Infectious diseases - Hib

What is Hib?

(This summary is still in the process of peer review by our Consultants)

The bacterium Haemophilus influenzae has been historically a common cause of infection in human populations. H. influenzae infections, while traditionally less common than many viral infections, cause a variety of childhood diseases, a number of which give rise to considerable morbidity and mortality [1]. H. influenzae type b (Hib) has in the past been responsible for a large proportion of the most serious forms of H. influenzae disease[2]. Hib disease is a significant cause of childhood hospitalisation and is consequently well known among paediatricians, but it is uncommon in the community and often unfamiliar to the general public [3]. However, Hib infections are now preventable and the introduction of national vaccination programs in more than 20 countries around the world, including Australia, has seen the near eradication of Hib disease from many developed countries [4]. As more countries implement vaccination programs, non-type b H. influenzae, for which no vaccines are yet available, will be responsible for a growing proportion of H. influenzae infections.

Haemophilus influenzae type b

H. influenzae type b is a gram-negative bacterium found among the normal flora of the human respiratory tract [5]. Colonisation with this bacterium does not necessarily result in infection and disease, but it is the most virulent of the encapsulated strains of H. influenzae and is estimated to cause between 80% [7, 8] and 95% [6] of invasive H. influenzae disease. The majority of cases occur between the ages of a few months and five years of age [5, 6, 9]. Hib is spread by respiratory secretions. Consequently, contact with other children in the same age group (either in large families or day care centres) has been identified as a principal risk factor for the development of Hib disease [1]. The risk posed by crowding is heightened in the absence of breastfeeding, which facilitates the development of disease [10] cited in [11].

Hib disease

The clinical manifestations of Hib include meningitis, epiglottitis, pneumonia, septicaemia, cellulitis, osteomyelitis, pericarditis and septic arthritis [12]. Meningitis and epiglottitis are considered the most serious forms of invasive Hib disease. Both cause significant morbidity and both are potentially fatal [3, 13]. Meningitis is an infection of the meninges (outer tissue membranes) of the brain and spinal cord [12]. Treatment requires intensive care and antibiotic therapy [12]. Most cases will respond to administration of large doses of antibiotics, but between 10% [14] and 20% [15] of survivors suffer serious and permanent neurological impairment [12]. If subsequent learning deficits and behavioural problems are included among the sequelae, the proportion of survivors affected may rise as high as 40% [1]. Like meningitis, epiglottitis, an infection of the upper airways that causes obstruction [8], requires hospitalisation and intensive care. It too may be fatal, but mortality is generally rare, recovery is usually complete, and long-term sequelae are uncommon [12].

As recently as a decade ago, prior to the introduction of the national vaccination program, the various forms of invasive Hib disease represented a significant threat to the health and wellbeing of all Australian children. At that time, it was estimated that between 500 and 700 Australian children contracted invasive Hib disease annually [16, 17, 18]. Approximately 20 of them died [3, 16, 19], approximately 20 suffered severe, permanent neurological handicap, and more were left with other, less profound neurological impairment [16, 19]. The impact of Hib varied between childhood populations and, in the late 1980s and early 1990s, a series of studies highlighted marked differences in the epidemiology of Hib disease in Indigenous and non-Indigenous children [12].

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Summary of Hib among Indigenous people

(This summary is still in the process of peer review by our Consultants)

Differences in the patterns of Hib infection observed among Indigenous and non-Indigenous children in the pre-vaccination era were clearly documented in total disease incidence, age distribution, clinical manifestations and risk factors for disease. The pattern since the implementation of the national vaccination strategy has been less well documented. It is clear that incidence rates, and consequent morbidity and mortality, have dropped dramatically in both non-Indigenous and Indigenous populations, but disease persists, albeit at lower levels.

The pre-vaccination era

In the era preceding vaccination, Indigenous children, particularly those from rural areas, exhibited patterns of Hib infection similar to those documented in developing countries and among the most disadvantaged populations in developed countries [6, 20]. Meningitis and pneumonia were the most common manifestations, and epiglottitis was not reported among the Indigenous population [18, 20, 22]. Incidence estimates for Indigenous children from this period varied across geographic locations, but were consistently greater than those reported for non-Indigenous children [8, 20]. In central Australia, incidence rates were higher than those reported anywhere else in the world [21]. Disease was typically contracted before the age of one [8, 20] and there was a greater risk of mortality and long-term morbidity [21, 23].

