Vaccines and Preventable Diseases:

Hib Vaccine - Q&A for Providers about the Return to the Hib "Booster" Dose

1. What Hib-containing vaccine products are currently available in the US?

There are 3 Hib-containing vaccine products currently available for all children. They are all PRP-T products; that is, polyribosyl-ribitol-phosphate [PRP] conjugated to inactivated tetanus toxoid (T). There is one other monovalent Hib product (PedvaxHIB; PRP-OMB–containing Hib vaccine) that is currently available for use only in certain populations.*

Vaccine	Trade Name	Indication	Manufacturer
Hib	ActHIB	Primary and booster dose	sanofi pasteur
DTaP-IPV/Hib	Pentacel	Primary and booster dose	sanofi pasteur
Hib	Hiberix	Booster dose	GSK
Hib	PedvaxHIB *	Primary and booster dose	Merck

*Providers who serve predominantly American Indian/Alaska Native (AI/AN) children living in AI/AN communities should continue to stock and use PedvaxHIB and vaccinate according to the routinely recommended schedule. This product is available from the VFC Pediatric Vaccine Stockpile, through state immunization programs.

2. Are the various Hib-containing products interchangeable?

Yes, all of the Hib-containing products are interchangeable except for GSK’s Hib monovalent product (Hiberix) which is only licensed for the booster dose in the US. Hiberix can be used as the booster dose for any of the available Hib-containing vaccines.

3. Can the Hib "booster" dose refer to either the third or the fourth dose of Hib-containing vaccine?

Yes. If for a given child a provider has used a sanofi product (either monovalent ActHib or combination vaccine Pentacel) for any of the doses in the series at the recommended ages, a total of 4 doses is needed (3 primary doses in the first year of life and 1 booster dose in the second year of life). If for a given child the provider has restricted use to Merck’s monovalent Hib product (PedvaxHib) or the combination product HepB-Hib (Comvax) for age appropriate doses, the total number of doses in this series is three (2 primary doses and 1 booster dose). If a child has fallen behind in the series of Hib vaccine, fewer doses are required to complete the series regardless of the previous brand used. See Table 1 catch up.

4. If there is a child who has received less than a full 2 or 3-dose primary Hib series, can GSK’s monovalent Hib vaccine (Hiberix) still be used for the booster dose?

Yes, as long as the child has received at least one prior dose of Hib-containing vaccine, and the Hiberix dose is the last dose of the child’s Hib series. For children older than 15 months who have received no prior doses of Hib-containing vaccine, Hiberix is not indicated for use. However, if Hiberix is inadvertently administered as the only dose for a child 15 months or older, the dose does not need to be repeated.

5. If a Hib-containing combination vaccine is the only product available to a practice to bring a child up-to-date for Hib, but the child is already up-to-date for the other vaccines in the combination, is it safe to administer the combination vaccine?

Providers should plan ahead so that adequate supplies of the appropriate products are available at the time of the child’s visit and that extra-immunization is minimized. However, if Pentacel (that is, the sanofi combination product DTaP-IPV/Hib) is the only Hib-containing vaccine available, this product should be used to complete the Hib vaccination series, even if the child has already received all the necessary doses of DTaP and IPV. Studies suggest that extra DTaP can lead to an increase in local reactogenicity (e.g., sore arm).

6. Is there any guidance about completing the HepB vaccine series in settings where Pentacel (DTaP-IPV/Hib) is being used for the Hib series?

Providers who are using Pentacel for the Hib series should use monovalent HepB vaccine to complete the HepB vaccine series. This will minimize extra-immunization. Providers will need to plan ahead to ensure they have adequate doses of HepB vaccine on hand. See guidance about completing the HepB vaccine series, taking into account the mother’s hepatitis B surface antigen status (HBsAg) and vaccine availability (26 KB, 2 pages).

7. If Hiberix is inadvertently given as some or all of the doses of the primary series, do the doses need to be repeated?

No

8. Does a Vaccine Information Statement (VIS) for DTaP and IPV need to be given along with Hib if the combination Hib-containing product (DTaP-IPV/HIB) is admininistered?

Yes, a VIS for each antigen must be given before a vaccine is administered. A separate VIS can be given for each individual antigen or a multi-vaccine VIS can be used. The multi-vaccine VIS was developed to simplify the process and is an optional alternative to existing individual VISs. It can be given anytime two or more vaccines are given together to infants or children. Please see Multi-Vaccine VIS Frequently Asked Questions.

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