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Health Care Agency
Public Health Services
Epidemiology & Assessment
(714) 834-8180
Fax: (714) 834-8196
Email: EPI@ochca.com
Health Referral Line
(800) 564-8448
(800) 801-7100 TDD
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Last updated
4-9-09
For updates on Hib
disease and the Hib vaccine shortage, see:
For information
about the recent increase in Hib disease in Minnesota in 2008, see:
For more
information about Hib disease in general, see:
Guidelines for prevention of transmission
FROM: Red Book: 2006 Report of the Committee on Infectious Diseases. 27th ed. Elk Grove Village, IL: American Academy of Pediatrics, 2006: 310-318.
Case
- Report the case to Epidemiology & Assessment within one (1) working day
Phone:
(714) 834-8180
Fax: (714) 834-8196
- Place case in respiratory (droplet) isolation until 24 hours after start of appropriate antimicrobial therapy
- If case was treated with a regimen other than cefotaxime or ceftriaxone (eg treated with meropenem, ampicillin, or chloramphenicol), give rifampin (see dosage below) to case just before discharge from the hospital to eradicate Hib colonization, IF;
- If the case received treatment with ceftriaxone or cefotaxime, rifampin is NOT necessary
Household contacts
For this situation, household contacts are defined as people residing with the case or who spent 4 or more hours with the case for at least 5 of the 7 days preceding days preceding the day of hospital admission for the case.
-
a child under age 12 months who has not received the primary series
- a child younger than 4 years of age who is unimmunized or incompletely immunized* (defined below)
- an immunocompromised child (regardless of immunization status)
Prophylaxis should be initiated as soon as possible. If household contacts are unable to fill prescriptions or you are unable to contact them, refer contacts to Epidemiology & Assessment at (714) 834-8180 as soon as possible.
- Vaccinate children who are unimmunized or incompletely immunized (defined below) for Hib
- Inform household that any exposed child who develops a febrile illness should be evaluated by a physician as soon as possible.
*Complete immunization is defined as:
-
at
least 1 dose of conjugate vaccine at 15 months of age or
older
-
2 doses
between 12 and 14 months of age
-
a 2- or
3- dose primary series when younger than 12 months with
a booster dose at 12 months of age or older. Note: the
primary series for Hib is 2 doses for the Merck Hib-containing
vaccines [PedvaxHIB® (monovalent Hib vaccine) and COMVAX® (Hib/hepatitis B)] and 3 doses for the Sanofi Pasteur
Hib-containing vaccines [ActHIB®
(monovalent Hib vaccine), Pentacel® (DTaP/IPV/Hib) and TriHIBit®
(DTaP/Hib)]. Primary series for Hib started with the
Merck vaccines and completed with the Sanofi Pasteur
vaccines should include 3 doses.
Day care, nursery school, or child care center contacts
- Chemoprophylaxis with rifampin (see below for dosage) should be considered for all day care, nursery school, or child care center attendees and child care providers when 2 or more cases of invasive disease have occurred within 60 days and unimmunized or incompletely immunized* (see above) children attend the child care facility. Please refer any child care exposures as soon as possible to Epidemiology & Assessment at 714-834-8180 for follow-up
Rifampin prophylaxis dosage**
- Infant less than 1 month old: 10 mg/kg once daily for 4 days
- All others: 20 mg/kg once daily to maximum of 600 mg daily for 4 days
** Rifampin is not recommended for pregnant women or persons with liver disease. Instruct patients that rifampin can stain soft contact lenses, turn urine orange, and interfere with oral contraceptives during current cycle.
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