In contrast, non-Indigenous children demonstrated the epidemiological pattern observed in other developed countries, typically presenting with meningitis or epiglottitis. About half the cases occurred in children over 18 months of age. The case fatality rate was low [16]. Estimates of the incidence of Hib disease among non-Indigenous Australians under 5 years of age from various parts of Australia typically ranged between 25 and 60 per 100,000 poplation [16, 20, 24, 25, 26].

Factors contributing to Hib disease among Indigenous children

The high incidence rates and poor outcomes observed among Indigenous children in the pre-vaccination era suggest that other risk factors (additional to those typically associated with Hib infection) contributed to the burden of Hib disease suffered by the Indigenous population [20]. There is evidence to suggest that the extremely high incidence of Hib disease observed among central Australian Aboriginal people prior to vaccination may have been due in part to their exposure to more virulent strains of Hib [18], or to genetic differences in susceptibility [8]. However, most of the factors that have influenced the risk of disease in Indigenous children have been associated with their poor social and environmental conditions [8].

Poor nutritional status is not uncommon among Indigenous children and may increase the risk of Hib infection . Low levels of breastfeeding among urban Indigenous populations are likely also to increase the risk. The poor living conditions frequently documented in Indigenous communities are considered ideal for the transmission of Hib, as they contribute to crowding and increase the risk of respiratory tract viruses that in turn facilitate infection with Hib. Other environmental conditions, such as exposure to woodsmoke, dust, and passive smoking, are thought also to compromise immunity and increase the susceptibility of Indigenous children to Hib infection [8]. Thus, a variety of factors may have contributed to the increased incidence of disease observed among Indigenous children in the pre-vaccination era. In those in whom disease did develop, mucosal damage and/or increased mucosal colonisation may have facilitated invasion into the blood, the resultant bacteraemia and symptomatic disease [5].

Evidence of Hib disease among Indigenous children

Numerous studies reported high incidence rates of Hib disease among Indigenous children in the years immediately preceding the introduction of Hib vaccination. Except for reports about Hib meningitis, there were few reports, however, about the full impact of invasive disease.

Incidence
Pre-vaccination incidence rates for Hib disease among Indigenous children varied between States and Territories. Estimates ranged from a complete absence of the disease among Indigenous people in the ACT [28] to 115 per 100,000 in Queensland [26], 225 per 100,000 in WA [24], 530 per 100,000 in the Northern Territory overall and 990 per 100,000 in central Australia [21]. The latter rate is higher than any reported internationally [18], and of an order of magnitude above and beyond that reported elsewhere in the nation [28].

Morbidity
Pneumonia, bacteraemia, and other forms of invasive Hib disease are all severe infections and may all require hospitalisation, but the higher incidence and serious outcomes associated with meningitis resulted in more detailed documentation of the short and long-term effects of this disease.

The short-term effects are exemplified in a study of bacterial meningitis among Indigenous children from the Northern Territory . The mean length of hospitalisation for Indigenous children was 15.5 days and significantly longer than the 9.9 days for non-Indigenous children [29]. The longer period of hospitalisation for Indigenous children could have been due to severity of illness, multiple diagnoses and/or subsequent complications [29]. A Western Australian study of the long-term effects of Hib meningitis demonstrated a three-fold increased risk of severe sequelae (defined as severe or profound intellectual and/or physical disability, such as cerebral palsy) among Indigenous children [23]. All cases of severe sequelae in Indigenous children occurred among those from the remote north and east of the State, so delays in transportation, diagnosis and/or treatment may have contributed to the poorer outcomes [23].

Mortality
The mortality associated with invasive Hib disease among Indigenous children was low compared to that attributed to many other causes, and case fatality rates were minimised by the availability of evacuation services and intensive care facilities [21]. Despite these services, mortality rates for Hib mortality was higher consistently for Indigenous children than for non-Indigenous children. In the Northern Territory, the case fatality rate of Hib meningitis in Indigenous children was 8.3% in the mid to late 1980s [21]. There were no deaths due to Hib meningitis among non-Indigenous children in the same period. Similar figures, ranging from 8.6% to 14%, were reported in a number of studies conducted in Western Australia [23, 24, 30]. All Indigenous case fatality rates were significantly greater than those reported for non-Indigenous children.

