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Tripathi N, Mukherjee S. Efficacy and Prolonged Safety of Haemophilus influenzae Type b Conjugate Vaccines. Infect Disord Drug Targets 2024; 24:e150124225640. [PMID: 38231056 DOI: 10.2174/0118715265269877231117070051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/14/2023] [Accepted: 10/03/2023] [Indexed: 01/18/2024]
Abstract
OBJECTIVE The purpose of this study was to find data proving the influence of the Haemophilus influenzae type b (Hib) conjugate vaccination on the frequency of invasive Hib illness. METHODOLOGY A systematic literature search was conducted on the PubMed database to identify peerreviewed publications pertaining to the epidemiology of Haemophilus influenzae meningitis, both before and after the introduction of Haemophilus influenzae type b (Hib) conjugate vaccines. The search query employed a combination of relevant keywords, including "invasive," "Haemophilus," "influenzae," "meningitis," and specific serotype b (Hib). Additionally, terms related to epidemiology, burden, risk factors, impact, Hib vaccine, Hib conjugate vaccine, combination vaccine, vaccine production, efficacy, immunisation coverage, surveillance, review, clinical aspects, outcomes, and various age groups (adults and children) were incorporated. RESULT The search encompassed articles published till now. Subsequently, relevant research papers concerning Haemophilus influenzae meningitis were subjected to a comprehensive review and analysis. CONCLUSION The Hib conjugate vaccination has shown to be extremely effective when administered to the entire population. However, changes to the immunisation protocol appear to be required in order to effectively manage invasive Hib illness.
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Affiliation(s)
- Nishita Tripathi
- Amity Institute of Biotechnology, Amity University Uttar Pradesh Lucknow Campus, Lucknow, Uttar Pradesh, India
| | - Sayali Mukherjee
- Amity Institute of Biotechnology, Amity University Uttar Pradesh Lucknow Campus, Lucknow, Uttar Pradesh, India
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Haque S, Swami P, Khan A. S. Typhi derived vaccines and a proposal for outer membrane vesicles (OMVs) as potential vaccine for typhoid fever. Microb Pathog 2021; 158:105082. [PMID: 34265371 DOI: 10.1016/j.micpath.2021.105082] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 07/02/2021] [Accepted: 07/02/2021] [Indexed: 12/22/2022]
Abstract
Typhoid fever is a serious systemic infection caused by Salmonella Typhi (S. Typhi), spread by the feco-oral route and closely associated with poor food hygiene and inadequate sanitation. Nearly 93% of S. Typhi strains have acquired antibiotic resistance against most antibiotics. Vaccination is the only promising way to prevent typhoid fever. This review covers the nature and composition of S. Typhi, pathogenecity and mode of infection, epidemiology, and nature of drug resistance. Several components (Vi-polysaccharides, O-antigens, flagellar antigens, full length OMPs, and short peptides from OMPs) of S. Typhi have been utilized for vaccine design for protection against typhoid fever. Vaccine delivery systems also contribute to efficacy of the vaccines. In this study, we propose to develop S. Typhi derived OMVs as vaccine for protection against typhoid fevers.
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Affiliation(s)
- Shabirul Haque
- Feinstein Institute for Medical Research, Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA.
| | - Pooja Swami
- Feinstein Institute for Medical Research, Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA.
| | - Azhar Khan
- Faculty of Applied Sciences and Biotechnology, Shoolini University, Solan, Himachal, Pradesh, India.
