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Haemophilus influenzae type b infections in day care attendees: implications for management
Insights
Haemophilus influenzae type b (Hib) causes serious infections like meningitis in young children. Vaccination at 24 months is recommended for children in day care to reduce risk.
Area of Science:
- Pediatrics
- Infectious Diseases
- Epidemiology
Background:
- Haemophilus influenzae type b (Hib) is a leading cause of bacterial meningitis and neurologic sequelae in young children.
- Day care settings may increase the risk of invasive Hib infections, but the mechanisms and susceptibility ages are unclear.
- Asymptomatic Hib carriage rates vary significantly in child day care environments.
Purpose of the Study:
- To evaluate the risk of Haemophilus influenzae type b infections in children attending day care.
- To assess the effectiveness of rifampin prophylaxis and the impact of Hib vaccination in day care settings.
Main Methods:
- Review of prospective and retrospective studies on Hib infection risk in day care.
- Analysis of asymptomatic carriage rates and the efficacy of rifampin prophylaxis.
- Consideration of age-related vaccine efficacy for Haemophilus influenzae type b.
Main Results:
- Conflicting data exist regarding increased infection risk in day care versus household contacts.
- Rifampin prophylaxis may reduce secondary infections, but further prospective studies are needed.
- The impact of Hib vaccination on day care epidemiology is unknown, but immunogenicity is age-dependent.
Conclusions:
- Rifampin prophylaxis is typically reserved for day care facilities with multiple invasive disease cases.
- Immunization of children in day care at 24 months is recommended due to age-related vaccine efficacy.
- Further research is needed to understand Hib transmission dynamics and vaccine impact in day care settings.
Abstract:
Haemophilus influenzae type b is a major cause of several infectious syndromes in young children, the most important of which is meningitis. The mortality rate for H. influenzae meningitis in the United States is less than 10%; 10%-15% of survivors are left with neurologic sequelae. Children in day care may be at increased risk for acquiring primary invasive H. influenzae infection, although the mechanism of increased risk and the age of increased susceptibility are not known. Three prospective studies estimated the risk of subsequent or secondary infections as significantly lower than that observed in age-susceptible household contacts; a retrospective analysis suggested a different conclusion. Asymptomatic carriage rates of H. influenzae type b in day care centers vary widely. A retrospective analysis suggested that the administration of rifampin might have prevented subsequent infections in day care contacts; prospective studies are necessary to convincingly demonstrate the efficacy of rifampin prophylaxis among day care contacts. Acquisition of H. influenzae type b carriage has occurred even among those previously treated with rifampin. Until further data are available, rifampin prophylaxis is usually reserved for use in those facilities in which two or more cases of invasive disease have occurred within 60 days. The impact of the H. influenzae type b capsular polysaccharide vaccine on the epidemiology of disease in day care facilities is not known. However, because the immunogenicity and protective efficacy of the H. influenzae capsular polysaccharide vaccine are strikingly age-related, we recommend immunizing children in day care at 24 months.