive H. influenzae disease in all age groups.105

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).105 159 199

Catch-up vaccination recommended by ACIP, AAP, and others for all children <5 years of age who are unvaccinated or incompletely vaccinated against Hib.105 159 199

Unvaccinated children <4 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.105 Other individuals at increased risk of invasive Hib infection 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.105 159 Historically, invasive Hib was more common in American Indians (e.g., Apache and Navajo tribes),45 105 166 Alaskan natives,40 45 85 105 Hispanics,166 blacks;29 105 166 boys;105 daycare attendees;105 166 children living in crowded conditions;105 166 and children who were not breastfed.105

PRP-OMP (PedvaxHIB) and PRP-T (ActHIB) are labeled by FDA for use in children through 5 years of age (up to 6 years of age);144 174 PRP-T (Hiberix) is labeled by FDA for use in children <5 years of age.223 Although efficacy and safety not established in older children or adults,144 174 223 224 225 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.105 156 159 166 199 200 Consider that immune response to the vaccine may be less in immunocompromised individuals.105 134 (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.144

Depending on age and vaccination status, Hib vaccine may be given as a monovalent vaccine containing PRP-OMP (PedvaxHIB),144 monovalent vaccine containing PRP-T (ActHIB, Hiberix),174 223 or a combination vaccine containing PRP-T.224 227

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.105 159 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.105 159 These experts state that any available age-appropriate monovalent or combination Hib vaccine can be used in other individuals.105 159

Hib-MenCY (MenHibrix): May be used in infants 6 weeks through 18 months of age when vaccination against Hib and meningococcal serogroups C and Y indicated.162 227 228 Although routine vaccination against meningococcal disease not recommended in infants who are not at increased risk,105 162 228 ACIP, AAP, and others state Hib-MenCY (MenHibrix) may be used for primary immunization against Hib in infants 6 weeks through 18 months of age who are at increased risk for meningococcal disease because they have certain chronic medical conditions (e.g., persistent complement component deficiencies or anatomic or functional asplenia, including sickle cell disease) or reside in communities with outbreaks of meningococcal serogroup C or Y.162 199 228 Does not provide adequate protection for infants and children traveling to or residing in areas with high endemic rates of meningococcal disease (e.g., “meningitis belt” of sub-Saharan Africa) since it does not provide protection against meningococcal serogroups A and W-135.162 199 228 Administration in infancy unlikely to provide persistent protection against meningococcal disease until 11 through 12 years of age, the age of recommended routine adolescent meningococcal vaccination.162

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.207 224 For prevention of Hib, ACIP states that DTaP-IPV/Hib (Pentacel) may be used for primary immunization doses and the booster dose at 12 through 15 months of age.207

Haemophilus b Vaccine Dosage and Administration

Administration

IM Administration

Monovalent Hib vaccines (PRP-OMP; PedvaxHIB), (PRP-T; ActHIB, Hiberix): Administer by IM injection.144 174 223

Combination Hib vaccines (Hib-MenCY; MenHibrix, DTaP-IPV/Hib, Pentacel): Administer by IM injection.224 227

Do not administer monovalent or combination Hib vaccines IV, sub-Q, or intradermally.144 174 223 224 227

Depending on patient age, administer IM into anterolateral thigh or deltoid muscle.134 144 224 227 In infants and children 6 weeks to 2 years of age, anterolateral thigh is preferred;134 alternatively, deltoid muscle can be used in those 1 through 2 years of age if muscle mass is adequate.134 In children ≥3 years of age, deltoid muscle preferred.134

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.134 208 209 Consider anatomic variability, especially in the deltoid; use clinical judgment to avoid inadvertent underpenetration or overpenetration of muscle.208 209

Avoid injection into gluteal area or into or near blood vessels or nerves.134 144 224 If gluteal muscle is chosen for infants <12 months of age because of special circumstances (e.g., physical obstruction of other sites), it is essential that clinician identify anatomical landmarks prior to injection.134

Syncope (vasovagal or vasodepressor reaction; fainting) may occur following vaccination;134 223 227 may be accompanied by transient neurologic signs (e.g., visual disturbance, paresthesia, tonic-clonic limb movements).223 227 Occurs most frequently in adolescents and young adults.134 Have procedures in place to avoid falling injury and restore cerebral perfusion following syncope.223 227 Syncope and secondary injuries may be averted if vaccinees sit or lie down during and for 15 minutes after vaccination.134 If syncope occurs, observe patient until symptoms resolve.134

May be given simultaneously with other age-appropriate vaccines.105 134 When multiple vaccines are administered during a single health-care visit, give each parenteral vaccine with a different syringe and at different injection site.105 134 Separate injection sites by at least 1 inch (if anatomically feasible) to allow appropriate attribution of any local adverse effects that may occur.134

PRP-OMP (PedvaxHIB)

Do not dilute.144

Shake well before use;144 thorough agitation necessary to maintain suspension.144 Should appear as slightly opaque white suspension.144

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;174 agitate thoroughly.174 Should appear clear and colorless.174 Consult manufacturer’s labeling for additional information regarding reconstitution.174

Administer promptly after reconstitution or store at 2–8°C and administer within 24 hours after reconstitution.174

Do not mix with any other vaccine or solution.174

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;223 agitate thoroughly.223 Consult manufacturer’s labeling for additional information regarding reconstitution.223

Administer promptly after reconstitution or store at 2–8°C and administer within 24 hours after reconstitution.223

Shake well before use.223

Do not mix with any other vaccine or solution.223

Hib-MenCY (MenHibrix)

Reconstitute single-dose vial of lyophilized Hib-MenCY (MenHibrix) by adding 0.6 mL of 0.9% sodium chloride diluent supplied by the manufacturer;227 shake well.227 Consult manufacturer’s labeling for additional information regarding reconstitution.227

Administer immediately after reconstitution.227

Do not mix with any other vaccine.227

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).224

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.224 Gently swirl until cloudy, uniform, white to off-white (yellow tinge) suspension is obtained.224

Administer immediately after reconstitution.224

Dosage

Dosing schedule (i.e., number of doses) varies according to specific vaccine administered and age at which vaccination is started.144 159 174 223 227 Follow age-appropriate dosage recommendations for the specific preparation used.144 159 174 223 227

PRP-OMP (PedvaxHIB) and PRP-T (ActHIB, Hiberix) monovalent Hib vaccines can be considered interchangeable for both primary and booster immunization.105 159 166 If the primary vaccination series included both PRP-OMB and PRP-T or if vaccine type previously given is unknown, 3 primary doses and a booster dose are needed to complete the series.105 159 166

ACIP and AAP recommend use of PRP-OMP (PedvaxHIB) for primary immunization in American Indian and Alaskan native children.105 159 (See Limitations of Vaccine Effectiveness under Cautions.)

Medically stable preterm infants should be vaccinated at the usual chronologic age using usual dosage.105 144 159 (See Pediatric Use under Cautions.)