The post-vaccination era

The medical and social importance of Hib infection generally, and within Indigenous populations particularly, resulted in the implementation in July 1993 of a fully-funded national infant program . Funding for a national 'catch-up' program targeting all children up to 5 years of age commenced in August 1993 [19, 24] Various studies conducted in the period following the introduction of Hib vaccines documented a marked decrease in the incidence of invasive Hib disease in Australian children [17, 24, 25, 27]. Both the Hib Case Reporting Scheme and the National Notifiable Diseases Surveillance System documented a fall of approximately 50% in the number of cases of invasive Hib disease reported in Australia between 1 July 1993 and 30 June1994 [17].

Evidence of Hib disease among Indigenous children

In Western Australia, information regarding the decline in invasive Hib disease has been derived from a population-based active surveillance system for non-Indigenous cases and a population-based, matched, case-control study for Indigenous children. Figures from 1994 demonstrated a rapid decline in the incidence of invasive Hib disease in both Indigenous and non-Indigenous children following the introduction of vaccination [24]. However, three cases of invasive Hib infection were reported in fully vaccinated Indigenous children and the study was unable to demonstrate that Hib vaccination conferred a statistically significant benefit for the Indigenous population. In contrast, not a single case of Hib meningitis was reported in Aboriginal or Torres Strait Islander children in far north Queensland between July 1993 and the end of 1994 [27]. In the Northern Territory, the incidence of invasive Hib disease in Indigenous children is reported to have dropped from 278 per 100,000 child-years in the pre-vaccination period (January 1989 to June 1993), to 37 per 100,000 child-years in the post-vaccination period (July 1993-December 1996) [25]. The relative risk of disease in Indigenous children following the introduction of vaccination, compared with the risk before vaccination, was calculated to be 0.13.

The persistence of Hib disease

Despite the rapid decrease in the number of reported Hib cases, nasopharyngeal carriage of Hib persists [31 cited in 32] and invasive disease continues to occur. Between July 1993 and June 1996, Australia-wide surveillance identified 412 cases of invasive disease due to Hib. Included were 18 deaths and 34 cases of vaccine failure (according to the Australian case definition of a vaccine failure) [33]. Ongoing surveillance is therefore necessary to evaluate the continuing efficacy of the Hib vaccination program. This applies to the Australian population as a whole. It may be particularly important for the Indigenous population, as evidence from the United States (US) confirms that Hib disease continues to occur, albeit at lower levels, in socioeconomically disadvantaged populations [11]. In the US, having a single parent mother and living in a crowded household remained independent risk factors for Hib disease regardless of vaccination status.

Additional prevention and control measures

Reduced numbers of Hib cases can clearly be attributed to the introduction of Hib vaccines, but the continued occurrence of cases will necessitate chemoprophylaxis under some circumstances. In the Kimberley, even in communities with high levels of immunisation, rifampicin is recommended for all household/family contacts of cases if any of the contacts are less than one year of age or if any of the contacts are aged between one and five years and are inadequately vaccinated [34].

Non-type b Haemophilus influenzae

Prevention and control strategies for Hib have markedly reduced the incidence of invasive disease, but comprehensive measures are still warranted for non-type b H. influenzae infections. Although traditionally less common and less serious than Hib, these infections have been responsible for morbidity and mortality among children in Indigenous populations and in developing countries, and will continue to be a problem despite Hib vaccination. Australian studies have confirmed that non-type b H. influenzae infections were responsible for as much as 20% of invasive disease in Indigenous children in the period preceding vaccination [7, 21]. While encapsulated strains of H. influenzae other than type b do cause invasive disease, non-encapsulated strains are more likely to cause mucosal infections (such as conjunctivitis and otitis media) and respiratory infections (such as bronchitis) [3, 6]. These infections also cause considerable morbidity and may become secondarily invasive in immuno-compromised individuals [6]. Recent studies have reported particularly high carriage rates of non-encapsulated H. influenzae among Indigenous infants and children [32, 35].

Evidence of mucosal infections in the Indigenous population

Conjunctivitis and otitis media provide examples of the increased risk of H. influenzae mucosal infections in the Indigenous population. Of 39 cases of H. influenzae conjunctivitis that occurred during an outbreak in the Katherine region in 1991, 36 were Indigenous and a number were severe enough to warrant hospitalisation. Cases occurred throughout the Katherine region, but the outbreak was focused in an Indigenous community where it was apparently precipitated by overcrowding during a festival. Cases occurred most commonly in the 0-4 year age group, but all ages were affected. Symptoms resolved quickly following treatment with a single oral dose of amoxycillin and probenicid [36]. Unlike H. influenzae conjunctivitis, which occurs sporadically, otitis media is highly prevalent among Indigenous infants and children. Recent studies indicate that early, dense bacterial colonisation of the nasopharynx with multiple species of respiratory bacteria (including a predominance of non-encapsulated H. influenzae) contribute to the early onset, persistence and severity of otitis media in Indigenous children [32, 37, 38, 39].