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Health System Barriers and Facilitators to Delivering Additional Vaccines through the National Immunisation Programme in China: A Qualitative Study of Provider and Service-User Perspectives. Vaccines (Basel) 2021; 9:vaccines9050476. [PMID: 34066844 PMCID: PMC8151436 DOI: 10.3390/vaccines9050476] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/18/2021] [Accepted: 04/26/2021] [Indexed: 11/17/2022] Open
Abstract
In China, there are two categories of vaccines available from the Chinese Center for Disease Control and associated public health agencies. Extended Program of Immunization (EPI) vaccines are government-funded and non-EPI vaccines are voluntary and paid for out-of-pocket. The government plans to transition some non-EPI vaccines to EPI in the coming years, which may burden public health system capacity, particularly in terms of budget, workforce, supply chains, and information systems. Our study explored vaccinator and caregiver perspectives on introducing non-EPI vaccines into routine immunization and perceived facilitators and barriers affecting this transition. We conducted a qualitative study from a realist perspective, analysing semi-structured interviews with 26 vaccination providers and 160 caregivers in three provinces, selected to represent regional socioeconomic disparities across Eastern, Central, and Western China. Data were analysed thematically, using deductive and inductive coding. Most participants were positive about adding vaccines to the national schedule. Candidate EPI vaccines most frequently recommended by participants were varicella, mumps vaccine, and hand-foot-mouth disease. Providers generally considered existing workspaces, cold-chain equipment, and funding sufficient, but described frontline staffing and vaccine information systems as requiring improvement. This is the first qualitative study to explore interest, barriers, and facilitators related to adding vaccines to China's national schedule from provider and caregiver perspectives. Findings can inform government efforts to introduce additional vaccines, by including efforts to retain and recruit vaccine programme staff and implement whole-process data management and health information systems that allow unified nationwide data collection and sharing.
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Hib Vaccines: Past, Present, and Future Perspectives. J Immunol Res 2016; 2016:7203587. [PMID: 26904695 PMCID: PMC4745871 DOI: 10.1155/2016/7203587] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 12/24/2015] [Indexed: 12/31/2022] Open
Abstract
Haemophilus influenzae type b (Hib) causes many severe diseases, including epiglottitis, pneumonia, sepsis, and meningitis. In developed countries, the annual incidence of meningitis caused by bacteria is approximately 5–10 cases per population of 100,000. The Hib conjugate vaccine is considered protective and safe. Adjuvants, molecules that can enhance and/or regulate the fundamental immunogenicity of an antigen, comprise a wide range of diverse compounds. While earlier developments of adjuvants created effective products, there is still a need to create new generations, rationally designed based on recent discoveries in immunology, mainly in innate immunity. Many factors may play a role in the immunogenicity of Hib conjugate vaccines, such as the polysaccharides and proteins carrier used in vaccine construction, as well as the method of conjugation. A Hib conjugate vaccine has been constructed via chemical synthesis of a Hib saccharide antigen. Two models of carbohydrate-protein conjugate have been established, the single ended model (terminal amination-single method) and cross-linked lattice matrix (dual amination method). Increased knowledge in the fields of immunology, molecular biology, glycobiology, glycoimmunology, and the biology of infectious microorganisms has led to a dramatic increase in vaccine efficacy.
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van der Put RM, de Haan A, van den IJssel JG, Hamidi A, Beurret M. HPAEC-PAD quantification of Haemophilus influenzae type b polysaccharide in upstream and downstream samples. Vaccine 2015; 33:6908-13. [DOI: 10.1016/j.vaccine.2014.07.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 06/02/2014] [Accepted: 07/08/2014] [Indexed: 11/26/2022]
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Gessner BD, Feikin DR. Vaccine preventable disease incidence as a complement to vaccine efficacy for setting vaccine policy. Vaccine 2014; 32:3133-8. [PMID: 24731817 DOI: 10.1016/j.vaccine.2014.04.019] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 03/28/2014] [Accepted: 04/02/2014] [Indexed: 01/09/2023]
Abstract
Traditionally, vaccines have been evaluated in clinical trials that establish vaccine efficacy (VE) against etiology-confirmed disease outcomes, a measure important for licensure. Yet, VE does not reflect a vaccine's public health impact because it does not account for relative disease incidence. An additional measure that more directly establishes a vaccine's public health value is the vaccine preventable disease incidence (VPDI), which is the incidence of disease preventable by vaccine in a given context. We describe how VE and VPDI can vary, sometimes in inverse directions, across disease outcomes and vaccinated populations. We provide examples of how VPDI can be used to reveal the relative public health impact of vaccines in developing countries, which can be masked by focus on VE alone. We recommend that VPDI be incorporated along with VE into the analytic plans of vaccine trials, as well as decisions by funders, ministries of health, and regulatory authorities.
