Children’s Vaccinations (Part Three): Hib and Polio

Two more vaccinations that are routinely scheduled for infants and young children beginning at age 2 months are Hib (Haemophilus influenza type B vaccine) and polio. Before introduction of the Hib vaccine, which is also sometimes referred to as the meningitis vaccine, about 500 children per year died because of this disease. Thanks to the polio vaccine, this devastating disease has been nearly eradicated around the world. Eight countries reported a total of 77 cases in 2014 as of May, according to the Centers for Disease Control and Prevention.

Let’s look at some basic information about Hib and polio and the vaccines developed to fight them.

Haemophilus influenza Type B (Hib) and the Vaccine

Hib is a contagious illness that is spread via mucus or droplets from throat or nose secretions when people cough, sneeze, share drinking utensils, or engage in similar behaviors. The bacteria enter the bloodstream and are carried throughout the body and often take refuge in the brain and spinal column. Despite its name, Hib is not a type of flu.

Hib bacteria can cause meningitis, which is an infection of the lining around the brain (meninges) and spinal cord. Hib is the most common cause of bacterial meningitis. The bacteria also can cause inflammation of the throat (epiglottitis) and pneumonia. Today, fewer than 55 cases of Hib occur in the United States.

When children receive all the recommended Hib injections, the vaccine is reported to be at least 95 percent effective. But how and when should your child receive the vaccine? In "What Your Doctor May Not Tell You About Children's Vaccinations", a recommendation for this vaccine is to get the vaccine separate from others scheduled for the same time; namely, hepatitis B, DTaP (discussed in a future article), and polio.

According to Ronald Kennedy, PhD, professor of microbiology at the University of Oklahoma Health Sciences Center, getting Hib along with hepatitis B and DTaP could make the Hib vaccine inactive. This is a question parents should discuss with their pediatrician, as the option to give children combination vaccines (there are several Hib combos available) and/or to give more than one vaccine at a time are situations moms and dads will face and need to address.

Read more about vaccination exemptions

As of January 1, 2014, there were six Hib vaccines available in the United States: three that contain Hib only and three combination vaccines. Here’s a quick rundown:

ActHIB (Hib alone; Sanofi Pasteur SA). It contains no preservatives, but the manufacturing process includes the use of formaldehyde (less than 0.5 micrograms per dose), ammonium sulfate, and formalin.
Hiberix (Hib alone; GlaxoSmithKline) is a booster dose for children ages 15 months through 4 years who have already been given their initial Hib injections. No preservatives are used but formaldehyde is used during manufacturing.
PedvaxHIB (Hib alone; Merck). This Hib vaccine can be used as the main injections or for the booster shot. It does not contain preservatives (no thimerosal), but amorphous aluminum hydroxyphosphate sulfate, sodium chloride, ethanol, phenol, and enzymes are used during production.
Comvax (Hib plus hepatitis B; Merck). This vaccine is prepared in yeast cultures, and ethanol plus phenol, amorphous aluminum hydroxyphosphate sulfate, and sodium borate are used during production.
Pentacel (Hib plus DTaP and polio; Sanofi Pasteur). This combination vaccine is for children ages 2 months through 4 years. It contains bovine serum albumin, formaldehyde, polysorbate 80, aluminum phosphate, and more.
MenHibRix (Hib plus Neisseria meningitides serogroups C&Y; GlaxoSmithKline). This is the only Hib vaccine that also helps protect against meningococcal serotypes C and Y. This vaccine is for infants ages 6 weeks through 18 months. It does not contain preservatives but formaldehyde is used during manufacturing. This vaccine may be recommended by doctors for infants who are at increased risk of infection.

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Much has been written and debated about the individual additives and ingredients in these and other vaccines. You can begin to get a range of perspectives (often conflicting) on these substances by visiting Dr. Mercola’s website and that of the CDC, for example.

The recommended dosing schedule for Hib from the CDC is as follows:

First dose: age 2 months
Second dose: age 4 months
Third dose: age 6 months unless your child was given PedvaxHib or Comvax at ages 2 and 4 months, in which case this third dose is not necessary
Fourth dose (booster injection): age 12 to 15 months

Approximately one-quarter of children experience minor side effects associated with Hib vaccine, such as minor pain, swelling, or redness at the injection site. Other adverse effects may include fever, crying, and fussiness, as noted for Pentacel vaccine. The CDC reports that rare side effects associated with Hib vaccines may include serious allergic reactions, high fever, and behavioral changes. Parents have reported other reactions such as development of Guillain-Barre syndrome or thrombocytopenia (an abnormal decline in blood platelet levels).

Between January 1, 1990 and May 31, 2013, the Vaccine Adverse Event Report System (VAERS) received 29,047 reports of adverse reactions associated with the Hib vaccines. In 95 percent of the cases, Hib vaccine was given concurrently with one or more other vaccines. About 17 percent of the reports were defined as serious, which means the event resulted in hospitalization, permanent disability, a life-threatening illness or death.

Any concerns about children developing Hib after receiving the vaccine seem to be unfounded. The vaccine contains only a minute fraction of the Hib microbe.

Polio and the Polio Vaccine

Poliomyelitis is a contagious viral disease that most often affects young children. Symptoms of polio can range from mild flu-like issues such as diarrhea, fever, and upper respiratory, to devastating problems that include paralysis. Approximately 4 to 8 percent of individuals with the virus fall into the latter category.

Two types of polio vaccine are available. The inactivated polio vaccine (IPV) is the one currently used in the United States and it is given by injection. Developed by Dr. Jonas Salk in the 1950s, the formulation was revised in the late 1980s and consists of inactivated poliovirus prepared in human cell culture. Use of the oral polio vaccine (OPV), which consists of a weakened live poliovirus, has been discontinued in the US. It carries a risk of vaccine-related paralytic poliomyelitis and is still administered throughout many parts of the world.

Currently the polio vaccine is available in three forms.

Ipol is the sole polio-only vaccine available in the United States. It is made by Sanofi Pasteur SA and contains three strains of the polio virus grown in monkey kidney cells. Each dose also contains minute amounts of 2-phenoxyethanol, formaldehyde, neomycin, streptomycin, polymyxin B, and calf serum protein.
Pediarix is a combination of polio, hepatitis B, and DTaP. The latter vaccine will be discussed in a future article.
Kinrix is a combination of polio and DTaP.

Read more about the flu vaccine

The CDC recommended schedule for the polio vaccine is as follows:

First dose at age 2 months
Second dose at age 4 months
Third dose at age 6 to 18 months
Fourth (booster) dose at age 4 to 6 years. Children who receive the third dose after age 4 years do not need the fourth dose

Any side effects after receiving the IPV are likely to occur after the first dose. They may include irritability as well as redness, swelling, pain, and a lump at the injection site.

The Bottom Line

Although these two vaccine have schedules that overlap and multiple-dose vaccines are available, some doctors recommend children receive the injections on separate occasions to help minimize the impact on the immune system. In addition, if adverse reactions do occur, parents will have a better idea of which vaccine was involved. Adverse reactions should be reported to your healthcare provider and to the Vaccine Adverse Event Reporting System (VAERS).

As with all children’s vaccines, parents should explore the pros and cons and consider the information carefully. They also should know there are vaccination exemptions for which they can apply.

Image: Apotek Hjartat