Policy/Procedure for Hemophilus Influenzae Meningitis

COMMUNICABLE DISEASE MANUAL POLICIES/PROCEDURES

HAEMOPHILUS INFLUENZAE TYPE B (HIB) INFECTION (MENINGITIS, EPIGLOTTITIS)

OBJECTIVE: Control and Management of Invasive Haemophilus Influenzae Type B (HIB) Infection.

DESCRIPTION: See: Introduction Haemophilus Influenzae Chemoprophylaxis Standing Order.

EQUIPMENT: MDSS User Manual and disease specific form found in MDSS. H-FLU Meningitis letter, Contact Sheet, and fax to MDCH Notification of Serious Communicable Disease if confirmed or suspect case. MDCH website at WWW.MICHIGAN.GOV/MDCH/0,1607,7-132-2945_5104_53072---,00.HTML and CDC website at WWW.CDC.GOV/DISEASESCONDITIONS/AZ/A.HTML Standing Orders Manual, under Medical Directions on employee website at HTTPS://VBCASSDHD.ORG/VBC/W/INTRANET/WP-LOGIN.PHP?REDIRECT_TO=HTTPS%3A %2F%2FWWW.VBCASSDHD.ORG%2FVBC%2FW%2FINTRANET%2FWP-ADMIN %2F&REAUTH=1

POLICY: Legal Responsibility: Michigan's communicable disease rules of Act. No. 368 of the Public Acts of 1978, as amended, being 333.5111 of the Michigan Compiled Laws. Immediately notify the Epidemiologist, Medical Director, Supervisor and Team Leader for confirmed or suspected cases. Epidemiologist (if not available team leader) to call MDHHS at 517-335- 8165 and Regional Epidemiologist. Nurse to Fax Notification of Serious Communicable Disease Form to MDHHS for confirmed or suspected cases. Immediate follow-up within 24 hours post referral. Enter into MDSS within 24 hours of receipt of referral.

PROCEDURE: A. Case Investigation

1. Referral received per phone call, laboratory results, or automatic document all case investigation proceedings.

2. Contact MD and/or client to start process of completing disease specific form in MDSS.

3. If case investigation reveals possible outbreak (any case outside of index case), notify CD Supervisor and Medical Director.

B. Case Classification

1. Clinical Case Definition: Invasive disease caused by Haemophilus influenzae may produce any of several clinical syndromes, including meningitis, bacteremia, epiglottitis, or pneumonia.

2. Case Classification:

D:\DOCS\2017-12-13\08D8E55034E01786550330287975DD4F.DOC REV: 8/28/2015 PAGE 1 OF 6 a. Probable: A clinically compatible case with detection of H. influenzae type b antigen in cerebrospinal fluid (CSF).

b. Confirmed: A clinically compatible case that has a laboratory-confirmed specimen from a sterile site or a positive specimen from a sterile site in a patient less than 15 years of age.

Comment: Positive antigen test results from urine or serum samples are unreliable for diagnosis of H. influenzae disease.

Note: False positive results may occur from asymptomatic nasopharyngeal carriage of Hib, recent Hib vaccination, or contamination of urine specimens by cross-reacting fecal organisms. Cases identified exclusively by these methods should not be reported.

3. Transmission: The mode of transmission is person-to-person by inhalation of respiratory droplets or by direct contact with respiratory secretions.

4. Incubation Period: Unknown, probably short, 2-4 days. See Hib Timeline attached.

5. Period of Communicability: As long as organisms are present, which may be for a prolonged period even without nasal discharge; non-communicable within 24-48 hours of starting appropriate antimicrobial therapy.

C. Lab Criteria for Diagnosis

1. Diagnosis is made by isolation of organism from blood or cerebrospinal fluid.

2. Isolation of H. influenzae from a normally sterile site (e.g., blood or cerebrospinal fluid (CSF) or, less commonly, joint, pleural, or pericardial fluid).

3. All isolates of H. influenzae from sterile sites in persons under 15 years of age should be serotyped. If the laboratory that cultured the H. influenzae organism does not perform serotyping, arrangements should be made to send the isolate to MDCH Laboratory for serotyping.

4. Confirmation of a case of H. influenzae type b invasive disease requires culture and isolation of the organism from a normally sterile body site, such as:

 Cerebrospinal fluid (CSF)  Blood  Joint fluid  Pleural effusion  Pericardial effusion D:\DOCS\2017-12-13\08D8E55034E01786550330287975DD4F.DOCPAGE 2 OF 6  Peritoneal fluid  Subcutaneous tissue fluid  Placenta  Amniotic fluid

5. Most hospitals and commercial microbiologic laboratories have the capability to isolate H. influenzae from cultured specimens, but many do not perform organism serotyping.

6. Serotyping of H. influenzae isolates is essential for complete and effective surveillance; arrangements should be made to serotype all isolates, especially from patients under 15 years of age.

7. The Michigan Department of Health and Human Services Laboratory performs serotyping. To make arrangements:

 Call the MDHHS VPD Surveillance Coordinator at 517-335-8159, or MDHHS Microbiology Laboratory at 517-335-8067.

 NOTE: The isolate must be growing well on a chocolate agar slant before it is transported.

 Complete MDHHS Microbiology/Virology Test Requisition, form DCH-0583 (formerly FB 200), indicating “H. flu serotyping” in the “Other Test” area.