Interruptions resulting in an interval between doses longer than recommended should not interfere with the final immunity achieved; there is no need to administer additional doses or start the vaccination series over.134 144

Pediatric Patients

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

Each dose is 0.5 mL.144

Routine primary immunization in early infancy consists of a series of 2 doses and a booster dose.105 144 199 Manufacturer, ACIP, AAP, and others recommend that doses be given at 2, 4, and 12 through 15 months of age.144 159 Initial dose may be given as early as 6 weeks of age.199 Minimum interval between first and second dose is 2 months (8 weeks).144 199 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.144 159

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.159 199

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.159 199 Third dose not needed.159

Previously unvaccinated infants and children 15 through 59 months of age: Give single dose.199

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

Each dose is 0.5 mL.174

Routine primary immunization in early infancy consists of a series of 3 doses and a booster dose.105 174 199 ACIP, AAP, and others recommend that doses be given at 2, 4, 6, and 12 through 15 months of age.105 199 Manufacturer recommends that doses be given at 2, 4, 6, and 15 through 18 months of age.174 Initial dose may be given as early as 6 weeks of age.105 159 174 199

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.159 199

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.159 199 Third dose not needed.159

Previously unvaccinated infants and children 15 through 59 months of age: Give single dose.199

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

Each dose is 0.5 mL.223

Routine primary immunization in early infancy consists of a series of 3 doses and a booster dose.105 199 223 ACIP, AAP, and others recommend that doses be given at 2, 4, 6, and 12 through 15 months of age.105 199 Manufacturer recommends that doses be given at 2, 4, 6, and 15 through 18 months of age.223 Initial dose may be given as early as 6 weeks of age.105 159 199 223

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.159 199

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.159 199 Third dose not needed.159

Previously unvaccinated infants and children 15 through 59 months of age: Give single dose.199

Infants 6 Weeks through 18 Months of Age (Hib-MenCY; MenHibrix)
IM

Each dose is 0.5 mL.227

Primary immunization in previously unvaccinated infants: Use a series of 4 doses.162 199 227 228 Give doses at 2, 4, 6, and 12 through 15 months of age.199 227 228

Initial dose usually given at 2 months of age, but may be given as early as 6 weeks of age.162 227 228 Fourth dose may be given as late as 18 months of age.162 227 228

If first dose given at ≥12 months of age, give a series of 2 doses at least 8 weeks apart.162 228

For those who remain at prolonged increased risk for meningococcal disease, ACIP recommends a dose of meningococcal vaccine (MCV4) 3 years after completion of Hib-MenCY (MenHibrix) primary immunization series and every 5 years thereafter.228

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

Each dose is 0.5 mL.224

May be used when immunization against diphtheria, tetanus, pertussis, poliovirus, and Hib is indicated in children 6 weeks through 4 years of age.207 224

Previously unvaccinated: Use a series of 4 doses.224 Give doses at 2, 4, 6, and 15 through 18 months of age.224 Initial dose usually given at 2 months of age, but may be given as early as 6 weeks of age.224

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.207 224

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.224 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.207

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.224

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.105 159 199

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.105 159 199

Previously received complete primary immunization series followed by a booster dose given at ≥12 months of age: No additional doses of Hib vaccine needed.105 159

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.105 156 159 199

Undergoing splenectomy: Give a single dose of Hib vaccine at least 14 days before surgery if previously unvaccinated.159 199 Some experts recommend a dose regardless of prior vaccination against Hib.159

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.159 199

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.134 200

Undergoing splenectomy: Give a single dose of Hib vaccine at least 14 days before surgery if previously unvaccinated.159 200 Some experts recommend a dose regardless of prior vaccination against Hib.159

HIV-infected adults: Hib vaccine not recommended unless patient also has anatomic or functional asplenia.155 159 200

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.159 200

Special Populations

Hepatic Impairment

No specific dosage recommendations.144 174 223 227

Renal Impairment

No specific dosage recommendations.144 174 223 227

Cautions for Haemophilus b Vaccine

Contraindications

  • PRP-OMP (PedvaxHIB): Hypersensitivity to any vaccine component.144

  • 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.174 223

  • Hib-MenCY (MenHibrix): Severe allergic reaction (e.g., anaphylaxis) to the vaccine, any vaccine component, or any vaccine containing meningococcal, Hib, or tetanus antigens.227

  • 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.224 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.224

Warnings/Precautions

Sensitivity Reactions

Hypersensitivity Reactions

Hypersensitivity reactions (e.g., anaphylaxis, anaphylactoid reaction, angioedema, rash, pruritus, urticaria) reported.174 223 227

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.144 174 223 227

Epinephrine and other appropriate agents and equipment should be readily available in case an immediate allergic reaction occurs.144 174 223 227

Latex Sensitivity

Stopper on vial of PRP-OMP (PedvaxHIB) contains natural rubber latex.144

ACIP states that vaccines supplied in vials or syringes containing dry natural rubber or natural rubber latex may be administered to individuals with latex allergies other than anaphylactic allergies (e.g., history of contact allergy to latex gloves), but should not be used in those with a history of severe (anaphylactic) allergy to latex unless benefits of vaccination outweigh risks of a potential allergic reaction.134 Contact-type allergy is the most common type of latex sensitivity.134

Neomycin and/or Polymyxin B Allergy

DTaP-IPV/Hib (Pentacel): Contains trace amounts of neomycin sulfate (≤4 pg) and polymyxin B (≤4 pg).224

Neomycin allergy usually results in delayed-type (cell-mediated) hypersensitivity reactions manifested as contact dermatitis.105 134 ACIP and AAP state that vaccines containing trace amounts of neomycin should not be used in individuals with history of anaphylactic reaction to neomycin, but use may be considered in those with history of delayed-type neomycin hypersensitivity if benefits of vaccination outweigh risks.105 134

Individuals with Altered Immunocompetence

May be administered to individuals immunosuppressed as the result of disease or immunosuppressive therapy.105 134 144 156 174 Consider possibility that the immune response to the vaccine may be reduced in individuals with altered immunocompetence (e.g., HIV infection, immunoglobulin deficiency, stem cell transplant recipients, cancer patients receiving chemotherapy).105 134 144 174 223 227

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;166 response in HIV-infected individuals varies with the degree of immunocompromise.166

Manufacturer of PRP-T (Hiberix) and Hib-MenCY (MenHibrix) states that safety and efficacy not evaluated in immunosuppressed children.223 227

AAP states that 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;105 however, those who are scheduled for splenectomy (e.g., for Hodgkin’s disease, spherocytosis, immune thrombocytopenia, hypersplenism) may benefit from an additional dose of a Hib vaccine given at least 14 days before surgery.105

Although children with HIV infection or IgG2 deficiency or those receiving chemotherapy are at increased risk of invasive Hib disease, it is unclear whether these children would benefit from additional doses of Hib vaccine after completion of the usual age-appropriate vaccination regimen.105

Concomitant Illness

Delay administration in individuals with acute febrile illness until symptoms have subsided.134 ACIP states that minor illness (with or without fever) generally does not preclude vaccination.134

Guillain-Barré Syndrome

If Guillain-Barré syndrome (GBS) occurred within 6 weeks of receipt of a vaccine containing tetanus toxoid, base a decision to administer a dose of a vaccine containing tetanus toxoid, including PRP-T (ActHIB, Hiberix) or Hib-MenCY (MenHibrix), on careful consideration of potential benefits and possible risks.174 223 227

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.134

ACIP states that vaccines may be given IM to such individuals if a clinician familiar with the patient’s bleeding risk determines that the preparation can be administered with reasonable safety.134 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.134 If patient is receiving therapy for hemophilia, administer the IM vaccine shortly after a scheduled dose of such therapy.134

Use of Combination Vaccines

Do not administer vaccine containing Hib antigen with any other Hib-containing vaccine.228