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Affiliation(s)
- Bradford D Gessner
- Agence de Médecine Preventive, 164 Rue de Vaugirard, 75015 Paris, France.
| | - Daniel R Feikin
- International Vaccine Access Center, Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA; Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Ahmed ASMNU, Khan NZ, Hussain M, Amin MR, Hanif M, Mahbub M, El-Arifeen S, Baqui AH, Qazi SA, Saha SK. Follow-up of cases of Haemophilus influenzae type b meningitis to determine its long-term sequelae. J Pediatr 2013; 163:S44-9. [PMID: 23773594 DOI: 10.1016/j.jpeds.2013.03.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To measure physical and neurologic impact of Haemophilus influenzae type b (Hib) meningitis on surviving children through short- and long-term follow-up. STUDY DESIGN Cases of Hib meningitis, diagnosed at a tertiary level pediatric hospital, were subjected to short- and long-term follow-up and compared with age, sex, and area of residence matched healthy controls. Follow-up assessments included thorough physical and neurodevelopmental assessments using a standardized protocol by a multidisciplinary team. RESULTS Assessments of short-term follow-up cohort (n = 64) revealed hearing, vision, mental, and psychomotor deficits in 7.8%, 3%, 20%, and 25% of the cases, respectively. Deficits were 10%, 1.4%, 21%, and 25% in long-term follow-up cohort (n = 71), in that order. Mental and psychomotor deficits were found in 2% of the controls, none of whom had vision or hearing deficits. CONCLUSIONS In addition to risk of death, Hib meningitis in children causes severe disabilities in survivors. These data facilitated a comprehensive understanding of the burden of Hib meningitis, specifically in developing countries where disabled children remain incapacitated because of lack of resources and facilities. The evidence generated from this study is expected to provide a compelling argument in favor of introduction and continuation of Hib conjugate vaccine in the national immunization program for children.
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Affiliation(s)
- A S M Nawshad Uddin Ahmed
- Department of Pediatrics, Bangladesh Institute of Child Health, Dhaka Shishu Hospital, Dhaka, Bangladesh
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Schossler JGS, Beck ST, Campos MMAD, Farinha LB. Incidência de meningite por Haemophilus influenzae no RS 1999-2010: impacto da cobertura vacinal. CIENCIA & SAUDE COLETIVA 2013. [DOI: 10.1590/s1413-81232013000500030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O objetivo deste artigo é analisar e verificar a situação epidemiológica das meningites causadas pelo agente Haemophilus influenzae tipo b nos últimos 10 anos no Rio Grande do Sul. Estudo retrospectivo, descritivo, utilizando o sistema de dados de notificação de meningites, e cobertura vacinal, armazenados em base on line Tabnet - Tabulação de dados Epidemiológicos - CEVS/SES/RS, abrangendo o período de 1999 a 2010. Foram utilizados casos notificados e confirmados, tendo como critério de seleção o ano de inicio dos sintomas, idade, diagnostico e evolução. Foi analisado o Estado do Rio Grande do Sul, representado por 19 coordenadorias de saúde. Comparações entre proporções foram avaliadas pelo teste de z. No RS foram notificados 3043 casos confirmados de meningite bacteriana, sendo 6,77% dos casos causados por H. influenzae. O coeficiente de incidência da meningite por H. influenzae, sem considerar faixa etária, caiu significativamente (95,6%) após 1999, assim como a mortalidade. Crianças menores de um ano continuam sendo as mais acometidas (52%), não havendo alteração na letalidade. Os resultados apresentados revelaram um impacto positivo das estratégias de vacinação contra Hib no Estado do Rio Grande do Sul nos últimos dez anos.
