6 Haemophilus influenzae type b (Hib) disease

6.8 Public health measures

It is a legal requirement that all cases of Hib disease be notified immediately on suspicion to the local medical officer of health, who will arrange for contact tracing, immunisation and administration of prophylactic rifampicin, where appropriate (for further information refer to the Communicable Disease Control Manual 2012).14

6.8.1 Management of contacts

All contacts should have their immunisation status assessed and updated, as appropriate. Note that the prophylaxis for Hib is different from that for meningococcal disease (see chapter 12).

Immunisation reduces – but does not necessarily prevent – the acquisition and carriage of Hib. Therefore, immunised children still need rifampicin prophylaxis, when indicated, to prevent them transmitting infection to their contacts. Careful observation of exposed household and early childhood service contacts is essential. Exposed children who develop a febrile illness should receive prompt medical evaluation.

Rifampicin chemoprophylaxis

To eradicate the carrier state and protect susceptible children, antimicrobial prophylaxis should be given to contacts as soon as possible, and ideally within seven days of the index case developing the disease, irrespective of their own immunisation status. Prophylaxis started after seven days may still be of benefit and is recommended.

Rifampicin recommendations

Chemoprophylaxis with rifampicin is recommended for the following contacts of an index case of Hib:

Use oral rifampicin 20 mg/kg (maximum 600 mg) daily for four days. The dose for infants aged under 4 weeks has not been established, but a dose of 10 mg/kg per day is recommended. This is a different regimen to that recommended for prophylaxis from meningococcal disease (see chapter 12).

The index case should also receive rifampicin unless treated with cefotaxime or ceftriaxone.

Rifampicin is not recommended for:

For more details on control measures, refer to the Communicable Disease Control Manual 201214 or the Control of Communicable Diseases Manual.15