Prevention and control measures

Further studies are required to fully elucidate the epidemiology of the various H. influenzae diseases, but control of non-type b H. influenzae will certainly depend on improvements in environmental, social and economic conditions. Less crowded living conditions, improved indoor air quality and improved hygiene are likely to reduce the risk of infection, as will strategies designed to promote infant growth and development and reduce the transmission of infectious diseases [8]. Hanna (1992) suggests that such strategies should include family planning services, optimal antenatal and obstetric care, promotion of breastfeeding, improved weaning and food preparation practices, growth monitoring, childhood immunisation, and frequent hand and face washing.

Such holistic primary prevention measures will be particularly important if, as has been documented elsewhere [40], H. influenzae develops resistance to such antimicrobial agents as ampicillin, rifampicin and tetracycline. Of added concern is the nasopharyngeal carriage of non-encapsulated H. influenzae isolates which are genetically similar to Hib, and the theoretical possibility of genetic exchange between Hib and non-encapsulated H. influenzae strains in Indigenous populations where the organism is highly endemic [32]. Such concerns demonstrate the relationship between Hib and other H. influenzae organisms and highlight the need for continued surveillance of Hib immunisation and H. influenzae carriage.

References
  1. Gilbert GL (1992) New vaccines for Haemophilus influenzae type b disease. The Medical Journal of Australia;156:518-520.
  2. Gilbert GL (1992) New vaccines against Haemophilus influenzae type b. Modern Medicine;35:70-71.
  3. McIntyre P (1992) Invasive Haemophilus influenzae type b disease in Australia: the beginning of the end? Medical Journal of Australia;156:516-518.
  4. Steinhoff MC (1997) Haemophilus influenzae type b infections are preventable everywhere. The Lancet;349:1186-1187.
  5. Clements DA, Gilbert GL (1990) Immunisation for the prevention of Haemophilus influenzae type b infections: a review. Australia and New Zealand Journal of Medicine;20:828-834.
  6. Clements DA, Gilbert GL (1990) Immunisation against Haemophilus influenzae. Medical Journal of Australia;152:397-398.
  7. Gratten M, Morey F, Hanna J, et al. (1994) Type, frequency and distribution of Haemophilus influenzae in central Australian Aboriginal children with invasive disease. Medical Journal of Australia;169:728-729.
  8. Hanna J (1992) The epidemiology and prevention of Haemophilus influenzae infections in Australian Aboriginal children. Journal of Paediatric Child Health;28:354-361.
  9. Bijlmer HA (1991) World-wide edipemiology of Haemophilus influenzae meningitis; industrialized versus non-industrialized countries. Vaccine;9:S5-S9.
  10. Istre GR, Conner JS, Broome CV, Hightower A, Hopkins RS (1985) Risk factors for primary invasive Haemophilus influenzae disease: increased risk from day care attendance and school-aged household members. Journal of Pediatrics;106:190-195.
  11. Jafari HS, Adams WG, Robinson KA, Plikaytis BD, Wenger JD (1999) Efficacy of Haemophilus influenzae type b conjugate vaccines and the persistence of disease in disadvantaged populations. American Journal of Public Health;89:364-368.
  12. Bower C (1993) HIB vaccination programs: an example of the nexus between epidemiology and equity in health promotion. Health Promotion Journal of Australia;3:44-45.
  13. McIntyre P, Jepson R, Leeder S, Irwig L (1993) The outcome of childhood Haemophilus influenzae meningitis: a population based study. Medical Journal of Australia;159:766-772.
  14. Moxon ER (1991) International conference on prevention of Hib meningitis in the 1990's: Introduction. Vaccine;9:S4.
  15. World Health Organization (2000) Haemophilus influenzae type b disease.: World Health Organization.
  16. Harris A, Hendrie D, Bower C, Payne C, de Klerk N, Stanley F (1994) The burden of Haemophilus influenzae type b diseases in Australia and an economic appraisal of the vaccine PRP-OMP. Medical Journal of Australia;160:483.
  17. Herceg A (1995) Haemophilus influenzae type b cases in Australia from 1 July 1993 to 30 June 1994 - results of the Hib case reporting scheme including immunisation status and vaccine failures. Communicable Diseases Intelligence;19:86-90.