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Beurret M, Hamidi A, Kreeftenberg H. Development and technology transfer of Haemophilus influenzae type b conjugate vaccines for developing countries. Vaccine 2012; 30:4897-906. [DOI: 10.1016/j.vaccine.2012.05.058] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 03/23/2012] [Accepted: 05/23/2012] [Indexed: 10/28/2022]
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Gupta M, Prinja S, Kumar R, Kaur M. Cost-effectiveness of Haemophilus influenzae type b (Hib) vaccine introduction in the universal immunization schedule in Haryana State, India. Health Policy Plan 2012; 28:51-61. [DOI: 10.1093/heapol/czs025] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Global status of Haemophilus influenzae type b and pneumococcal conjugate vaccines: evidence, policies, and introductions. Curr Opin Infect Dis 2010; 23:236-41. [DOI: 10.1097/qco.0b013e328338c135] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kim KH, Lee H, Chung EH, Kang JH, Kim JH, Kim JS, Lee HJ, Oh SH, Park EA, Park SE. Immunogenicity and safety of two different Haemophilus influenzae type b conjugate vaccines in Korean infants. J Korean Med Sci 2008; 23:929-36. [PMID: 19119431 PMCID: PMC2610654 DOI: 10.3346/jkms.2008.23.6.929] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2007] [Accepted: 02/17/2008] [Indexed: 11/23/2022] Open
Abstract
The incidence of invasive diseases, including meningitis caused by Haemophilus influenzae type b (Hib) was markedly decreased after routine immunization of Hib vaccine through diverse schedules in many countries. The purpose of this study was to evaluate the immunogenicity and safety of Hib conjugate vaccines in Korean children before the implementation of a national immunization program against Hib in Korea. A multicenter controlled trial was performed on two different Hib vaccines in Korean children. A total of 319 infants were enrolled: 199 infants were immunized with the Hib polysaccharide conjugated to the tetanus toxoid (PRP-T) and 120 infants with the Hib polysaccharide conjugated to the outer-membrane protein of Neisseria meningitides (PRP-OMP). Immunogenicity was evaluated by enzyme-linked immunosorbent assay (ELISA) and serum bactericidal assay. Both vaccines showed good immunologic responses after primary immunization. After 2 doses of PRP-T or PRP-OMP, 78.9% and 91.7% of infants achieved an antibody level of >or=1.0 microg/mL, respectively. Both vaccines were safe and well-tolerated. No serious adverse events were observed. Thus, Hib conjugate vaccines appear to be safe and show good immunogenicity in Korean infants. These results will be important reference data for the implementation of Hib vaccine in the national immunization program of Korea.
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Affiliation(s)
- Kyung Hyo Kim
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea.
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Abstract
An economic evaluation of Haemophilus influenzae type b (Hib) immunization was conducted to examine whether Hib immunization should be included in Korea's national immunization program. The costs and benefits included direct and indirect values and an estimation of the economic efficiency. We determined that a universal Hib immunization program in Korea would prevent 17 deaths and 280 invasive Hib cases. When we assumed the one Hib immunization cost as 26,000 won, the national Hib immunization would cost 34.6 billion won. Costs for various Hib diseases were estimated at 26.8 billion won (11.8 billion won from direct costs and 14.9 billion won from indirect costs). A benefit-cost ratio of 0.77 showed that the economic efficiency of the integration of Hib immunization in Korea is low because of the low incidence rate of Hib disease and high price of vaccine. However, if the Hib immunization cost decrease to less than 20,000 won, a benefit-cost ratio increase to 1.0 and above, integrating Hib immunization into the national immunization program with economic efficiency can be considered.