When combination vaccine containing Hib and other antigens ([Hib-MenCY; MenHibrix], [DTaP-IPV/Hib; Pentacel]) is used, consider cautions, precautions, and contraindications associated with each antigen.227

Limitations of Vaccine Effectiveness

May not protect all vaccine recipients against Hib.144 174

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.144

Hib vaccine does not result in protective antibodies immediately following vaccination.144

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).105 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.105

Although PRP-OMP (PedvaxHIB) contains Hib antigen conjugated to outer membrane protein complex (OMPC) of Neisseria meningitidis and antibodies to OMPC have been demonstrated in patients who received the vaccine, the clinical relevance of these antibodies not established.144 PRP-OMP (PedvaxHIB) is not an immunizing agent against meningococcal disease.159

Although PRP-T (Hiberix) and Hib-MenCY (MenHibrix) contain Hib antigen conjugated to tetanus toxoid, these vaccines are not a substitute for routine immunization against tetanus.223 227

Improper Storage and Handling

Improper storage or handling of vaccines may reduce vaccine potency resulting in reduced or inadequate immune responses in vaccinees.134

Inspect all vaccines upon delivery and monitor during storage to ensure that the appropriate temperature is maintained.134 (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.134 144 174

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.134

Specific Populations

Pregnancy

Category C.144 174 223 227 Not labeled by FDA for use in adolescents or adults144 174 223 227 and not usually recommended for this age group.93 105 159

Lactation

Not labeled by FDA for use in adolescents or adults144 174 223 227 and not usually recommended for this age group.93 105 144 159 174 200

ACIP states that, because inactivated vaccines do not multiply within the body, they should not pose any unusual problems for lactating women or their infants.134

Pediatric Use

PRP-OMP (PedvaxHIB): Safety and efficacy not established in infants <6 weeks of age or in children ≥6 years of age.144

PRP-T (ActHIB): Safety and efficacy not established in infants <6 weeks of age.174

PRP-T (Hiberix): Safety and efficacy not established in infants <6 weeks of age or in children and adolescents 5–16 years of age.223

Hib-MenCY (MenHibrix): Safety and efficacy not established in infants <6 weeks of age or in those >18 months of age.227

DTaP-IPV/Hib (Pentacel): Safety and efficacy not established in infants <6 weeks of age or in children 5–16 years of age.224

Do not administer Hib vaccine to infants <6 weeks of age.144 159 Manufacturer of PRP-OMP states that infants who receive the vaccine before 6 weeks of age may develop immunologic tolerance resulting in reduced response to subsequent vaccine doses.144

Apnea reported following IM administration of vaccines in some infants born prematurely.223 224 227 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.223 224 227

Geriatric Use

Not labeled by FDA for use in adults, including geriatric adults;,144 174 223 224 227 not usually recommended for this age group.93 105 159 200

Common Adverse Effects

PRP-OMP (PedvaxHIB) or PRP-T (ActHIB Hiberix): Injection site reactions (pain, erythema, swelling), fever, irritability, lethargy, drowsiness, restlessness.144 174 223

Hib-MenCY (MenHibrix): Injection site reactions (e.g., pain, redness, swelling), systemic effects (e.g., fever, irritability, drowsiness, loss of appetite).227

DTaP-IPV/Hib (Pentacel): Injection site reactions (tenderness, redness, swelling), systemic effects (fever, decreased activity/lethargy, inconsolable crying, fussiness/irritability).224

Interactions for Haemophilus b Vaccine

Other Vaccines

Simultaneous administration with other age-appropriate vaccines, including live virus vaccines, toxoids, or inactivated or recombinant vaccines, during the same health-care visit is not expected to affect immunologic responses or adverse reactions to any of the preparations.105 134 174 Immunization against Hib can be integrated with immunization against diphtheria, tetanus, pertussis, hepatitis B, influenza, pneumococcal disease, poliovirus, rotavirus, measles, mumps, rubella, and varicella.105 159 174 Each parenteral vaccine should be administered using a different syringe and different injection site.105 134

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) can be administered concurrently with DTaP at different sites without a decrease in antibody response or an increase in adverse reactions17 18 111 144 157 174 179 223

PRP-T (Hiberix): Concurrent administration with DTaP-HepB-IPV (Pediarix) and pneumococcal 13-valent conjugate vaccine (PCV13; Prevnar 13) in infants 2, 4, and 6 months of age did not reduce antibody response to DTaP or the other antigens223

Hib-MenCY (MenHibrix): Concurrent administration with DTaP-HepB-IPV (Pediarix) and pneumococcal 7-valent conjugate vaccine (PCV7; (Prevnar; no longer commercially available in US) in infants at 2, 4, and 6 months of age did not reduce antibody response to DTaP or the other antigens227

Hepatitis A vaccine (HepA)

HepA (Havrix, Vaqta): Concomitant administration with Hib vaccine at different site (with or without other concurrent vaccines) resulted in immune responses and adverse effects similar to those reported when the vaccines were administered at different times76 198

Hepatitis B vaccine (HepB)

Hib-MenCY (MenHibrix): Concurrent administration with DTaP-HepB-IPV (Pediarix) and PCV7 (Prevnar) in infants at 2, 4, and 6 months of age did not reduce antibody response to HepB or the other antigens227

HepB and Hib vaccine may be administered simultaneously (using separate syringes and separate injection sites)105 163

Do not prepare extemporaneous combinations of HepB and Hib vaccine163

Immune globulin (immune globulin IM [IGIM], immune globulin IV [IGIV]) 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 vaccine134

Hib vaccine may be given simultaneously with (using different syringes and different injection sites) or at any interval before or after immune globulin or specific hyperimmune globulin134

Immunosuppressive agents (e.g., alkylating agents, antimetabolites, corticosteroids, cytotoxic drugs, radiation)

Potential for decreased antibody response to vaccines134 174 223 227

Vaccines generally should be administered 2 weeks prior to initiation of immunosuppressive therapy or deferred until ≥3 months after such therapy is discontinued and immunocompetence restored79 134

Children ≤5 years of age: If Hib vaccine given within 14 days of starting immunosuppressive therapy or while receiving immunosuppressive therapy, repeat vaccine doses beginning at least 3 months following completion of such therapy;105 159 199 revaccination not needed in those who received Hib vaccine >14 days before chemotherapy105 159

Measles, mumps, and rubella vaccine (MMR)

Simultaneous administration of MMR and Hib vaccine does not interfere with the immune response or increase adverse effects of either vaccine174

Hib-MenCY (MenHibrix): Concurrent administration with MMR, varicella vaccine (VAR), and PCV7 (Prevnar) in infants 12 through 15 months of age did not interfere with immune response to MMR227

MMR and Hib vaccine may be administered simultaneously (using different syringes and different injection sites)105 134 159

Meningococcal vaccine

Hib and meningococcal vaccines may be administered simultaneously (using separate syringes and separate injection sites)105 159

Alternatively, fixed-combination vaccine (Hib-MenCY; MenHibrix) can be used when Hib vaccine is indicated in infant 6 weeks through 18 months of age at increased risk for meningococcal disease162 227 228

Pneumococcal vaccine

Hib-MenCY (MenHibrix): Concurrent administration with PCV7 (Prevnar) and DTaP-HepB-IPV (Pediarix) in infants at 2, 4, and 6 months of age did not reduce antibody response to PCV7 or the other antigens227

Hib vaccine may be administered concurrently with pneumococcal 23-valent polysaccharide vaccine (PPSV23; Pneumovax) at a different site using a separate syringe105 134

