Thursday, November 25, 2010

Did the Vaccine Save Humanity from Haemophilus influenzae Type B?

Was the vaccine solely responsible for drastically reducing Hi type B cases in America? Let's see what the CDC really says.

"Before vaccines became widely used, about 20,000 Hib cases were reported each year in the country." 

To get to 20,000 annual cases, which is an incident rate of about 100 per 100,000 under 5 years of age, we have to zip back to the 1980s.  (Notice that the Type B, Hi-B, is specified in this quote.)

Oh, but the conjugate vaccine, what is still used today, was not widely introduced until 1991.

It's extremely disingenuous to imply that there were 20,000 cases in 1991. This is completely false. According to the CDC's own data the amount of cases had dropped to 8 per 100,000 (or around 1,600 total) for all types of Hi disease in those under 5, (not just Type B).

"After children began receiving the vaccinations in the early 1990s, CDC officials said, there was a 99 percent drop in cases." 

The vaccine may have been responsible for the drop in disease from around 1,600 cases to the 15-30 we see today, but not from 20,000 to 15-30. So 92% of the 99% drop of the amount of cases from 1980 had nothing to do with the vaccine.

["Progress Toward Eliminating Haemophilus influenzae Type B Disease Among Infants and Children - United States, 1987-1997." MMWR. November 27, 1998]

See the graphs and charts at the bottom of the page:

The CDC's Pink Book acknowledges this play on numbers but still attempts to attribute it to the vaccine:

"The incidence of invasive Hib disease began to decline dramatically in the late 1980s, coincident with licensure of conjugate Hib vaccine." 

Note the words "coincident" and "licensure" and the lack of the term "widespread use." The vaccine was being created and produced in the 1980s, but was not routine in the population until 1991.

Always put your thinking cap on when reading vaccine documents!

According to the CDC for 2009 (invasive):

HIB cases - 10
Non serotype B - 64 (not covered by the vaccine)
Unknown serotype - 56 (not covered by the vaccine)

Here's a summary:

The first Hib vaccine was licensed in 1985. Hib was put on the childhood recommended schedule of immunizations in 1993. Prior to 1991, Hib was not a notifiable disease.

Here are the number of reported Hib cases:

1991 (2,764)
1992 (1,412)
1993 (1,419) Hib was placed on the childhood schedule, resulting in widespread/routine vaccination and state-by-state mandates for entry to daycare/school.
1994 (1,174)
1995 (1,180)
1996 (1,170)
1997 (1,162)
1998 (1,194)
1999 (1,309)
2000 (1,398)
2001 (1,597)
2002 (1,743)
2003 (2,013)

This is FROM the CDC.

Historical reporting data from the CDC:

Some more from the CDC:

Additional resources on the Hib vaccine:

The Hib conjugate vaccine is produced by Merck. Here is the actual manufacturer insert:

The vaccine is given at 2, 4, 6 months and then again between 12-15 months according to the CDC schedule:

The primary concern with conjugate/bacterial vaccines (Hib, Prevnar, Menactra, etc) is Serotype Replacement. This link has a compiled resource list of serotype issues:

Here is an article on the issue of otitis media (ear infection) connected to bacterial vaccination:

Here are some studies on Hib and serotype replacement:

//In addition to the proportional increase in cases of non-type b Haemophilus influenzae disease in the post-H. influenzae type b vaccine era, the incidence of invasive H. influenzae disease was found to be approaching the rates of H. influenzae type b disease that were documented in the prevaccine period. Fifty-six percent of invasive disease now occurs in individuals aged >10 years.\\

//During January 1996–December 2004, 770 cases of invasive H. influenzae disease were reported to the Illinois Department of Public Health (Springfield). The incidence of disease increased from 0.4 to 1.0 cases per 100,000 persons, including an increase of incidence in adults aged 65 years from 1.1 to 3.9 cases per 100,000 persons. Nontypeable H. influenzae disease accounted for the greatest proportion of cases (35.8%–61.5%) in all but 1 age group. The number of cases of invasive nontypeable H. influenzae disease increased by 657%, from a low of 7 cases in 1996 to a high of 53 cases in 2004\\