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Affiliation(s)
- Sangjin Shin
- Department of Health Care Management and Policy, Seoul National University, School of Public Health, Seoul, Korea
| | - Young-jeon Shin
- Department of Preventive Medicine, Hanyang University, College of Medicine, Seoul, Korea
| | - Moran Ki
- Department of Preventive Medicine, Eulji University, School of Medicine, Daejeon, Korea
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Rahman M, Hossain S, Baqui AH, Shoma S, Rashid H, Nahar N, Zaman MK, Khatun F. Haemophilus influenzae type-b and non-b-type invasive diseases in urban children (<5years) of Bangladesh: implications for therapy and vaccination. J Infect 2008; 56:191-6. [PMID: 18280571 DOI: 10.1016/j.jinf.2007.12.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2007] [Revised: 11/15/2007] [Accepted: 12/17/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To prospectively study the epidemiology and antibiotic resistance of Haemophilus infuenzae isolates from invasive infections in children. METHODS Children (<5years) with pneumonia, meningitis and septicemia from three hospitals in Dhaka, Bangladesh were enrolled (1999-2003); clinical and laboratory data, and blood for cultures were collected. Cerebrospinal fluid (CSF) of meningitis cases was analyzed (Gram stain, culture and biochemical tests). Hib antigen was detected by latex agglutination (LA) in culture-negative pyogenic CSF and PCR was done for bexA gene in culture- and LA-negative pyogenic CSF. Antibiotic susceptibility was determined by E-Tests and beta-lactamase by nitrocefin stick. RESULTS Seventy-three cases of H. influenzae infections (46 of 293 meningitis cases, 25 of 1493 pneumonia cases, 2 of 48 septicemia cases) were detected; 63%, 34% and 3% of them had meningitis, pneumonia and septicemia respectively. H. influenzae type b (Hib) caused infections in 80.8% of cases (60.3% meningitis, 20.5% pneumonia). Most (86%) infections clustered in 4-12month infants. The case-fatality in pneumonia was 8% compared to 19% in meningitis. H. influenzae isolates from pneumonia and meningitis children were equally resistant to antibiotics (46% vs 43%). Of 10 drugs tested, isolates were resistant to ampicillin (31%), chloramphenicol (42%), trimethoprim-sulfamethoxazole (44%) and azithromycin (1.4%). Multidrug-resistant (MDR) strains were equally prevalent in Hib (31%) and non-b-type (29%) isolates, and in pneumonia (31%) and meningitis (34%) cases. None was resistant to amoxicillin-clavulanate, ceftriaxone, ciprofloxacin, levofloxacin, moxifloxacin, and gatifloxacin. Of all H. influenzae infections, 40%, 4.4% and 100% of pneumonia, meningitis and septicemia cases were caused by other serotypes or non-typeable strains. All ampicillin-resistant-strains produced beta-lactamase without detection of beta-lactamase-negative-ampicillin-resistant (BLNAR) strains. CONCLUSION Hib is a leading cause of invasive bacterial infections in infants. Multidrug-resistant H. influenzae is common and requires amoxicillin-clavulanate, ceftriaxone or azithromycin as empirical therapy with specific recommendation for use of ceftriaxone for treatment of meningitis particularly MDR cases. New fluoroquinolines has potential utility. An effective national Hib vaccination programme is essential in Bangladesh although non-Hib infections will remain an issue.
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Affiliation(s)
- Mahbubur Rahman
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
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Lee EHJ, Lewis RF, Makumbi I, Kekitiinwa A, Ediamu TD, Bazibu M, Braka F, Flannery B, Zuber PL, Feikin DR. Haemophilus influenzae type b conjugate vaccine is highly effective in the Ugandan routine immunization program: a case-control study. Trop Med Int Health 2008; 13:495-502. [DOI: 10.1111/j.1365-3156.2008.02027.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rossi IA, Zuber PLF, Dumolard L, Walker DG, Watt J. Introduction of Hib vaccine into national immunization programmes: A descriptive analysis of global trends. Vaccine 2007; 25:7075-80. [PMID: 17825458 DOI: 10.1016/j.vaccine.2007.07.058] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2007] [Revised: 07/27/2007] [Accepted: 07/28/2007] [Indexed: 11/18/2022]
Abstract
Despite the demonstration of effectiveness and public health impact of Hib conjugate vaccines, the majority of infants from poorest countries do not yet have access to this safe and effective preventive intervention. This paper provides a descriptive analysis of the main characteristics of countries that have included Hib vaccine in their national immunization programmes before 2006. It highlights the importance of regularly analyzing the process of decision-making involved in implementation of public health interventions, in order to learn from cumulative experience and expedite the introduction of future interventions.
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Affiliation(s)
- Isabelle A Rossi
- Institute of Social and Preventive Medicine, University of Lausanne, rue du Bugnon 17, 1005 Lausanne, Switzerland.
