Immunologic memory in Haemophilus influenzae type b conjugate vaccine failure

Haemophilus influenzae type b conjugate vaccines

Haemophilus influenzae type b (Hib) is one of the leading causes of invasive bacterial infection in young children worldwide. During childhood, acquisition of antibody directed against the polysaccharide capsule of the organism, presumably as a result of asymptomatic carriage, confers protection and disease is much less common after the age of 4 years. Like other polysaccharides, the polyribosyl ribitol phosphate (PRP) of the Hib capsule is a T-independent antigen and not immunogenic when administered as a vaccine in infancy. Because the highest rates of disease occur in the first 2 years of life, efficacious Hib vaccines have been designed by covalently linking the PRP capsule to a carrier protein that recruits T-cell help for the polysaccharide immune response and induces anti-PRP antibody production even in the first 6 months of life. Introduction of Hib protein-polysaccharide conjugate vaccines into many industrialized countries over the past 15 years has resulted in the virtual elimination of invasive Hib disease. However, despite the success of the vaccine programme several factors may interfere with the effectiveness of the vaccine in the routine programme, as observed in the UK recently. Such factors may include interference with other concomitant vaccines, waning immunity in the absence of booster doses of vaccine, and reduced natural boosting as a result of decreased transmission of the organism. However, the burden of disease remains highest in resource-poor countries and urgent efforts are needed to provide the benefits of this vaccine for children living in regions where it cannot be used for economic and logistical reasons.

T helper cells and efficacy of Haemophilus influenzae type b conjugate vaccination

A small number of fully vaccinated children in the UK have experienced invasive Haemophilus influenzae type b (Hib) infection. A rise in disease in recent years has been associated with lower vaccine-induced antibody levels over the first 5 years of life, forcing greater dependence on immunological memory for protection. This has necessitated the introduction of a catch-up campaign, designed to boost immunity in children aged 6 months to 4 years of age. We suggest that the conjugate vaccine's inability to induce pathogen specific helper T cells, combined with a loss of natural boosting due to reduced circulation of Hib, may have contributed to the rising incidence of invasive disease 10 years after introduction of the conjugate vaccine. If so, the changing epidemiology of Hib infection in the UK may in part reflect the failure of a subunit vaccine to activate adequately all the necessary components of the immune system. This observation has implications for optimal scheduling of more recently licensed meningococcal and pneumococcal conjugate vaccines.