Prevention of Haemophilus influenzae type b infections in day care: a public health perspective.

The availability of new data regarding the risk of invasive Haemophilus influenzae type b (Hib) among day care attendees allows the formulation of a practical public health approach to this problem. It is now clear that day care attendees are at significantly increased risk for development of primary invasive Hib disease. While the risk of secondary Hib disease for most is low, risk is substantially increased when young day care attendees are exposed to a primary case to a degree analogous to that of household contacts. Because risk for primary Hib disease is increased among day care attendees, immunization of these children with Hib polysaccharide vaccine is of the highest priority and may be appropriate for children as young as 18 months of age. In light of new data documenting the efficacy of rifampin in prevention of secondary disease, the use of this medication is indicated when unvaccinated day care attendees younger than two years old have had significant contact with a primary case.