Hib-MenCY (MenHibrix): May be administered concurrently with pneumococcal 13-valent conjugate vaccine (PCV13; Prevnar 13) in infants 2 through 18 months of age228

Poliovirus vaccine

PRP-OMP (PedvaxHIB) or PRP-T (ActHIB, Hiberix) may be administered concurrently with IPV using separate syringes and different injection sites;105 159 alternatively, Hib vaccine is commercially available in combination with DTaP and IPV (DTaP-IPV/Hib; Pentacel)224

Rotavirus vaccine

Rotavirus vaccines (Rotarix, RotaTeq) have been administered concomitantly with Hib vaccines without decreased immune response to either vaccine219 221 222

Tests to diagnose Hib disease

May interfere with interpretation of antigen tests used to diagnose Hib disease;88 93 223 227 administration of Hib vaccine results in antigenuria144 174 227

Urine antigen detection may not have diagnostic value in evaluating suspected Hib disease in children within 1–2 weeks following administration of a Hib vaccine88 93 174 223 227

Antigen testing of urine and serum specimens no longer recommended for diagnosis of Hib infection105 166

Vaccines, inactivated or toxoids

Hib vaccine does not affect immune response to diphtheria or tetanus toxoids, pertussis vaccine, HepB vaccine, or pneumococcal vaccine174 195

May be administered concomitantly with or at any interval before or after inactivated vaccines or toxoids routinely used in infants and children134

Varicella vaccine (VAR)

Simultaneous administration of VAR and Hib vaccine does not increase risk of breakthrough varicella infection32 162 227

Hib-MenCY (MenHibrix): Concurrent administration with VAR, MMR, and PCV7 (Prevnar) in infants 12 through 15 months of age did not interfere with immune response to VAR227

VAR and Hib vaccine may be administered simultaneously (using different syringes and different injection sites)134

Stability

Storage

Parenteral

For Injection, for IM Use

PRP-T (ActHIB) and 0.4% sodium chloride diluent: 2–8°C;174 do not freeze.174 Following reconstitution with diluent provided by manufacturer, store at 2–8°C and use within 24 hours.174

PRP-T (Hiberix): 2–8°C; protect from light.223 Store 0.9% sodium chloride diluent supplied by manufacturer at 2–8°C or room temperature <25°C;223 do not freeze;223 discard if freezing occurs.223 Following reconstitution with diluent provided by manufacturer, store at 2–8°C and use within 24 hours; do not freeze.223 Discard reconstituted vaccine if frozen or if not used within 24 hours.223

Hib-MenCY (MenHibrix): 2–8°C;227 protect from light.227 Store 0.9% sodium chloride diluent supplied by manufacturer at 2–25°C; do not freeze; discard if freezing occurs.227 Use immediately after reconstitution.227 Discard reconstituted vaccine if frozen.227

Kit containing DTaP-IPV and ActHIB (DTaP-IPV/Hib; Pentacel): 2–8°C.224 Do not freeze; if freezing occurs, discard vaccine.224 Use immediately after reconstitution.224

Suspension, for IM Use

PRP-OMP (PedvaxHIB): 2–8°C;144 do not freeze.144

Actions

  • Commercially available as monovalent PRP-OMP vaccine (PedvaxHIB)144 and as monovalent PRP-T vaccine (ActHIB, Hiberix).174 223 PRP-T also available as a fixed-combination vaccine containing Hib and meningococcal groups C and Y antigens (Hib-MenCY; MenHibrix)227 and in a kit used to provide a combination vaccine containing diphtheria, tetanus, pertussis, poliovirus, and Hib antigens (DTaP-IPV/Hib; Pentacel).224

  • Hib vaccines contain antigenic capsular polysaccharides extracted from Hib.144 159 174 223 227 Vaccine capsular polysaccharides are derived from polyribosylribitol phosphate (PRP), a major Hib virulence factor.159 166

  • 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)129 144 148 159 160 or tetanus toxoid (PRP-T; ActHIB) (PRP-T; Hiberix) (Hib-MenCY; MenHibrix) (DTaP-IPV/Hib; Pentacel).174 223 227

  • 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.129 159 166 174

  • Hib vaccines stimulate active immunity to Hib infection by inducing production of specific antibodies.38 111 117 144 166 Hib capsular polysaccharide present in the vaccines promotes production of Hib anticapsular antibody; this antibody provides protection against Hib infection.6 7 14 38 55 59 75 117 159 166

  • 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.166 174 223

  • 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;144 95% had protective antibody levels approximately 1 month after a booster dose given at 12–15 months of age.144

  • 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;174 223 98–100% had protective antibody levels 1 month after a booster dose given at 15–23 months of age.174 223

  • If complete vaccination series administered as recommended, regimens that include PRP-OMP or PRP-T are considered equivalent.105 159 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.105

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]).144 174 203 223 227

  • Advise patient and/or patient’s parent or guardian of the risks and benefits of vaccination against Hib.144 174 223 227

  • Importance of receiving the complete primary vaccination series to ensure the highest level of protection against Hib.144 174 227

  • Importance of informing clinicians if any severe or unusual adverse reactions occur.203 223 227 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].203

  • Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant illnesses.144 174 223 227

  • Importance of informing patients and/or patient’s parent or guardian of other important precautionary information.144 174 223 227 (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

Liquid PedvaxHIB

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

Meningococcal Groups C and Y and Haemophilus b Tetanus Toxoid Conjugate Vaccine (Hib-MenCY)

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Parenteral

For injection, for IM use

5 mcg of meningococcal C capsular polysaccharide conjugated to approximately 5 mcg of tetanus toxoid protein carrier, 5 mcg of meningococcal Y capsular polysaccharide conjugated to approximately 6.5 mcg of tetanus toxoid protein carrier, and 2.5 mcg of Haemophilus b capsular polysaccharide conjugated to approximately 6.25 mcg of tetanus toxoid protein carrier per 0.5 mL

MenHibrix

GlaxoSmithKline

AHFS DI Essentials. © Copyright 2018, Selected Revisions December 4, 2017. 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.

References

6. Smith DH, Peter G, Ingram DL et al. Responses of children immunized with the capsular polysaccharide of Haemophilus influenzae, type b. Pediatrics. 1973; 52:637-44. http://www.ncbi.nlm.nih.gov/pubmed/4542777?dopt=AbstractPlus

7. Peltola H, Kayhty H, Sivonen A et al. Haemophilus influenzae type b capsular polysaccharide vaccine in children: a double-blind field study of 100,000 vaccinees 3 months to 5 years of age in Finland. Pediatrics. 1977; 60:730-7. http://www.ncbi.nlm.nih.gov/pubmed/335348?dopt=AbstractPlus

8. Makela PH, Peltola H, Kayhty H et al. Polysaccharide vaccines of group A Neisseria meningitidis and Haemophilus influenzae type b: a field trial in Finland. J Infect Dis. 1977; 136:S43-50. http://www.ncbi.nlm.nih.gov/pubmed/408432?dopt=AbstractPlus

9. Pincus DJ, Morrison D, Andrews C et al. Age-related response to two Haemophilus influenzae type b vaccines. J Pediatr. 1982; 100:197-201. http://www.ncbi.nlm.nih.gov/pubmed/7035637?dopt=AbstractPlus

10. Parke JC Jr, Schneerson R, Robbins JB et al. Interim report of a controlled field trial of immunization with capsular polysaccharides of Haemophilus influenzae type b and group C Neisseria meningitidis in Mecklenburg County, North Carolina (March 1974–March 1976). J Infect Dis. 1977; 136:S51-6.

