Invasive Haemophilus disease advice for clinicians and microbiologists

Information for microbiologists

Isolates should be sent on chocolate agar for confirmation of typing to:-

Dr. Mary Slack:
Haemophilus Reference Unit
Respiratory & Systemic Infection Laboratory
HPA Colindale
61 Colindale Avenue,
London NW9 5EQ

Any isolate of Haemophilus influenzae from a normally sterile site (CSF, blood, pleural fluid, joint fluid, etc) should be submitted to the HPA Haemophilus Reference Unit (HRU) for confirmation and typing. The strain should be accompanied by a HRU request form, duly completed.

R2 Haemophilus reference unit form (PDF, 313 KB)

Cases where there is a strong suspicion of an invasive Haemophilus infection (latex agglutination positive for Hib, Gram-staining of CSF revealed Gram-negative coccobacilli which morphologically resemble haemophili), should also be notified to the HPA HRU.

Information for GPs and clinicians

The HPA is currently conducting enhanced surveillance on all cases of invasive H. influenzae disease in England and Wales. We would, therefore, be grateful if you could inform the HPA HRU of any cases that you are aware of (Tel: 020 8327 6091 / 020 8327 7104; Email: mary.slack@hpa.org.uk).

It is particularly important that we identify all cases of invasive Hib disease as part of post-vaccine licensure surveillance. It is also important to ascertain Hib immunisation history in cases of Hib invasive disease that arise in individuals who would have been eligible for the vaccine (i.e. born after 30/09/1988).

Clinicians should be aware that Hib conjugate vaccine failure has been associated with minor abnormalities of immunoglobulins and subclasses. If there is any evidence of recurrent infections in the child, referral to a paediatric immunologist may be advised.

Testing of Hib antibody concentrations after invasive Hib disease and/or Hib conjugate vaccination is available by sending 1 ml of serum to the Manchester Medical Microbiological Partnership, PO BOX 209, Clinical Sciences Building, Manchester Royal Infirmary, Manchester, M13 9WZ (Tel. 0161 276 6793; Email: Ray.Borrow@hpa.org.uk).

If required, clinical or immunological advice can be obtained from Dr Shamez Ladhani (Tel. 020 8327 7155; Email: shamez.ladhani@hpa.org.uk).

Guidance on the management of cases and contacts of invasive Hib disease have been published (see Guidance).

For more information on Hib vaccination, see chapter 16 on ‘Haemophilus influenzae type B (Hib)’ of Immunisation against infectious disease (the Green Book).

Immunological information

Hib conjugate vaccine failure has been associated with minor abnormalities of immunoglobulins and subclasses, both here and in the United States. If there is any suggestion of recurrent infection in the child, referral to a paediatric immunologist may be advised.

Hib antibody can be measured on a specimen of serum (1ml), which may be available locally or sent to:- Manchester Medical Microbiological Partnership, PO BOX 209, Clinical Sciences Building, Manchester Royal Infirmary, Manchester, M13 9WZ (Tel. 0161 276 6793; Email: Ray.Borrow@hpa.org.uk).

If required, clinical or immunological advice can be obtained by contacting Dr Shamez Ladhani (Tel. 020 8327 7155; Email: shamez.ladhani@hpa.org.uk).