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Eurosurveillance, Volume 7, Issue 19, 08 May 2003

Citation style for this article: Ramsay ME. Vaccination catch-up campaign in response to recent increase in invasive Hib infection in the United Kingdom – implications for the rest of Europe?. Euro Surveill. 2003;7(19):pii=2225. Available online:

Vaccination catch-up campaign in response to recent increase in invasive Hib infection in the United Kingdom - implications for the rest of Europe?

Mary Ramsay (, and Jodie McVernon, Health Protection Agency Communicable Disease Surveillance Centre, London, England.

A catch-up immunisation campaign against Haemophilus influenzae type b (Hib) is scheduled to commence in England and Wales in the second week of May ( This decision has been made in response to a recent increase in invasive infections due to this organism, with 145 cases of confirmed Hib disease reported in children under five in England and Wales last year. While this is still far lower than the 773 cases observed in this age group in 1990, before routine immunisation was implemented, it is a dramatic rise from the nadir of 22 in 1998 (1). To the end of 2001, surveillance in several European Union (EU) countries indicated that this experience was unique to the United Kingdom (UK) ( A more recent report of a rise in cases in the Netherlands in 2002 is cause for concern (2).

Multiple factors are believed to have contributed to the UK increase. One of these has been the distribution since late 1999 of combination Hib vaccines containing acellular pertussis (DTaP-Hib), which have lower immunogenicity for the Hib component than the equivalent whole cell pertussis containing preparations (DTwP-Hib). An analysis of vaccines received by fully immunised children presenting with invasive Hib disease in the UK, compared with healthy controls matched by date of birth, has been conducted (3). Significantly more cases than controls in the time period studied received all three doses of their infant primary course as DTaP-Hib, compared with two or three doses of another Hib vaccine (Conditional odds ratio (OR) 6.77; 95% confidence interval (CI) 3.26, 14.07) (3). This is the first study to show a reduction in clinical protection with these vaccines, within the context of an accelerated 2, 3, and 4 month infant immunisation schedule without a booster dose. In Germany however, where DTaP-Hib is routinely administered with a fourth dose in the second year, no similar increase in Hib incidence has occurred (4).

There are many differences in the way Hib vaccines are given throughout the EU. The choice of combinations used, age at immunisation, spacing of the primary course, and late first year or early second year boosters are all variables known to affect immunogenicity. While Germany's experience would suggest that a booster dose is more effective in controlling disease (4), it should be noted that the Netherlands, which saw a four fold rise in cases last year, administers Hib at 2, 3, 4, and 11 months of age (2). These observations raise questions about the long term impact of all conjugate Hib vaccines and therefore for the ongoing control of Hib in Europe. Answers that will ensure optimal delivery of immunisation schedules will only be found through ongoing commitment to high quality surveillance for this and other vaccine preventable diseases.


  1. Trotter CL, Ramsay ME, Slack MPE. Rising incidence of Haemophilus influenzae type b disease in England and Wales indicates a need for a second catch-up vaccination campaign. Comm Dis Pub Health 2003; 6: 55-8. (
  2. Rijkers GT, Vermeer-de Bondt PE, Spanjaard L, Breukels MA, Sanders EAM. Return of Haemophilus influenzae type b infections [letter]. Lancet 2003; 361: 1563. ( [registration required]
  3. McVernon J, Andrews N, Slack MPE, Ramsay ME. Risk of vaccine failure after Haemophilus influenzae type b (Hib) combination vaccines with acellular pertussis. Lancet 2003; 361: 1521-3. ( [registration required]
  4. Schmitt HJ, von Kries R, Hassenpflug B, Hermann M, Siedler A, Niessing W, et al. Haemophilus influenzae type b disease: impact and effectiveness of diphtheria-tetanus toxoids-acellular pertussis (-inactivated poliovirus)/H. influenzae type b combination vaccines. Pediatr Infect Dis J 2001; 20: 767-74. (

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