Action for child survival: elimination of Haemophilus influenzae type b meningitis in Uganda.

Abstract

OBJECTIVE:

To guide immunization policy, we determined the public health benefit of introducing Haemophilus influenzae type b (Hib) vaccine in Uganda and estimated the vaccine effectiveness.

METHODS:

Surveillance data for acute bacterial meningitis among children aged 0-59 months were reviewed from three hospital sentinel sites, for July 2001 to June 2007, to determine the incidence of Hib meningitis, the effectiveness of Hib vaccine with a case-control design, and the number of vaccine-preventable cases and deaths of Hib disease in Uganda.

FINDINGS:

Of the 13 978 children from 17 districts with suspected bacterial meningitis, 269 had confirmed Hib meningitis, declining from 69 patients in the prevaccine year (2001-2002) to three in 2006-2007. Hib meningitis incidence dropped from 88 cases per 100,000 children aged < 5 years in the year before vaccine introduction to 13 within 4 years, and to near zero in the fifth year. Vaccine effectiveness for 2 or more doses was 93% (95% confidence interval, CI: 69-99) against confirmed Hib meningitis and 53% (95% CI: 11-68) against purulent meningitis of unknown cause. In Uganda, Hib vaccine prevents an estimated 28 000 cases of pneumonia and meningitis, 5000 deaths and 1000 severe meningitis sequelae each year.

CONCLUSION:

Infant immunization with Hib vaccine has virtually eliminated Hib meningitis in Uganda within 5 years. Ensuring long-term benefits of Hib vaccine urgently requires sustainable vaccine financing, high-quality ongoing surveillance, and a health sector able to deliver a robust immunization programme.

• Authors: Rosamund F Lewis, Annet Kisakye, Bradford D Gessner, Chaplain Duku, John Bosco Odipio, Robert Iriso, Denis Nansera, Fiona Braka, Issa Makumbi, Addy Kekitiinwa
• Journal: Bulletin of the World Health Organization (Bull World Health Organ) Vol. 86 Issue 4 Pg. 292-301 (Apr 2008) ISSN: 1564-0604 [Electronic] Switzerland
• PMID: 18438518 (Publication Type: Journal Article)

Chemical References

• Haemophilus Vaccines
• Haemophilus influenzae type b polysaccharide vaccine

Topics

• Bacterial Capsules (administration & dosage)
• Child, Preschool
• Haemophilus Vaccines (administration & dosage)
• Haemophilus influenzae type b (immunology, isolation & purification)
• Humans
• Immunization Programs
• Infant
• Infant, Newborn
• Meningitis, Haemophilus (epidemiology, prevention & control, virology)
• Pneumonia, Bacterial (epidemiology, prevention & control, virology)
• Population Surveillance
• Uganda (epidemiology)