What precautions should hospital staff take for a patient diagnosed with Haemophilus influenzae type B (Hib) meningitis?

Hospital Precautions for Haemophilus influenzae Type B (Hib) Meningitis

Hospital staff should implement standard precautions (not droplet or airborne isolation) for patients with Hib meningitis, as secondary transmission in healthcare settings has not been documented and chemoprophylaxis is not recommended for hospital staff. 1

Key Distinction: Hib vs. Meningococcal Meningitis

Hib meningitis does NOT require respiratory isolation or droplet precautions, unlike meningococcal meningitis which requires immediate respiratory isolation until 24 hours of effective antibiotics. 2 This is a critical distinction that prevents unnecessary isolation measures.

• Standard infection control precautions (hand hygiene, gloves when touching body fluids, gowns if soiling expected) are sufficient for Hib cases. 1
• No special masks, private rooms, or respiratory isolation are required for healthcare workers caring for Hib patients. 1

Patient Management Before Discharge

Index patients under 2 years old who are NOT treated with cefotaxime or ceftriaxone must receive rifampin prophylaxis before hospital discharge to eradicate nasopharyngeal carriage. 1

• Cefotaxime and ceftriaxone eradicate Hib colonization, so rifampin is unnecessary if either antibiotic was used for treatment. 1
• This prevents the patient from transmitting Hib to household contacts after discharge. 1

Contact Tracing and Chemoprophylaxis (Post-Discharge Focus)

While hospital staff do not require prophylaxis, the hospital must facilitate appropriate contact identification:

Household Contacts

Rifampin chemoprophylaxis is indicated for the index patient (unless treated with cefotaxime/ceftriaxone) and ALL household contacts when:

• Any household member is under 4 years old AND not fully vaccinated, OR
• Any household member under 18 years old is immunocompromised (regardless of vaccination status). 1

Child Care Contacts

Rifampin prophylaxis for child care settings is only indicated when:

• Two or more cases of invasive Hib disease occur within 60 days, AND
• Unimmunized or underimmunized children attend the facility. 1
• When indicated, prophylaxis should be given to all attendees and child care providers regardless of age or vaccine status. 1

Rationale for No Healthcare Worker Prophylaxis

• Secondary cases of Hib disease are rare and occur almost exclusively among household contacts, particularly children under 48 months (2.1% attack rate). 1
• The highest risk is among household contacts under 12 months (6% attack rate) and under 24 months (3% attack rate). 1
• Cases of secondary transmission in healthcare settings have not been documented, which is why there are no control measures or chemoprophylaxis recommendations for hospital staff. 1

Common Pitfalls to Avoid

• Do not confuse Hib meningitis with meningococcal meningitis: Meningococcal disease requires immediate respiratory isolation and healthcare worker prophylaxis if exposed to respiratory secretions; Hib does not. 2
• Do not delay discharge planning for rifampin administration: Patients under 2 years not treated with cefotaxime/ceftriaxone need rifampin before leaving the hospital. 1
• Do not forget to assess household composition: The presence of young unvaccinated children or immunocompromised individuals in the home triggers the need for household chemoprophylaxis. 1