Haemophilus influenzae Type b (Hib)—Child Care and Schools

What is Haemophilus influenzae type b?

• Haemophilus influenzae type b (Hib) is a type of bacteria that causes infections. This bacteria can cause serious infections, such as epiglottitis (ie, infection of the flap that covers the windpipe) and infection of skin, lungs, blood, joints, and coverings of the brain (eg, meningitis).

• There are H influenzae types other than type b that can infect ears, eyes, and sinuses and in rare instances can cause meningitis.

• Infections caused by Hib can be prevented by the Hib vaccine, which is one of the routine childhood immunizations.

• Not to be confused with "the flu," a disease caused by influenza, a virus.

What are the signs or symptoms?

Depends on the site of infection. May include

• Fever

• Vomiting

• Irritability

• Stiff neck

• Rapid onset of difficulty breathing

• Cough

• High-pitched, noisy breathing on inspiration (breathing in) called stridor

• Warm, red, swollen joints

• Swelling and discoloration of the skin, particularly of the cheek and around the eye

What are the incubation and contagious periods?

• Incubation period: Unknown

• Contagious period: Until 24 hours after antibiotic treatment has begun

How is it spread?

• Respiratory (droplet) route: Contact with large droplets that form when a child talks, coughs, sneezes, or sings. These droplets can land on or be rubbed into the eyes, nose, or mouth. The droplets do not stay in the air; they usually travel no more than 3 feet and fall onto the ground.

• Contact with respiratory secretions or contaminated objects from children who carry these bacteria.

How do you control it?

• H influenzae type b (Hib) infection is a vaccine-preventable disease. Children should receive the vaccine according to the most recent immunization recommendations. Children younger than 5 years of age who are underimmunized are at increased risk of invasive or severe infection from Hib. Knowledge of the vaccine status of children is desirable.

• Use good hand-hygiene technique at all the times listed in Chapter 2 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition.

• Preventive antibiotics (chemoprophylaxis) for exposed children and staff members may be recommended by the local health department if a child develops a severe infection due to Hib. Alerting the local health department if a child has been diagnosed with Hib is very important. This is not commonly needed because of widespread Hib immunization, which protects immunized individuals from infection.

A classic presentation of Haemophilus influenzae type b (Hib) facial cellulitis in a 10-month-old. This once-common infection has been nearly eliminated among children who have been immunized with the Hib vaccine.

AMERICAN ACADEMY OF PEDIATRICS, COURTESY OF GEORGE NANKERVIS, MD

Child lying down squints up at us, the left side of their face affected by unilateral swelling, purple-red pigmentation spanning from the lower eyelid to chin.

What are the roles of the educator and the family?

• Report the infection to the staff member designated by the early childhood education (ECE) program or school for decision-making and action related to care of ill children and staff members. That person, in turn, alerts possibly exposed family and staff members and the parents of underimmunized children to watch for symptoms and notifies the Child Care Health Consultant.

• Report the infection to the local health department. The health professional who makes the diagnosis may not report that the infected child is a participant in an ECE program or school, and this could lead to delay in controlling the spread.

• If 2 or more Hib cases occur within 60 days at an ECE program or school with underimmunized children, antibiotics might be needed for all children, child care providers, and household members to prevent the spread of this disease. Underimmunized children should also receive a dose of the vaccine. Do not exclude children and staff members who have been exposed as long as no other exclusion criteria are met.

• Ensure exposed children who develop a fever are seen by a pediatric health professional as soon as possible.

• Clean or sanitize surfaces that are touched by hands frequently, such as toys, tables, and doorknobs according to the Routine Schedule for Cleaning, Sanitizing, and Disinfecting in Chapter 8 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition.

Exclude from educational setting?

Yes. Exclude all children with a diagnosis of Hib infection.

Readmit to educational setting?

Yes, when all the following criteria are met:

• After the child has been cleared by a pediatric health professional

• When the child is able to participate and staff members determine they can care for the child without compromising their ability to care for the health and safety of the other children in the group