General informationThis section has been translated automatically.
Preventive measures (RKI):
- Protective vaccination: Against Hib, protective vaccination with a conjugate vaccine has been recommended in Germany since 1990 in infancy and early childhood. Since August 2020, the recommendation of the Standing Commission on Vaccination (STIKO) is to perform a basic immunization at the age of 2, 4 and 11 months with 1 vaccine dose each. It makes sense to carry out these vaccinations with a combination vaccine (e.g. DTaP-IPV-Hib-HepB), which simultaneously protects against tetanus, diphtheria, whooping cough, polio, Hib and hepatitis B. If a child between 1 and 4 years of age who has not been vaccinated against Hib receives the Hib vaccination, a single vaccination is sufficient. From the age of 5 years, Hib vaccination is indicated only in exceptional cases, such as functional or anatomical asplenia (see recommendations of the STIKO). The monovalent Hib single vaccine (Act-Hib®) is currently not marketed in Germany, but can usually be ordered through international pharmacies. The Hib vaccination rate was 91.4% among school-beginners in 2018 based on the school entry examination for the whole of Germany.
- No vaccination currently exists against the other Hi types.
Invasive Hi disease: Immediate hospitalization should be obtained if invasive Hi disease is suspected. Patients with invasive Hi disease must be isolated for up to 24 h after initiation of effective therapy. After this time, the patient is no longer considered infectious. During this period, strict hand hygiene and the adequate use of personal protective equipment according to the basic hygiene concept must be observed by the nursing staff and the attending physicians.
Contact persons: Contact persons and their environment should be informed about the risk of infection and the clinical picture; for a period of approx. 5 days, attention should be paid to fever and non-specific general symptoms (tiredness, aching limbs, malaise).
Communal facilities (according to § 33 IfSG, e.g. kindergartens, schools, homes): According to § 34 para. 1 IfSG, persons who have contracted or are suspected of having contracted Hib meningitis are not allowed to visit communal facilities or to carry out any activities in which they have contact with the people cared for there until a further spread of the disease through them is no longer to be feared according to medical judgement. A re-admission for sick persons is possible at the earliest 24 h after the start of an effective antibiotic therapy. See also recommendations for re-admission to community facilities in accordance with Section 34 of the Infection Protection Act.
Pursuant to § 34 (7), the competent authority may, in agreement with the public health authority, allow exceptions from the prohibitions mentioned in § 33 IfSG for the facilities mentioned in § 33 IfSG, if measures are or have been taken to prevent transmission of the listed disease.
Dealing with contact persons: In case of occurrence of individual diseases, chemoprophylaxis is recommended for all household members of patients with invasive Hib infection and close (face-to-face) contact who are at least 1 month old, if an unvaccinated or inadequately vaccinated child under 5 years of age or a person with relevant immunodeficiency or suppression lives in this household. The aim here is to prevent further transmission in groups of people at increased risk of invasive Hib disease. In addition, if individual cases occur, unvaccinated children under 5 years of age should also receive appropriate chemoprophylaxis if they have had close contact (face-to-face) with a person with invasive Hib infection in a community setting. The drug of choice for prophylaxis is rifampicin per os for 4 days (note age-dependent dosage). As the administration of rifampicin is contraindicated in pregnant women, they may receive ceftriaxone (1 x 250 mg i.m.) if necessary. Prophylaxis should be started as early as possible, but no later than 7 days after the onset of the index case (see STIKO recommendations). In addition to chemoprophylaxis, unvaccinated or incompletely vaccinated children under 5 years of age should be revaccinated against Hib. Furthermore, according to § 34 para. 3 IfSG, the above-mentioned regulations on visiting and working in communal facilities also apply to contact persons in whose community a disease or a suspicion of Hib meningitis has occurred according to medical judgement. See also recommendations for re-admission to communal facilities according to § 34 Infection Protection Act.
In the case of contact persons who have taken post-exposure prophylaxis, re-admission can take place 24-48 h after the start of chemoprophylaxis. For contacts who have not taken chemoprophylaxis, medical judgment for readmission should be made by the appropriate health department or attending physician. However, according to the assumed maximum incubation period, readmission is indicated at the earliest 4 days after last contact and when symptom-free.
Since transmission is rare in cases of disease caused by Hi types other than Hib, post-exposure prophylaxis is not recommended in these cases.
Measures in case of outbreaks: Outbreaks of Hib are rather rare and usually involve only a few cases. Transmissions occur particularly in families and in community settings where young children are cared for. Outbreaks in closed communities and in paediatric and geriatric hospital wards have also been described. As with individual cases of Hib, it is critical to initiate immediate hospitalization of the patient for early diagnosis and antibiotic therapy, if necessary, when invasive Hi infection is clinically suspected, and to recommend chemoprophylaxis for close face-to-face contacts to further limit the outbreak (see "Measures for Individual Illnesses").
If ≥ 2 cases have occurred in a community infant facility within approximately 2 months and the facility is caring for unvaccinated or under-vaccinated children, chemoprophylaxis is recommended for all children regardless of vaccination status and age and for caregivers in the same group. In addition, the missing vaccinations of the basic immunisation should be completed for children under 5 years of age.
Legal basis (obligation to report according to IfSG): According to § 7 Abs. 1 Nr. 18 IfSG only the direct detection of Haemophilus influenzae from cerebrospinal fluid or blood, as far as it indicates an acute infection, is reported by name to the public health department. The reports must be submitted to the public health department at the latest 24 h after the knowledge has been obtained.
In § 8 IfSG the persons obliged to report are named (https://www.gesetze-im-internet.de/ifsg/__8.html). Section 9 of the IfSG specifies the information that may be included in the notification to the public health department (https://www.gesetze-im-internet.de/ifsg/__9.html).