11. Granoff DM, Boies EG, Munson RS Jr. Immunogenicity of Haemophilus influenzae type b polysaccharide-diphtheria toxoid conjugate vaccine in adults. J Pediatr. 1984; 105:22-7. http://www.ncbi.nlm.nih.gov/pubmed/6610736?dopt=AbstractPlus

13. Anderson P, Peter G, Johnston RB Jr et al. Immunization of humans with polyribophosphate, the capsular antigen of Hemophilus influenzae, type b. J Clin Invest. 1972; 51:39-44. http://www.ncbi.nlm.nih.gov/pubmed/4536615?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=332926&blobtype=pdf

14. Peltola H, Kayhty H, Virtanen M et al. Prevention of Hemophilus influenzae type b bacteremic infections with the capsular polysaccharide vaccine. N Engl J Med. 1984; 310:1561-6. http://www.ncbi.nlm.nih.gov/pubmed/6610125?dopt=AbstractPlus

16. Robbins JB, Parke JC Jr, Schneerson R et al. Quantitative measurement of “natural” and immunization-induced Haemophilus influenzae type b capsular polysaccharide antibodies. Pediatr Res. 1973; 7:103-10. http://www.ncbi.nlm.nih.gov/pubmed/4120458?dopt=AbstractPlus

17. Anderson P, Smith DH, Ingram DL et al. Antibody to polyribophosphate of Haemophilus influenzae type b in infants and children: effect of immunization with polyribophosphate. J Infect Dis. 1977; 136(Suppl):S57-62. http://www.ncbi.nlm.nih.gov/pubmed/302291?dopt=AbstractPlus

18. Hill JC. Summary of a workshop on Haemophilus influenzae type b vaccines. J Infect Dis. 1983; 148:167-75. http://www.ncbi.nlm.nih.gov/pubmed/6604112?dopt=AbstractPlus

20. Kayhty H, Karanko V, Peltola H et al. Serum antibodies after vaccination with Haemophilus influenzae type b capsular polysaccharide and responses to reimmunization: no evidence of immunologic tolerance or memory. Pediatrics. 1984; 74:857-65. http://www.ncbi.nlm.nih.gov/pubmed/6387614?dopt=AbstractPlus

21. Coulehan JL, Hallowell C, Michaels RH et al. Immunogenicity of a Haemophilus influenzae type b vaccine in combination with diphtheria-pertussis-tetanus vaccine in infants. J Infect Dis. 1983; 148:530-4. http://www.ncbi.nlm.nih.gov/pubmed/6311913?dopt=AbstractPlus

22. Lepow ML, Peter G, Glode MP et al. Response of infants to Haemophilus influenzae type b polysaccharide and diphtheria-tetanus-pertussis vaccines in combination. J Infect Dis. 1984; 149:950-5. http://www.ncbi.nlm.nih.gov/pubmed/6376656?dopt=AbstractPlus

23. Dajani AS, Asmar BI, Thirumoorthi MC. Systemic Haemophilus influenzae disease: an overview. J Pediatr. 1979; 94:355-64. http://www.ncbi.nlm.nih.gov/pubmed/370354?dopt=AbstractPlus

24. Schlech WF III, Ward JI, Band JD et al. Bacterial meningitis in the United States, 1978 through 1981: the national bacterial meningitis surveillance study. JAMA. 1985; 253:1749-54. http://www.ncbi.nlm.nih.gov/pubmed/3871869?dopt=AbstractPlus

25. Cochi SL, Broome CV, Hightower AW. Immunization of US children with Haemophilus influenzae type b polysaccharide vaccine: a cost-effectiveness model of strategy assessment. JAMA. 1985; 253:521-9. http://www.ncbi.nlm.nih.gov/pubmed/3918181?dopt=AbstractPlus

27. Granoff DM, Squires JE, Munson RS Jr et al. Siblings of patients with Haemophilus meningitis have impaired anticapsular antibody responses to Haemophilus vaccine. J Pediatr. 1983; 103:185-91. http://www.ncbi.nlm.nih.gov/pubmed/6603504?dopt=AbstractPlus

28. Norden CW, Michaels RH, Melish M. Effect of previous infection on antibody response of children to vaccination with capsular polysaccharide of Haemophilus influenzae type b. J Infect Dis. 1975; 132:69-74. http://www.ncbi.nlm.nih.gov/pubmed/1080178?dopt=AbstractPlus

29. Granoff DM, Pandey JP, Boies E et al. Response to immunization with Haemophilus influenzae type b polysaccharide-pertussis vaccine and risk of Haemophilus meningitis in children with the Km(1) immunoglobulin allotype. J Clin Invest. 1984; 74:1708-14. http://www.ncbi.nlm.nih.gov/pubmed/6334101?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=425349&blobtype=pdf

30. Ambrosino DM, Glode MP, Williams CL et al. Antibody response of infants to Haemophilus influenzae type b capsular polysaccharide combined with Bordetella pertussis. J Infect Dis. 1985; 151:1174. http://www.ncbi.nlm.nih.gov/pubmed/2860187?dopt=AbstractPlus

31. Istre GR, Conner JS, Broome CV et al. Risk factors for primary invasive Haemophilus influenzae disease: increased risk from day care attendance and school-aged household members. J Pediatr. 1985; 106:190-5. http://www.ncbi.nlm.nih.gov/pubmed/3871478?dopt=AbstractPlus

32. Granoff DM, Daum RS. Spread of Haemophilus influenzae type b: recent epidemiologic and therapeutic considerations. J Pediatr. 1980; 97:854-60. http://www.ncbi.nlm.nih.gov/pubmed/7000999?dopt=AbstractPlus

33. Redmond SR, Pichichero ME. Hemophilus influenzae type b disease: an epidemiologic study with special reference to day-care centers. JAMA. 1984; 252:2581-4. http://www.ncbi.nlm.nih.gov/pubmed/6333520?dopt=AbstractPlus

34. Fleming DW, Leibenhaut MH, Albanes D et al. Secondary Haemophilus influenzae type b in day-care facilities: risk factors and prevention. JAMA. 1985; 254:509-14. http://www.ncbi.nlm.nih.gov/pubmed/3874293?dopt=AbstractPlus

35. Ginsburg CM, McCracken GH Jr, Rae S et al. Haemophilus influenzae type b disease: incidence in a day-care center. JAMA. 1977; 238:604-7. http://www.ncbi.nlm.nih.gov/pubmed/301947?dopt=AbstractPlus

37. King SD, Ramlal A, Wynter H et al. Safety and immunogenicity of a new Haemophilus influenzae type b vaccine in infants under one year of age. Lancet. 1981; 2:705-9. http://www.ncbi.nlm.nih.gov/pubmed/6116855?dopt=AbstractPlus

38. Schneerson R, Rodrigues LP, Parke JC Jr et al. Immunity to disease caused by Hemophilus influenzae type b. II: specificity and some biologic characteristics of “natural,” infection-acquired, and immunization-induced antibodies to the capsular polysaccharide of Hemophilus influenzae type b. J Immunol. 1971; 107:1081-89. http://www.ncbi.nlm.nih.gov/pubmed/5315273?dopt=AbstractPlus