 Send the cultured isolate to:

Michigan Department of Health and Human Services Bureau of Laboratories DASH Unit 3350 N. Martin Luther King Blvd. Building 44, Room 155 Lansing, MI 48909

D. Control Measures for Contacts

1. Chemoprophylaxis with Rifampin is used for certain household and daycare contacts of patients with invasive Haemophilus Influenzae Type B (HIB) infection. See Standing Orders, under Medical Direction at HTTPS://VBCASSDHD.ORG/VBC/W/INTRANET/WP- LOGIN.PHP?REDIRECT_TO=HTTPS%3A%2F%2FWWW.VBCASSDHD.ORG %2FVBC%2FW%2FINTRANET%2FWP-ADMIN%2F&REAUTH=1 Contacts who develop symptoms suggestive of invasive HIB disease such as fever or headache, should be evaluated promptly. (A household contact is defined as an individual living with the index patient or a non-resident who spent 4 or more hours with the index patient for at least 5 of the 7 days preceding hospital admission of the index patient.) Rifampin chemoprophylaxis for household contacts is no longer indicated if all contacts aged 12 to 48 months are fully vaccinated against HIB disease. A child is considered fully

D:\DOCS\2017-12-13\08D8E55034E01786550330287975DD4F.DOCPAGE 3 OF 6 immunized against HIB disease following (a) at least one dose of conjugate vaccine at 15 months of age; (b) two doses of conjugate vaccine at 12-14 months of age; or (c) two or more doses of conjugate vaccine at less than 12 months of age, followed by a booster dose at 12 months of age. In households with one or more infants less than 12 months of age (regardless of vaccination status) or with a child aged 1-4 years who is inadequately vaccinated, all household contacts should receive Rifampin prophylaxis following a case of invasive HIB disease that occurs in any family member. Daycare centers that operate like homes with children less than 2 years old and children present 25 hours per week may be treated like a household.

2. Exclusion of exposed susceptible contacts: In out-of-home child care, only children who are age-appropriately immunized should be permitted to enter the child care group during the time prophylaxis is given and for two (2) months after onset of the cases. (Source: Red Book)

3. The use of Rifampin in daycare centers is controversial. If a case of HIB disease has occurred, and any children less than 2 years of age have been exposed, all parents should be notified. (see recommended letter). Although data on risks are not optimal, all students (regardless of age) and staff in the center should receive Rifampin prophylaxis. However, Rifampin prophylaxis is not necessary if all children less than 4 years of age are fully immunized. A case of HIB infection does not constitute a reason to close the facility. Children in daycare centers who are partially immunized for HIB and are to receive chemoprophylaxis should also receive Rifampin. In addition to chemoprophylaxis, unvaccinated or incompletely vaccinated children should receive a dose of vaccine and be scheduled for the completion of the recommended age-specific immunization schedule. (Source: Red Book)

4. Please see the Haemophilus Influenzae Chemoprophylaxis Standing Order for the indications, contraindications, dosage, and administration of Rifampin as well as a review of the side effects and appropriate references.

5. Chemoprophylaxis Not Recommended:

 When the serotype of H. influenzae is known and is not type b.  For occupants of households with no children younger than four (4) years of age other than the index patient.  For occupants of households when all household contacts 12 to 48 months of age have completed their Hib immunization series and when household contacts younger than 12 months of age have completed their primary series of Hib immunizations.

D:\DOCS\2017-12-13\08D8E55034E01786550330287975DD4F.DOCPAGE 4 OF 6  For nursery school and child care contacts of one index case, especially those older than two (2) years of age.  For pregnant women  For hospital personnel exposed to a child with invasive Hib disease.

6. Families are to obtain Rifampin with their own resources. If no resources available, health department can supply. (TB Program, J-75). If medical doctor but no pay mechanism, obtain physician’s telephone orders. (See policy for doctor order procedure).

7. If liquid Rifampin is needed from pharmacy, and if no pay mechanism, use J-75 for payment of reconstitution. Health Department supplies Rifampin. If no medical doctor, obtain prescription from Medical Director before administering.

8. The epiglottitis contact sheet is used to list those taking Rifampin.

9. The emphasis in education is on good personal hygiene, health maintenance, reducing direct contact by avoiding overcrowding and avoiding droplet contact. An excellent Question and Answer Hib Information Sheet from the Immunization Action Coalition is located with your Fact Sheets in this policy.

E. MDSS Case Report

1. Complete case investigation using disease specific form in MDSS

2. CD Supervisor reviews case for completeness and closes MDSS case report.

3. In the event of death, obtain and send copies of hospital discharge summary, death certificate, and autopsy report to MDHHS Immunization Division.

4. Michigan Department of Health and Human Services Immunization Division Attn.: Immunization Coordinator 201 Townsend Street PO Box 30195 Lansing MI 48913

RESOURCES: Current Epidemiology and Prevention of Vaccine Preventable Diseases (pink book) Current Red Book Current Control of Communicable Diseases Manual Current disease specific “Fact Sheet” Chemoprophylaxis Standing Order VPD Guidelines at www.michigan.gov/immunize

D:\DOCS\2017-12-13\08D8E55034E01786550330287975DD4F.DOCPAGE 5 OF 6 Websites: WWW.CDC.GOV/DISEASESCONDITIONS/AZ/A.HTML

WWW.MICHIGAN.GOV/MDCH/0,1607,7-132-2945_5104_53072---,00.HTML

Standing Orders, under Medical Direction on the Employee website at HTTPS://VBCASSDHD.ORG/VBC/W/INTRANET/WP-LOGIN.PHP? REDIRECT_TO=HTTPS%3A%2F%2FWWW.VBCASSDHD.ORG%2FVBC %2FW%2FINTRANET%2FWP-ADMIN%2F&REAUTH=1

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