  18. Moor PE, Collignon PC, Gilbert GL (1999) Pulsed-field gel electrophoresis used to investigate genetic diversity of Haemophilus influenzae type b isolates in Australia shows differences between Aboriginal and non-Aboriginal isolates. Journal Of Clinical Microbiology;37:1524-1531.
  19. Isaacs D (1994) Haemophilus influenzae type b immunisation. Mod Med;37:35-36.
  20. Gilbert GL (1991) Epidemiology of Haemophilus influenzae type B disease in Australia and New Zealand. Vaccine;9:S10-S13.
  21. Hanna JN (1990) The epidemiology of invasive Haemophilus influenzae infections in children under five years of age in the Northern Territory: a three-year study. The Medical Journal of Australia;152:234-238.
  22. Hanna J, Torzillo P (1991) Acute respiratory infections in Australian Aboriginal children: current knowledge and future requirements. Papua and New Guinea Medical Journal;34:204-210.
  23. Bower C, Payne J, Condon R, Hendrie D, Harris A, Henderson R (1994) Sequelae of Haemophilus influenzae type b meningitis in Aboriginal and non-Aboriginal children under 5 years of age. Journal of Paediatric Child Health;30:393-397.
  24. Bower C, Condon R, Payne J, Burton P, Watson C, Wild B (1998) Measuring the impact of conjugate vaccines on invasive Haemophilus influenzae type b infection in Western Australia. Australian and New Zealand Journal of Public Health;22:67-72.
  25. Markey P (1998) The effect of conjugate Hib vaccines on the incidence of invasive Hib disease in the Northern Territory. The Northern Territory Communicatble Diseases Bulletin;5:3.
  26. Scott J (1993) Review of notifications of invasive Haemophilus influenzae type b infections in Queensland, 1990 to 1993. Communicable Diseases Intelligence;17:403-407.
  27. Hanna J, Messer R (1995) Haemophilus Influenzae type B meningitis in far North Queensland, 1989 to 1994. Communicable Diseases Intelligence;19:91-93.
  28. McGregor A, Bell J, Abdool I, Collingnon P (1992) Invasive Haemophilus influenzae infection in the Australian Capital Territory region. Medical Journal of Australia;156:569-572.
  29. Hanna J (1989) Bacterial meningitis in children in the Northern Territory [letter]. Medical Journal of Australia;151:173.
  30. Hanna JN, Wild BE (1991) Bacterial meningitis in children under five years of age in Western Australia. The Medical Journal of Australia;155:160-164.
  31. Leach AJ, Shelby-James TM, Morris PS, Mathews JD (1997) Impact of Haemophilus influenzae type b (Hib) conjugate vaccine on Hib carriage in Aboriginal infants [abstract]. International Conference on Acute Respiratory Infections. Canberra, Australia.
  32. Smith-Vaughan HC, Sriprakash KS, Leach AJ, Mathews JD, Kemp DJ (1998) Low genetic diversity of Haemophilus influenzae type b compared to nonencapsulated H. influenzae in a population in which H. influenzae is highly endemic. Infection and Immunity;66:3403-3409.
  33. Herceg A (1997) The decline of Haemophilus influenzae type b disease in Australia. Communicable Diseases Intelligence;21:173-175.
  34. Adams L, Mak D (1998) A diagnosis in decline: HIB meningitis. Kimberley Public Health Bulletin May 1998:2 - 6.
  35. Gibson P, Stuart J, Wlodarczyk J, Olson L, Hensley M (1996) Nasal inflammation and chronic ear disease in Australian Aboriginal children. Journal of Paediatric Child Health;32:143-147.
  36. Paterson B (1992) An outbreak of Haemophilus influenzae conjunctivitis - Katherine Region, Northern Territory. Communicable Diseases Intelligence Bulletin;16:183-6.
  37. Leach AJ, Boswell JB, Asche V, Nienhuys TG, Mathews JD (1994) Bacterial colonization of the nasopharynx predicts very early onset and persistence of otitis media in Australian Aboriginal infants. Pediatric Infectious Disease Journal;13:983-9.
  38. Smith-Vaughan HC, Leach AJ, Shelby-James TB, Kemp K, Kemp DJ, Mathews JD (1996) Carriage of multiple ribotypes of non-encapsulated Haemophilus influenzae in Aboriginal infants with otitis media. Epidemiol Infect;116:177-183.
  39. Smith-Vaughan HC, Sriprakash KS, Mathews JD, Kemp DJ (1997) Nonencapsulated Haemophilus influenzae in Aboriginal infants with otitis media: Prolonged carriage of P2 porin variants and evidence for horizontal P2 gene transfer. Infect Immunity;65:1468-1474.
  40. Van Alphen L, Bijlmer H (1990) Molecular epidemiology of Haemophilus influenzae type b. Pediatrics;85:636-642.