//Phenotypes and genetic relatedness of invasive Haemophilus influenzae strains were evaluated from 1989 through 2001. Among 119 isolates, multidrug resistance decreased (from 50 to 0%), the level of H. influenzae serotype b (Hib) strains declined (from 81 to 16%), the level of noncapsulated strains rose (from 19 to 80%), and the first invasive H. influenzae serotype f strain was described.\\

//Though numbers of Hib infections in adults fell after the introduction of Hib vaccines for children (P = 0.035), and there was no increase in infections caused by other capsulated Hi serotypes, total numbers of invasive Hi infections increased due to a large rise in infections caused by non-capsulated Hi (ncHi) strains (P = 0.0067)\\

"Nontypeable H influenzae form biofilm in vitro and ex vivo and has been implicated in chronic infection such as otitis media, sinusitis, and bronchitis. Nontypeable H influenzae biofilm formation was found in patients with CF on the apical surface of airway epithelia with decreased antibiotic susceptibility. Studies into the nature of this biofilm structure and proteins will help develop strategies to fight chronic infections. Persons at risk for invasive H influenzae disease include those with asplenia, sickle cell disease, complement deficiencies, Hodgkin disease, congenital or acquired hypogammaglobulinemia, and T-cell immunodeficiency states (eg, persons infected with human immunodeficiency virus [HIV])."

//widespread use of Hib conjugate vaccine and the subsequent reduction in Hib colonization may have opened an ecologic niche for increased colonization with Hia or other non-Hib strains...the potential for serotype replacement remains a concern (16). Three population-based studies have documented small increases in the incidence of non–type b H. influenzae disease after the introduction of the Hib conjugate vaccine...or a preexisting background rate of non-b serotype disease may have simply been uncovered due to the decreasing Hib rates.\\

//Furthermore, the potential risk of the vaccine exceeds the potential benefit. We compared a group that received four doses of the vaccine, a group that received one dose, and a group that was not vaccinated. The cumulative incidence of diabetes per 100 000 in the three groups receiving four, one, and no doses of the vaccine was 261, 237, and 207 at age 7 and 398, 376, and 340 at age 10 respectively. 

Classen JB et al. Association between type 1 diabetes and Hib vaccine. BMJ 1999;319:1133. \\

This is from the CDC's Pink Book page on Hib-

//In 1998–2000, approximately 44% of children younger than 5 years of age with confirmed invasive Hib disease were younger than 6 months of age and too young to have completed a three-dose primary vaccination series. Fifty-six percent were age 6 months or older and were eligible to have completed the primary vaccination series. Of these age-eligible children, 68% were either incompletely vaccinated (fewer than 3 doses) or their vaccination status was unknown. Thirty-two percent of children aged 6–59 months with confirmed type b disease had received three or more doses of Hib vaccine, including 22 who had received a booster dose 14 or more days before onset of their illness. The cause of Hib vaccine failure in these children is not known. \\

""RESULTS: VAERS received 29 747 reports after Hib vaccines; 5179 (17%) were serious, including 896 reports of deaths. Median age was 6 months (range 0-1022 months). Sudden infant death syndrome was the stated cause of death in 384 (51%) of 749 death reports with autopsy/death certificate records. The most common nondeath serious AE categories were neurologic (80; 37%), other noninfectious (46; 22%) (comprising mainly constitutional signs and symptoms); and gastrointestinal (39; 18%) conditions. No new safety concerns were identified after clinical review of reports of AEs that exceeded the data mining statistical threshold.
CONCLUSION: Review of VAERS reports did not identify any new or unexpected safety concerns for Hib vaccines."

Could it be BOOBS that saved the day?

Here is a compilation of studies on Hib and breastfeeding:

Here is a Swedish study in the International Journal of Epidemiology that found the protective effect of breastfeeding lasted 5 to 10 years and was stronger against meningitis from HIB.


  1. Interesting - thanks for posting this. I saw on your breastfeeding and Hib studies link that a correlation is claimed between increasing breastfeeding rates 10-15 years prior to decreasing infection rates - do you think the breastfeeding renewal in the 70's might be why Hib rates went down in the 80's?

  2. All the info I need.... Thanks Guggie :)