Southwest District Health, providing health care services to SW Idaho

PUBLIC HEALTH ADVISORY
CDC Warns to Intensify Efforts to Protect Against Meningitis

Childhoon Immunization against Menengitis

The Centers for Disease Control and Prevention (CDC) stresses how important it is for parents and health care providers to be vigilant in ensuring that all young children are appropriately vaccinated with the 3 dose primary series of Hib (Haemophilus influenzae type b) vaccine to protect against Meningococcal disease, or what is commonly referred to as meningitis or spinal meningitis.

Meningitis is a serious, sometimes fatal bacterial infection that occurs worldwide. Symptoms may include a sudden onset of a high fever, severe headache, chills, red or purple rash, stiff neck, joint or muscle pain, a sensitivity to bright lights, drowsiness, confusion, nausea, and vomiting. In newborns and small infants, the classic symptoms of fever, headache, and neck stiffness may be absent or difficult to detect, and the infant may only appear slow, inactive, irritable, vomiting, or feeding poorly.

Meningitis is spread by close, direct, or prolonged contact with an infected person through saliva or respiratory and throat secretions. This kind of contact includes intimate kissing or living in the same household. Meningitis bacteria are not spread by casual contact or by simply breathing the air where a person with meningitis has been.

We are fortunate in the United States to have safe and effective vaccines to prevent against Hib. However, other countries do experience large, periodic epidemics. That is why ensuring your child’s vaccinations are current is essential. Whereas Meningococcal vaccines cannot prevent all types of the disease, they do protect many people who might become sick if they didn’t get the vaccine.

A nationwide shortage of Hib vaccine began in December 2007. This continued shortage resulted in a recommendation by CDC to defer the Hib booster (routinely recommended at 12 - 15 months) for children who are NOT at high risk of Hib infection temporarily, until supplies are restored. This recommendation is still in effect.

Even though Hib cases in the U. S. are controlled, because of this vaccine shortage and the temporary deferral of the booster dose at 12 - 15 months for non-high risk children may have resulted in increased Hib carriage and transmission in non-symptomatic children, which could potentially increase the number of cases at the local level.

The good news is that there is enough Hib-containing vaccine for all U.S. children to receive the primary series. All children should complete the primary series by 7 months of age; high risk children should continue to receive the full primary series and the booster dose. Completion of the primary series with currently available vaccine products (manufactured by sanofi pasteur) requires a total of 3 doses of Hib-containing vaccine (2, 4, and 6 months). Although there is enough Hib-containing vaccine nationally to support these recommendations, there may be times when practitioners do not have an adequate supply of vaccine. If Hib vaccine is not available in the office at the time of a visit, children who are unable to receive one of the primary series doses should be tracked and recalled to schedule an appointment to receive their dose as soon as vaccine becomes available in the office. Parents should also take note and make sure the series is completed.

Certain children are at increased risk for Hib disease, including children with sickle cell disease, HIV infection, and compromised immune systems. CDC recommends that providers continue to vaccinate these children with available Hib conjugate vaccines according to the routinely recommended schedules, including the 12 through 15 month booster dose.

Recommendations
The following non-high risk children should be scheduled to receive the primary series of Hib vaccine as outlined below:

If the child is at least 6 weeks but less than 12 months of age and has received zero, one, or two doses of Hib vaccine, schedule the child for the first or next dose(s) immediately with a minimum of four weeks between the doses. These children will need one booster dose when the Hib vaccine shortage is over.
If the child is between 12 and 14 months of age and has not had any doses of Hib vaccine, schedule appointments for two doses, eight weeks apart.
If the child is between 12 and 14 months of age and has received Hib vaccine but did not complete the primary series before they turned 1 year old (i.e., had 1 dose of the Merck product OR 1-2 doses of the sanofi product), schedule an appointment for 1 additional dose, a minimum of eight weeks from the last dose.
If the child is at least 15 months of age but less than 5 years of age and has not received any doses of Hib vaccine OR has not completed the primary series (i.e., had 1 dose of the Merck product OR 1-2 doses of the sanofi product), schedule an appointment for one dose.
If the child is 5 years old or older and hasn’t received any Hib vaccine, Hib vaccine is not necessary.

If parents can not remember this information, print this public health alert and take it with you when you see your medical provider.

For more information about Hib disease and vaccination contact Southwest District Health at 455-5345 or CDC at 1-800-232-4636/1-800-CDC-INFO or by email at www.cdc.gov/vaccines/about/contact/nipinfo_contact_form.htm. Information about current vaccine shortages and delays can be found at http://www.cdc.gov/vaccines/vac-gen/shortages/default.htm.

Additional Sources of Information
CDC. Invasive Haemophilus influenzae Type B Disease in Five Young Children – Minnesota, 2008. MMWR 2009;58:1-3.

CDC. Continued shortage of Haemophilus influenzae Type B (Hib) Conjugate Vaccines and Potential Implications for Hib Surveillance – United States, 2008. MMWR 2008;57(46):1252-1255.
CDC. Interim recommendations for the Use of Haemophilus influenzae Type B (Hib) Conjugate Vaccines Related to the Recall of Certain Lots of Hib-containing Vaccines (PedvaxHIB and Comvax). MMWR 2007; 56(50):1318-1320.

Immunization for Children's Schedule