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Policies and strategies

Currently no information collected and/or compiled

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Guidelines

Australian Standard Vaccination Schedule 2000-2002
Commonwealth Department of Health and Aged Care

Hib immunisation
Commonwealth Department of Health and Aged Care

Guidelines for the control of infectious diseases; Hib
Department of Human Services; Victoria, Australia

New guidelines for management and prevention of meningococcal disease in Australia
Medical Journal of Australia

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Programs and projects

Currently no information collected and/or compiled

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Health promotion resources

Currently no information collected and/or compiled

Lessons learned

Case studies

Currently no information collected and/or compiled

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Evaluations

Hull BP, McIntyre PB, Couzos S (2004)
Evaluation of immunisation coverage for Aboriginal and Torres Strait Islander children using the Australian Childhood Immunisation Register.
Australian and New Zealand Journal of Public Health;28(1):47-52
View ANZJPH abstract

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Published resources

Journal articles

2004

Hanna J (2004)
Impact of Haemophilus influenzae type b (Hib) vaccination on Hib meningitis in children in Far North Queensland, 1989 to 2003.
Communicable Diseases Intelligence;28(2):255-257
View CDI abtsract
View full paper (HTML)
View full paper (PDF)

Hull BP, McIntyre PB, Couzos S (2004)
Evaluation of immunisation coverage for Aboriginal and Torres Strait Islander children using the Australian Childhood Immunisation Register.
Australian and New Zealand Journal of Public Health;28(1):47-52
View ANZJPH abstract

2003

Horby P, Gilmour R, Wang H, McIntyre P (2003)
Progress towards eliminating Hib in Australia: an evaluation of Haemophilus influenzae type b prevention in Australia, 1 July 1993 to 30 June 2000.
Communicable Diseases Intelligence;27(3):324-341
View full paper (HTML)
View full paper (PDF - 225KB)

Prior to 2000

Adams L, Mak D (1998)
A diagnosis in decline: Hib meningitis.
Kimberley Public Health Bulletin, 2-6.

This article outlines the case study of an Aboriginal baby with Haemophilus influenzae type b (Hib), causing meningitis. Adams and Mak state that 'up until the availability of an effective vaccine for Hib in the late 1980's Hib was the most common cause of meningitis children 7 years, and the definitive cause of epiglottis. Now after the implementation of widespread vaccination programs this infection is a rarity, being mostly confined to children less than one year of age.' The complications of Hib meningitis include seizures, Syndrome of Inappropriate ADH secretion and sensory-neural hearing loss. Disease control measures are outlined and include a working guide to the treatment of household or family contacts.

Australian Indigenous HealthInfoNet abstract

Markey P (1998)
The effect of conjugate Hib vaccines on the incidence of invasive Hib disease in the NT.
Northern Territory Communicable Diseases Bulletin. 5 (1), 3.

This paper summarises the effect of the 1993 introduction of the Hib vaccines on the incidence of invasive Hib disease in the Northern Territory. Prior to the immunisation program there had been a high incidence of infection caused by invasive Haemophilus influenzae type b. The incidence in the Aboriginal population was over five times greater than for non-Aboriginals. Following the introduction of the vaccine program there was a decline of invasive Hib disease from 141/100,000 to 19/100,000 in children under five years. The number of cases of Aboriginal children with Hib disease fell from 84 to 9, while for non-Aboriginals the number dropped from 23 to 3. The program was considered to be effective and successful in reducing the incidence of invasive Hib disease.