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Thoon KC, Chong CY, Ng WYM, Kilgore PE, Nyambat B. Epidemiology of invasive Haemophilus influenzae type b disease in Singapore children, 1994–2003. Vaccine 2007; 25:6482-9. [PMID: 17651871 DOI: 10.1016/j.vaccine.2007.06.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2006] [Revised: 06/08/2007] [Accepted: 06/10/2007] [Indexed: 11/24/2022]
Abstract
Invasive Haemophilus influenzae type b (Hib) diseases are major causes of childhood morbidity and mortality. For the period from 1994 to 2003, we retrospectively identified 53 children with invasive Hib disease including 31 with meningitis, 14 with pneumonia, 2 with septic arthritis, 2 with epiglottitis, 1 with neutropenic sepsis, and 3 who were bacteraemic without a focus. Two children died and 22 had serious sequelae; significantly, survivors with sequelae had presented with meningitis (P-value<0.001) or sepsis (P-value=0.001). During the 11-year period, the annual incidence of invasive Hib disease was estimated to be 4.4/100,000 children <5 years old. With rising affluence, decreasing costs of vaccines, and increased costs in caring for survivors, universal infant immunization with Hib vaccine may need to be reconsidered in Singapore.
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Affiliation(s)
- Koh Cheng Thoon
- Infectious Disease Service, Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore
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Abstract
Acute bacterial meningitis remains an important cause of morbidity and mortality in children. Children <2 years of age are particularly susceptible to infection with encapsulated bacteria due to their immature response to polysaccharide antigens. Conjugate vaccines, which induce T cell memory, can provide immunological protection for these children. The Haemophilus influenzae type b (Hib) conjugate vaccine was the first such vaccine to become available. The efficacy of the vaccine has been quoted as being 98%. Its introduction was followed by a dramatic decrease in the incidence of all invasive Hib disease, including meningitis. This reduction was in part due to the ability of these vaccines to reduce nasopharyngeal carriage of the organism and thereby induce herd immunity. Different Hib vaccines use a variety of protein carriers and differ in their immunogenicity and efficacy. The most suitable vaccine needs to be determined according to the local epidemiology of Hib disease. Commercial combination vaccines may lead to lower antibody levels. A recent increase in the incidence of Hib disease in the UK highlights the importance of continued surveillance and the need for booster vaccinations to ensure continued protection. Conjugate vaccines to Streptococcus pneumoniae and Neisseria meningitidis have been developed. The introduction of a pneumococcal conjugate vaccine in the US has led to a decrease in the rate of infection by nearly 60% in children <5 years of age. A reduction in pneumococcal carriage may also modify disease epidemiology. The UK introduced the conjugate meningococcal C vaccine into its infant schedule with a corresponding reduction in N. meningitidis group C disease. A recent decrease in the effectiveness of the vaccine, however, suggests a booster may be necessary in the future. Our present understanding of the immunology of conjugate vaccines is far from complete. Developed countries have introduced conjugate vaccines into their immunisation schedules to prevent bacterial meningitis; however, their high cost precludes their use in many developing countries. Progress needs to be made in order to get these highly effective vaccines to those areas that need them.
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Affiliation(s)
- Nick Makwana
- Department of Child Health, Royal Liverpool Childrens Hospital, Liverpool, England
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Miranzi SDSC, de Moraes SA, de Freitas ICM. Impact of the Haemophilus influenzae type b vaccination program on HIB meningitis in Brazil. CAD SAUDE PUBLICA 2007; 23:1689-95. [PMID: 17572819 DOI: 10.1590/s0102-311x2007000700021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2005] [Accepted: 12/27/2006] [Indexed: 11/21/2022] Open
Abstract
This study aimed to evaluate the impact of vaccination against Haemophilus influenzae type b (HIB) in Brazil on the morbidity, mortality, and case fatality of HIB meningitis, using the Ministry of Health database and population data from the Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatística - IBGE). Impact was evaluated through a time series analysis (1983-2002), using regression forecasting (RF) by dividing the time series into two periods: (a) historical (1983-1998) and (b) validation (1999-2002). Impact of the vaccination was positive, although more significant for incidence and mortality than for case fatality rates.
