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Guidance for Haemophilus influenzae type b (Hib) vaccination in high-risk groups

High-risk group*	Hib vaccine guidance
Patients aged <12 months	Follow routine Hib vaccination recommendations
Patients aged 12 to 59 months	If unimmunized or received 0 or 1 dose before age 12 months: 2 doses, 8 weeks apart
	If received ≥2 doses before age 12 months: 1 dose, 8 weeks after last dose
	If completed a primary series and received a booster dose at age ≥12 months: No additional doses
Patients aged <60 months undergoing chemotherapy or radiation therapy^¶	If routine Hib doses administered ≥14 days before starting therapy: Revaccination not required
	If dose administered within 14 days of starting therapy or given during therapy: Repeat doses starting at least 3 months following therapy completion
Patients aged ≥15 months undergoing elective splenectomy	If unimmunized^Δ: 1 dose prior to procedure^◊
Asplenic patients aged >59 months and adults	If unimmunized^Δ: 1 dose
HIV-infected children aged ≥60 months	If unimmunized^Δ: 1 dose
HIV-infected adults	Hib vaccination is not recommended
Recipients of hematopoietic stem cell transplant, all ages	Regardless of Hib vaccination history: 3 doses (at least 4 weeks apart) beginning 6 to 12 months after transplant

HIV: human immunodeficiency virus.
* Persons with functional or anatomic asplenia, HIV infection, immunoglobulin deficiency including immunoglobulin G2 subclass deficiency, or early component complement deficiency; recipients of a hematopoietic stem cell transplant; and those receiving chemotherapy or radiation therapy for malignant neoplasms.
¶ Some experts suggest conducting serologic testing for these patients.
Δ Patients who have not received a primary series and booster dose or at least 1 dose of Hib vaccine after 14 months are considered unimmunized.
◊ Some experts suggest vaccination at least 14 days before the procedure. Some experts suggest administering a dose prior to elective splenectomy regardless of prior vaccination history.

Reproduced from: Briere EC, Rubin L, Moro PL, et al. Prevention and control of Haemophilus influenzae type b Disease: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2014; 63:1.

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