39. Siber GR, Schur PH, Aisenberg AC et al. Correlation between serum IgG-2 concentrations and the antibody response to bacterial polysaccharide antigens. N Engl J Med. 1980; 303:178-82. http://www.ncbi.nlm.nih.gov/pubmed/6966763?dopt=AbstractPlus

40. Ward JI, Margolis HS, Lum MKW et al. Haemophilus influenzae disease in Alaskan Eskimos: characteristics of a population with an unusual incidence of invasive disease. Lancet. 1981; 1:1281-4. http://www.ncbi.nlm.nih.gov/pubmed/6112604?dopt=AbstractPlus

42. Centers for Disease Control and Prevention. Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2007; 56(RR-4):1-40. http://www.cdc.gov/mmwr/PDF/rr/rr5604.pdf

43. Centers for Disease Control and Prevention. Simultaneous administration of varicella vaccine and other recommended childhood vaccines—United States, 1995-1999. MMWR Morb Mortal Wkly Rep. 2001; 50:1058-61. http://www.ncbi.nlm.nih.gov/pubmed/11808928?dopt=AbstractPlus

45. Coulehan JL, Michaels RH, Williams KE et al. Bacterial meningitis in Navajo Indians. Public Health Rep. 1976; 91:464-68. http://www.ncbi.nlm.nih.gov/pubmed/824672?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=1440563&blobtype=pdf

47. Band JD, Fraser DW, Ajello G et al. Prevention of Hemophilus influenzae type b disease. JAMA. 1984; 251:2381-6. http://www.ncbi.nlm.nih.gov/pubmed/6368889?dopt=AbstractPlus

48. Osterholm MT, Murphy TV. Does rifampin prophylaxis prevent disease caused by Hemophilus influenzae type b? JAMA. 1984; 251:2408-9. Editorial.

50. Sell SHW, Merrill RE, Doyne EO et al. Long-term sequelae of Hemophilus influenzae meningitis. Pediatrics. 1972; 49:206-11. http://www.ncbi.nlm.nih.gov/pubmed/5059526?dopt=AbstractPlus

53. Pichichero ME, Sommerfelt AE, Steinhoff MC et al. Breast milk antibody to the capsular polysaccharide of Haemophilus influenzae type b. J Infect Dis. 1980; 142:694-8. http://www.ncbi.nlm.nih.gov/pubmed/6970233?dopt=AbstractPlus

55. Casto DT, Edwards DL. Preventing Haemophilus influenzae type b disease. Clin Pharm. 1985; 4:637-48. http://www.ncbi.nlm.nih.gov/pubmed/3907936?dopt=AbstractPlus

59. Granoff DM, Cates KL. Haemophilus influenzae type b polysaccharide vaccines. J Pediatr. 1985; 107:330-6. http://www.ncbi.nlm.nih.gov/pubmed/3897497?dopt=AbstractPlus

61. Anderson P, Pichichero ME, Insel RA. Immunization of 2-month-old infants with protein-coupled oligosaccharides derived from the capsule of Haemophilus influenzae type b. J Pediatr. 1985; 107:346-51. http://www.ncbi.nlm.nih.gov/pubmed/3875705?dopt=AbstractPlus

62. Anderson P, Pichichero ME, Insel RA. Immunogens consisting of oligosaccharides from the capsule of Haemophilus influenzae type b coupled to diphtheria toxoid or the toxin protein CRM197. J Clin Invest. 1985; 76:52-9. http://www.ncbi.nlm.nih.gov/pubmed/3874882?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=423703&blobtype=pdf

63. Anderson P, Pichichero ME, Insel RA et al. Capsular antigens noncovalently or covalently associated with protein as vaccines to Haemophilus influenzae type b: comparison in 2-year-old children. J Infect Dis. 1985; 152:634-6. http://www.ncbi.nlm.nih.gov/pubmed/3875668?dopt=AbstractPlus

64. Anderson P, Insel RA, Smith DH et al. A polysaccharide-protein complex from Haemophilus influenzae type b: III. Vaccine trial in human adults. J Infect Dis. 1981; 144:530-8. http://www.ncbi.nlm.nih.gov/pubmed/7035578?dopt=AbstractPlus

66. Peltola H, Virtanen M, Makela PH. Efficacy of Haemophilus influenzae type b capsular polysaccharide vaccine on the incidence of epiglottitis and meningitis. Pathol Biol. 1983; 31:141-3. http://www.ncbi.nlm.nih.gov/pubmed/6341944?dopt=AbstractPlus

67. Ambrosino DM, Schiffman G, Gotschlich EC et al. Correlation between G2m(n) immunoglobulin allotype and human antibody response and susceptibility to polysaccharide encapsulated bacteria. J Clin Invest. 1985; 75:1935-42. http://www.ncbi.nlm.nih.gov/pubmed/3924957?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=425551&blobtype=pdf

68. Pichichero ME, Insel RA. Mucosal antibody response to parenteral vaccination with Haemophilus influenzae type b capsule. J Allergy Clin Immunol. 1983; 72:481-6. http://www.ncbi.nlm.nih.gov/pubmed/6605372?dopt=AbstractPlus

70. Sell SH. Long term sequelae of bacterial meningitis in children. Pediatr Infect Dis. 1983; 2:90-3. http://www.ncbi.nlm.nih.gov/pubmed/6856496?dopt=AbstractPlus

72. O’Reilly RJ, Anderson P, Ingram DL et al. Circulating polyribophosphate in Haemophilus influenzae, type b meningitis: correlation with clinical course and antibody response. J Clin Invest. 1975; 56:1012-22. http://www.ncbi.nlm.nih.gov/pubmed/1099117?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=301957&blobtype=pdf

73. Johnston RB Jr, Anderson P, Rosen FS et al. Characterization of human antibody to polyribophosphate, the capsular antigen of Haemophilus influenzae, type b. Clin Immunol Immunopathol. 1973; 1:234-40. http://www.ncbi.nlm.nih.gov/pubmed/4543490?dopt=AbstractPlus

74. Kayhty H, Schneerson R, Sutton A. Class-specific antibody response to Haemophilus influenzae type b capsular polysaccharide vaccine. J Infect Dis. 1983; 148:767. http://www.ncbi.nlm.nih.gov/pubmed/6605394?dopt=AbstractPlus

75. Alexander HE, Heidelberger M, Leidy G. The protective or curative element in type b H. influenzae rabbit serum. Yale J Biol Med. 1944; 16:425-34. http://www.ncbi.nlm.nih.gov/pubmed/21434159?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=2601607&blobtype=pdf

76. GlaxoSmithKline. Havrix (hepatitis A vaccine) suspension for intramuscular injection prescribing information. Research Triangle Park, NC; 2012 Jul.

