Management of patients with an inadequate haemophilus influenzae type b antibody response

Abstract

Introduction: Haemophilus influenzae type b (Hib) may cause respiratory and systemic disease; it is associated with COPD exacerbation. Hib vaccination is advised in children, and in adults at risk of invasive disease.

Aims: To assess (i)physician action following request of Hib antibody levels and (ii)the effect of vaccination on patient outcome.

Methods: 573 respiratory patients had specific Hib antibody assays between 01.06.2011 and 31.05.2013. Hospital data on 47.8% (n=274) with an inadequate baseline response were reviewed. Patients were divided into responders (normal response to vaccination) and non-responders (< doubling of baseline and/or value <1.0mcg/ml). Patients' wellbeing was assessed via telephone interview and number of antibiotic courses prescribed pre- and post-vaccination.

Results: 49.6% (n=136) with an inadequate baseline antibody response were not vaccinated. Of those who were 105 (38.3%) were true responders. Of the 33 patients with an inadequate 2^nd antibody level only 18 had been re-vaccinated (true non-responders). 13/18 patients were re-tested, 4 had an inadequate 3^rd assay post 2^nd vaccination.

Conclusion: Physician action is poor following detection of an inadequate Hib antibody response. Vaccination responders may have reduced need for antibiotics and improved symptoms compared to non-responders. Exploration of these findings is needed.