Australian Indigenous HealthInfoNet abstract

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Reports and publications

McIntyre P, Amin J, Gidding H, Hull B, Torvaldsen S, Tucker A, Turnbull F, Burgess M (2000)
Vaccine preventable diseases and vaccination covereage in Australia, 1993-1998.
Canberra: Department of Health and Aged Care.
To download a PDF version of this report, click here.

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Theses

Hanna J (1988) The epidemiology of invasive Haemophilus Influenzae infections in children under five years of age in the Northern Territory and central Australia. Unpublished Master of Public Health Thesis, University of Adelaide, Adelaide.

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Key references

  • Bower C, Condon R, Payne J, Burton P, Watson C, Wild B (1998) Measuring the impact of conjugate vaccines on invasive Haemophilus influenzae type b infection in Western Australia. Australian and New Zealand Journal of Public Health;22:67-72
  • Gilbert GL (1992) New vaccines for Haemophilus influenzae type b disease. Medical Journal of Australia, 156:518-520
  • Gilbert GL (1992) New vaccines against Haemophilus influenzae type b. Modern Medicine, 35(6):70-71
  • Gratten M, et al. (1994) Type, frequency and distribution of Haemophilus influenzae in central Australian Aboriginal children with invasive disease. Medical Journal of Australia, 169:728-729
  • Hanna J (1992) The epidemiology and prevention of Haemophilus influenzae infections in Australian Aboriginal children. Journal of Paediatric Child Health, 28:354-361
  • Harris A, et al. (1994) The burden of Haemophilus influenzae type b diseases in Australia and an economic appraisal of the vaccine PRP-OMP. Medical Journal of Australia, 160:483
  • Herceg A (1995) Haemophilus influenzae type b cases in Australia from 1 July 1993 to 30 June 1994 - results of the HIB case reporting scheme including immunisation status and vaccine failures. Communicable Diseases Intelligence, 19(4):86-90
  • Scott J (1993) Review of notifications of invasive Haemophilus influenzae type b infections in Queensland, 1990 to 1993. Communicable Diseases Intelligence, 17(8):403-407

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Bibliography

If you have access to EndNote bibliographic software you may download our Hib EndNote library containing relevant references from the Australian Indigenous HealthInfoNet bibliographic database. If you use Netscape Navigator as your browser click the right mouse button and choose the 'save link as' option to save to your computer. If you use Internet Explorer you should choose the 'save target as' option.

View Hib EndNote library (595KB - compiled September 2007)

If you do not have EndNote you may view the associated reference lists:

View Hib reference list (word doc - 289KB - compiled September 2007)
View Hib reference list (PDF - 178KB - compiled September 2007)

Alternatively you may wish to search through the HealthInfoNet bibliographic database for references about Hib.

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Organisations

Australia

Australian Department of Health and Aged Care
Hib Immunisation information and guidelines

Department of Human Services; Victoria
General Hib information and a recommended immunisation schedule

National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS)
The Centre carries out research, undertakes surveillance of vaccine preventable diseases and provides independent expert advice about all aspects of diseases which can be prevented by vaccination, particularly in children. It provides a national perspective on social and other issues related to immunisation.

International

Centers for Disease Control (CDC): Division of Bacterial and Mycotic Diseases
Site has technical information and articles on Hib including clinical features and incidence.

National Meningitis Trust
UK's leading voluntary organisations formed to provide information on meningitis

World Health Organization (WHO)
The WHO site has useful information on vaccines and immunisation

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Other information

Journals

Currently no information collected and/or compiled

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Conference proceedings and abstracts

Currently no information collected and/or compiled

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Other

Australian Immunisation Handbook, 7th edition.
To download a copy of this report, which contains detailed information about immunisation (including for Hib), click here.

Children's Vaccine Program
Information on immunisation and vaccines

Frequently asked questions
US Association of State and Territorial Directors of Health Promotion and Public Health Education

Haemophilus influenza type b fact sheets
Commonwealth Department of Health and Aged Care; Population Health Division, Australia

Hib fact sheet
Commonwealth Department of Health and Aged Care

Immunisation coverage in Australian children: a systematic review 1990-1998
Australian Department of Health and Aged Care; National Centre for Disease Control/Communicable Diseases Network Australia New Zealand



Tasmania online
Search for Hib immunisation charts, services, and articles. Site also includes an index to all Tasmanian content.

Understanding childhood immunisation.
To download a copy of this report, which contains general information about immunisation (including for Hib), click here.

 

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Last updated: 6 September 2007