79. Siber GR, Gorham C, Martin P et al. Antibody response to pretreatment immunization and post-treatment boosting with bacterial polysaccharide vaccines in patients with Hodgkin’s disease. Ann Intern Med. 1986; 104:467-75. http://www.ncbi.nlm.nih.gov/pubmed/3082268?dopt=AbstractPlus

83. Cochi SL, Fleming DW, Hightower AW et al. Primary invasive Haemophilus influenzae type b disease: a population-based assessment of risk factors. J Pediatr. 1986; 108:887-96. http://www.ncbi.nlm.nih.gov/pubmed/3712153?dopt=AbstractPlus

84. Granoff DM, McKinney T, Boies EG et al. Haemophilus influenzae type b disease in an Amish population: studies of the effects of genetic factors, immunization, and rifampin prophylaxis on the course of an outbreak. Pediatrics. 1986; 77:289-95. http://www.ncbi.nlm.nih.gov/pubmed/3485275?dopt=AbstractPlus

85. Ward JI, Lum MKW, Hall DB et al. Invasive Haemophilus influenzae type b disease in Alaska: background epidemiology for a vaccine efficacy trial. J Infect Dis. 1986; 153:17-26. http://www.ncbi.nlm.nih.gov/pubmed/3484505?dopt=AbstractPlus

87. Gulig PA, McCracken GH, Frisch CF et al. Antibody response of infants to cell surface-exposed outer membrane proteins of Haemophilus influenzae type b after systemic Haemophilus disease. Infect Immun. 1982; 37:82-8. http://www.ncbi.nlm.nih.gov/pubmed/6980838?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=347494&blobtype=pdf

88. Spinola SM, Sheaffer CI, Gilligan PH. Antigenuria after Haemophilus influenzae type b polysaccharide vaccination. J Pediatr. 1986; 108:247-9. http://www.ncbi.nlm.nih.gov/pubmed/3484781?dopt=AbstractPlus

90. Tuley RJ (Mead Johnson Nutritional Division, Evansville, IN): Personal communication; 1986 Jun 30.

93. Reviewers’ comments (personal observations); 1986 Jun.

94. Kabat EA, Bezer AE. The effect of variation in molecular weight on the antigenicity of dextran in man. Arch Biochem Biophys. 1958; 78:306-18. http://www.ncbi.nlm.nih.gov/pubmed/13618012?dopt=AbstractPlus

95. Gotschlich EC, Rey M, Triau R et al. Quantitative determination of the human immune response to immunization with meningococcal vaccines. J Clin Invest. 1972; 51:89-96. http://www.ncbi.nlm.nih.gov/pubmed/4621363?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=332933&blobtype=pdf

96. Insel RA, Amstey M, Pichichero ME. Postimmunization antibody to the Haemophilus influenzae type b capsule in breast milk. J Infect Dis. 1985; 152:407-8. http://www.ncbi.nlm.nih.gov/pubmed/3875665?dopt=AbstractPlus

103. Amstey MS, Insel R, Munoz J et al. Fetal-neonatal passive immunization against Haemophilus influenzae, type b. Am J Obstet Gynecol. 1985; 153:607-11. http://www.ncbi.nlm.nih.gov/pubmed/3877464?dopt=AbstractPlus

105. American Academy of Pediatrics. Red Book: 2015 Report of the Committee on Infectious Diseases. 30th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2015.

106. Einhorn MS, Weinberg GA, Anderson EL et al. Immunogenicity in infants of Haemophilus influenzae type b polysaccharide in a conjugate vaccine with Neisseria meningitidis outer-membrane protein. Lancet. 1986; 2:299-302. http://www.ncbi.nlm.nih.gov/pubmed/2874327?dopt=AbstractPlus

109. Granoff DM, Shackelford PG, Pandey JP et al. Antibody responses to Haemophilus influenzae type b polysaccharide vaccine in relation to Km(1) and G2m(23) immunoglobulin allotypes. J Infect Dis. 1986;154:257-64.

110. Granoff DM, Shackelford PG, Suarez BK et al. Hemophilus influenzae type b disease in children vaccinated with type b polysaccharide vaccine. N Engl J Med. 1986; 315:1584-90. http://www.ncbi.nlm.nih.gov/pubmed/3491315?dopt=AbstractPlus

111. Kayhty H, EsKola J, Peltola H et al. Immunogenicity in infants of a vaccine composed of Haemophilus influenzae type b capsular polysaccharide mixed with DPT or conjugated to diphtheria toxoid. J Infect Dis. 1987; 155:100-6. http://www.ncbi.nlm.nih.gov/pubmed/3491858?dopt=AbstractPlus

117. Hendley JO, Wenzel JG, Ashe KM et al. Immunogenicity of Haemophilus influenzae type b capsular polysaccharide vaccines in 18-month-old infants. Pediatrics. 1987; 80:351-4. http://www.ncbi.nlm.nih.gov/pubmed/3306597?dopt=AbstractPlus

128. Price C (Praxis Biologics, Rochester, NY): Personal communication; 1989 Mar 15.

129. Weinberg GA, Granoff DM. Polysaccharide-protein conjugate vaccines for the prevention of Haemophilus influenzae type b disease. J Pediatr. 1988; 113:621-31. http://www.ncbi.nlm.nih.gov/pubmed/3050001?dopt=AbstractPlus

134. National Center for Immunization and Respiratory Diseases. General recommendations on immunization --- recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2011; 60:1-64.

137. Mast EE, Margolis HS, Fiore AE et al. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP) part 1: immunization of infants, children, and adolescents. MMWR Recomm Rep. 2005; 54(RR-16):1-31. http://www.ncbi.nlm.nih.gov/pubmed/16371945?dopt=AbstractPlus http://www.cdc.gov/mmwr/PDF/rr/rr5416.pdf

144. Merck. Liquid PedvaxHIB Haemophilus b conjugate vaccine (meningococcal protein conjugate) prescribing information. Whitehouse Station, NJ; 2010 Dec.

148. Sood SK, Daum RS. Disease caused by Haemophilus influenzae type b in the immediate period after homologous immunization: immunologic investigation. Pediatrics. 1990; 85(Suppl 4 pt2):698-704. http://www.ncbi.nlm.nih.gov/pubmed/2107522?dopt=AbstractPlus

155. Panel on Opportunistic Infections in HIV-infected Adults and Adolescents. Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America (July 6, 2017). Updates may be available at HHS AIDS Information (AIDSinfo) website. http://www.aidsinfo.nih.gov

156. Panel on Opportunistic Infection in HIV-exposed and HIV-infected children, US Department of Health and Human Services (HHS). Guidelines for the prevention and treatment of opportunistic infections in HIV-exposed and HIV-infected children: recommendations from the National Institutes of Health, Centers for Disease Control and Prevention, the HIV Medicine Association of the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the American Academy of Pediatrics (December 15, 2016). Updates may be available at HHS AIDS Information (AIDSinfo) website. http://www.aidsinfo.nih.gov

157. Kayhty H, Peltola H, Eskola J et al. Immunogenicity of Haemophilus influenzae oligosaccharide-protein and polysaccharide-protein conjugate vaccination of children at 4, 6, and 14 months of age. Pediatrics. 1989; 84:995-9. http://www.ncbi.nlm.nih.gov/pubmed/2587155?dopt=AbstractPlus

159. Briere EC, Rubin L, Moro PL et al. Prevention and control of haemophilus influenzae type b disease: recommendations of the advisory committee on immunization practices (ACIP). MMWR Recomm Rep. 2014; 63(RR-01):1-14. http://www.ncbi.nlm.nih.gov/pubmed/24572654?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=4047970&blobtype=pdf

160. Holmes SJ, Murphy TV, Anderson RS et al. Immunogenicity of four Haemophilus influenzae type b conjugate vaccines in 17- to 19-month-old children. J Pediatr. 1991; 118:364-71. http://www.ncbi.nlm.nih.gov/pubmed/1999775?dopt=AbstractPlus

161. Turner RB, Cimino CO, Sullivan BJ. Prospective comparison of the immune response of infants to three Haemophilus influenzae type b vaccines. Pediatr Infect Dis J. 1991; 10:108-12. http://www.ncbi.nlm.nih.gov/pubmed/2062600?dopt=AbstractPlus

