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
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.
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.
Chemoprophylaxis with rifampicin is recommended for the following contacts of an index case of Hib:
- all household contacts, regardless of age, who live in a home where there are one or more children aged under 5 years, and who are either unimmunised or partially immunised
- all members of a household where there is a child aged under 12 months, even if the child has had three doses (primary series) of the Hib vaccine
- all members of a household where there is an immunosuppressed person
- all staff and children at an early childhood service where two or more cases of Hib have occurred within 60 days.
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:
- occupants of households where there are no children aged under 5 years other than the index case
- occupants of households where all contacts aged 12 months to under 5 years have completed their immunisation series, including the second-year-of-life dose
- pregnant women – rifampicin is contraindicated in pregnant women; pregnant women who are a household contact of an index case should receive ceftriaxone.
For more details on control measures, refer to the Communicable Disease Control Manual 201214 or the Control of Communicable Diseases Manual.15