Vaccine 31 (2013) 61686169

Contents lists available at ScienceDirect

Vaccine
journal homepage: www.elsevier.com/locate/vaccine

Meeting report

Haemophilus inuenzae type b (Hib) Vaccination WHO position paper: July 2013-Recommendations

a r t i c l e i n f o a b s t r a c t

Keywords: This article presents the World Health Organizations (WHO) evidence and recommendations for the use
Haemophilus inuenzae type b of Haemophilus inuenzae type b vaccination from the WHO position paper on H. inuenzae type b (Hib)
Hib Vaccination July 2013 recently published in the Weekly Epidemiological Record [1]. This position paper
Vaccines
summarizes the WHO position on the inclusion of Hib vaccines in all national immunization programmes,
Position paper
recent developments in the eld and the potential of different Hib immunization schedules to further
Recommendations
reduce morbidity and mortality. The current document replaces the position paper on the use of Hib
vaccines published in 2006 [2].
Footnotes to this paper provide a number of core references. In accordance with its mandate to provide
guidance to Member States on health policy matters, WHO issues a series of regularly updated position
papers on vaccines and combinations of vaccines against diseases that have an international public health
impact. These papers are concerned primarily with the use of vaccines in large-scale immunization pro-
grammes; they summarize essential background information on diseases and vaccines, and conclude with
WHOs current position on the use of vaccines in the global context. This paper reects the recommen-
dations of WHOs Strategic Advisory Group of Experts (SAGE) on immunization. These recommendations
were discussed by SAGE at its April 2013 meeting. Evidence presented at the meeting can be accessed at
http://www.who.int/immunization/sage/previous/en/index.html.

In view of their demonstrated safety and efcacy, WHO recom-
mends the inclusion of conjugate Hib vaccines in all infant
immunization programmes. Vaccination remains the only effec-
tive means of preventing Hib disease and is becoming increasingly
important as Hib antibiotic resistance grows.
The use of Hib vaccines should be part of a comprehensive strat-
egy to control pneumonia including exclusive breastfeeding for 6
months, hand washing with soap, improved water supply and san-
itation, reduction of household air pollution, and improved case
management at community and health facility levels [3].
WHO recommends that any one of the following Hib immuniza-
tion schedules may be followed: 3 primary doses without a booster
(3p + 0); 2 primary doses plus a booster (2p + 1); and 3 primary
doses with a booster (3p + 1).
In countries where the peak burden of severe Hib disease occurs
in young infants, providing 3 doses of vaccine early in life may
confer a greater benet.
In some settings (e.g. where the greatest disease morbidity and
mortality occur later, or where rate reductions of disease are not
fully sustained after the routine use of Hib vaccine), it may be
advantageous to give a booster dose by following either a 2p + 1
or 3p + 1 schedule.
The age at rst dose and the number of primary doses should
be set after consideration of the local epidemiology, vaccine pre-
sentation (Hib conjugate mono-valent vaccine or Hib conjugate
vaccine in combination with other antigens) and how this ts into
the overall routine immunization schedule. Because serious Hib
disease occurs most commonly in children aged between 4 and
18 months, immunization should start from 6 weeks of age, or as
early as possible thereafter.
The interval between doses should be at least 4 weeks if 3 pri-
mary doses are given, and at least 8 weeks if 2 primary doses are
given. When given, the booster dose should be administered at least
6 months after completion of the primary series.
If the vaccination course has been interrupted, the schedule
should be resumed without repeating the previous dose. Children
who start vaccination late, but are aged <12 months, should com-
plete the vaccination schedule (e.g. have 3 primary doses or 2
primary doses plus a booster). When a rst dose is given to a child
>12 months of age, only one dose is recommended. Hib vaccine is
not required for healthy children after 5 years of age.
The Hib conjugate vaccine is contraindicated in people with
known allergies to any component of the vaccine. There are no other
known contraindications or precautions.
It is important to establish and maintain high quality surveil-
lance for Hib disease, in order to monitor the impact and changes
in disease epidemiology over time. Surveillance should cover not
only the age group targeted for immunization but also older age
groups in order to document the impact of vaccination on age pat-
terns of disease and identify the need for, and timing of, booster
dose.
Some countries have observed increases in disease incidence
several years after vaccine introduction, but these increases have
been very small relative to the overall Hib disease reductions fol-
lowing vaccine introduction. Increases in the incidence of Hib cases
should be investigated promptly and include documentation of the

0264-410X/$ see front matter

http://dx.doi.org/10.1016/j.vaccine.2013.10.045
 Meeting report / Vaccine 31 (2013) 61686169 6169

age, Hib vaccination status, time since last Hib vaccine dose, and WHO*
HIV status of the affected individuals. World Health Organization Immunization, Vaccines
and Biologicals, 20 via Appia, 1211-CH Geneva,
References Switzerland
Tel.: +41 22 791 4527.
[1] Haemophilus inuenzae type b (Hib) Vaccination Position Paper July 2013.
Weekly Epidemiological Record 2013;88(39):41328.
[2] WHO Position Paper on Haemophilus inuenzae type b conjugate vaccines. 30 September 2013
Weekly Epidemiological Record 2006;81(47):44552.
[3] Ending preventable child deaths from pneumonia and diarrhoea by 2025: the 9 October 2013
integrated global action plan for pneumonia and diarrhoea. Geneva, World
Health Organization/The United Nations Childrens Fund (UNICEF), Available
Available online 21 October 2013
at http://www.who.int/maternal child adolescent/news events/news/2013/
gappd launch/en/; 2013 [accessed 09.13].
Reproduced with permission of the copyright owner. Further reproduction prohibited without
permission.