162. Centers for Disease Control and Prevention (CDC). Infant meningococcal vaccination: Advisory Committee on Immunization Practices (ACIP) recommendations and rationale. MMWR Morb Mortal Wkly Rep. 2013; 62:52-4. http://www.ncbi.nlm.nih.gov/pubmed/23344698?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=4604873&blobtype=pdf

163. American Academy of Pediatrics Committee on Infectious Diseases. Universal hepatitis B immunization. Pediatrics. 1992; 89:795-800. http://www.ncbi.nlm.nih.gov/pubmed/1557285?dopt=AbstractPlus

166. Centers for Disease Control and Prevention. Epidemiology and prevention of vaccine-preventable diseases. 13th ed. Washington DC: Public Health Foundation; 2015. Available at CDC website. http://www.cdc.gov/vaccines/pubs/pinkbook/index.html

174. Sanofi Pasteur. ActHIB (Haemophilus b conjugate vaccine [tetanus toxoid conjugate]) solution for intramuscular injection prescribing information. Swiftwater, PA; 2016 Apr.

176. King GE, Markowitz LE, Heath J et al. Antibody response to measles-mumps-rubella vaccine of children with mild illness at the time of vaccination. JAMA. 1996; 275:704-7. http://www.ncbi.nlm.nih.gov/pubmed/8594268?dopt=AbstractPlus

177. Dennehy PH, Saracen CL, Peter G. Seroconversion rates to combined measles-mumps-rubella-varicella vaccine of children with upper respiratory tract infection. Pediatrics. 1994; 94:514-6. http://www.ncbi.nlm.nih.gov/pubmed/7936862?dopt=AbstractPlus

178. Ratnam S, West R, Gadag V. Measles and rubella antibody response after measles- mumps-rubella vaccination in children with afebrile upper respiratory tract infection. J Pediatr. 1995; 127:432-4. http://www.ncbi.nlm.nih.gov/pubmed/7658276?dopt=AbstractPlus

179. Centers for Disease Control and Prevention. FDA approval of haemophilus b conjugate vaccine combined with an acellular pertussis vaccine. MMWR Morb Mortal Wkly Rep. 1996; 45:993-5. http://www.ncbi.nlm.nih.gov/pubmed/9005308?dopt=AbstractPlus

190. Food and Drug Administration. Natural rubber-containing medical devices; user labeling. 21 CFR Part 801. Final rule. (Docket No. 96N-0119) Fed Regist. 1997; 62:51021-30.

192. Food and Drug Administration. Amended economic impact analysis of final rule requiring use of labeling on natural rubber containing devices; 21 CFR Part 801. Final rule. (Docket no. 96N-0119). Fed Regist. 1998; 63:50660-704. http://www.ncbi.nlm.nih.gov/pubmed/10185803?dopt=AbstractPlus

193. Food and Drug Administration. Latex-containing devices; user labeling. 21 CFR Part 801. Proposed rule. (Docket No. 96N-0119). Fed Regist. 1996; 61:32617-21.

195. Wyeth. Prevnar 13 (pneumococcal 13-valent conjugate vaccine [diphtheria CRM197 protein]) suspension for intramuscular injection prescribing information. Philadelphia, PA; 2013 Jan.

198. Merck & Co. Vaqta (hepatitis A vaccine inactivated) suspension for intramuscular injection prescribing information. Whitehouse Station, NJ; 201 Nov.

199. Centers for Disease Control and Prevention. Advisory Committee on Immunization Practices (ACIP) recommended immunization schedules for persons aged 0 through 18 years–United States, 2017. Updates may be available at CDC website. http://www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html

200. Centers for Disease Control and Prevention. Advisory Committee on Immunization Practices (ACIP) recommended adult immunization schedule–United States, 2017. Updates may be available at CDC website. http://www.cdc.gov/vaccines/schedules/hcp/index.html

203. Centers for Disease Control and Prevention. Haemophilus influenzae type b (Hib) vaccine information statement. 2015 Apr 2. From CDC website. http://www.cdc.gov/vaccines/pubs/vis/default.htm

207. . Licensure of a diphtheria and tetanus toxoids and acellular pertussis adsorbed, inactivated poliovirus, and haemophilus B conjugate vaccine and guidance for use in infants and children. MMWR Morb Mortal Wkly Rep. 2008; 57:1079-80. http://www.ncbi.nlm.nih.gov/pubmed/18830213?dopt=AbstractPlus

208. Lippert WC, Wall EJ. Optimal intramuscular needle-penetration depth. Pediatrics. 2008; 122:e556-63. http://www.ncbi.nlm.nih.gov/pubmed/18694903?dopt=AbstractPlus

209. Groswasser J, Kahn A, Bouche B et al. Needle length and injection technique for efficient intramuscular vaccine delivery in infants and children evaluated through an ultrasonographic determination of subcutaneous and muscle layer thickness. Pediatrics. 1997; 100:400-3. http://www.ncbi.nlm.nih.gov/pubmed/9282716?dopt=AbstractPlus

219. Dennehy PH, Bertrand HR, Silas PE et al. Coadministration of RIX4414 oral human rotavirus vaccine does not impact the immune response to antigens contained in routine infant vaccines in the United States. Pediatrics. 2008; 122:e1062-6. http://www.ncbi.nlm.nih.gov/pubmed/18977955?dopt=AbstractPlus

220. Centers for Disease Control and Prevention (CDC). Continued shortage of Haemophilus influenzae Type b (Hib) conjugate vaccines and potential implications for Hib surveillance--United States, 2008. MMWR Morb Mortal Wkly Rep. 2008; 57:1252-5. http://www.ncbi.nlm.nih.gov/pubmed/19023262?dopt=AbstractPlus

221. Merck & Co. RotaTeq (rotavirus vaccine, live, oral, pentavalent) oral solution prescribing information. Whitehouse Station, NJ; 2017 Feb.

222. GlaxoSmithKline. Rotarix (rotavirus vaccine, live, oral) oral suspension prescribing information. Research Triangle Park, NC; 2016 Apr.

223. GlaxoSmithKline. Hiberix (Haemophilus b conjugate vaccine [tetanus toxoid conjugate]) solution for intramuscular injection prescribing information. Research Triangle Park, NC; 2016 Jan.

224. Sanofi Pasteur. Pentacel (diphtheria and tetanus toxoids and acellular pertussis adsorbed, inactivated poliovirus and Haemophilus b conjugate [tetanus toxoid conjugate] vaccine) suspension for intramuscular injection prescribing information. Swiftwater, PA; 2013 Oct.

225. Centers for Disease Control and Prevention (CDC). Licensure of a Haemophilus influenzae type b (Hib) vaccine (Hiberix) and updated recommendations for use of Hib vaccine. MMWR Morb Mortal Wkly Rep. 2009; 58:1008-9. http://www.ncbi.nlm.nih.gov/pubmed/19763078?dopt=AbstractPlus

227. GlaxoSmithKline. MenHibrix (Meningococcal groups C and Y and Haemophilus b tetanus toxoid conjugate vaccine) solution for intramuscular injection prescribing information. Research Triangle Park, NC;2013 Nov.

228. Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, CDC. Prevention and control of meningococcal disease. MMWR Recomm Rep. 2013; 62(RR-2):1-22.

Hide