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Abstract
OBJECTIVE To ascertain the uptake of newer vaccines in Chandigarh. METHODS Uptake of newer vaccines was ascertained in under five children through house to house survey during Jan 2004-Sep 2005 in sector 44 of Chandigarh. RESULTS Of 1031 children of the total urban population, More than 40% got immunized with newer vaccines. Maximum coverage was seen for Hepatitis B 461 (44.7%) for 3 doses followed by immunization against Hib 287(27.8%). MMR vaccine coverage was 285 (27.6%). For typhoid and varicella coverage was less. More than 50% children got immunization from private sector. CONCLUSION The newer vaccines are available in the market and being used by the people especially being catered by the private sector.
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Affiliation(s)
- Sonia Puri
- Department of Community Medicine, Govt. Medical College, College Building, Sector 32-A, Chandigarh, India.
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Miranzi SDSC, Moraes SAD, Freitas ICMD. Tendência das meningites por Haemophilus influenzae tipo b no Brasil, em menores de 5 anos, no período de 1983 a 2002. Rev Soc Bras Med Trop 2006; 39:473-7. [PMID: 17160326 DOI: 10.1590/s0037-86822006000500010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2005] [Accepted: 09/08/2006] [Indexed: 11/22/2022] Open
Abstract
Trata-se de um estudo ecológico, tipo série histórica (1983-2002), onde foram calculados os coeficientes de incidência, mortalidade e letalidade de meningites por Haemophilus influenzae , tipo b, no Brasil, e avaliou-se a tendência da morbi-mortalidade em menores de 5 anos. Para a análise de tendência dos coeficientes construíram-se modelos de regressão polinomial para as faixas etárias de < 1 ano e de 1 a 4 anos. O nível de significância adotado foi alfa=0,05. 43,9% dos casos confirmados ocorreram em menores de 1 ano e 38,7% nos de 1 a 4 anos. Os indicadores de maior magnitude também foram observados nestas duas faixas etárias. Desde o início da série, houve uma tendência de ascensão dos coeficientes de incidência e mortalidade até, aproximadamente, 1999, quando foi observado declínio abrupto destes indicadores. Os resultados reforçam a eficiência do Programa de Vacinação contra HIB, no Brasil, que favoreceu, inclusive, faixas etárias não vacinadas (Imunidade Rebanho).
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Arora R, Puliyel JM. Economic evaluation tailored to promote vaccine uptake: how third world consumers can respond. Expert Rev Pharmacoecon Outcomes Res 2005; 5:515-6. [PMID: 19807578 DOI: 10.1586/14737167.5.5.515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Barzilay EJ, O'Brien KL, Kwok YS, Hoekstra RM, Zell ER, Reid R, Santosham M, Whitney CG, Feikin DR. Could a single dose of pneumococcal conjugate vaccine in children be effective? Modeling the optimal age of vaccination. Vaccine 2005; 24:904-13. [PMID: 16203059 DOI: 10.1016/j.vaccine.2005.08.092] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2005] [Revised: 08/08/2005] [Accepted: 08/22/2005] [Indexed: 02/02/2023]
Abstract
Using incidence rates from CDC's Active Bacterial Core surveillance and immunogenicity data from the Navajo/Apache trial of pneumococcal conjugate vaccine (PCV), we used Markov modeling to predict the optimal age to give a single dose of PCV. Antibody concentration thresholds of 0.35 and 1.0 mcg/ml were considered protective. Our outcome was vaccine serotype-specific invasive pneumococcal disease (IPD) incidence at 24 months. The models predicted the optimal age to vaccinate is 5-7 months with vaccine-induced immunologic memory and 8-10 months without memory. IPD reduction ranged from 15 to 62%, depending on model parameters. A single PCV dose in infants could prevent substantial IPD.
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Affiliation(s)
- Ezra J Barzilay
- Emory University School of Medicine, Department of Pediatrics, Atlanta, GA, USA
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Feikin DR, Nelson CB, Watt JP, Mohsni E, Wenger JD, Levine OS. Rapid assessment tool for Haemophilus influenzae type b disease in developing countries. Emerg Infect Dis 2004; 10:1270-6. [PMID: 15324548 PMCID: PMC3323330 DOI: 10.3201/eid1007.030737] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Haemophilus influenzae type b disease prevalence in children provides estimates of national disease prevalence. Haemophilus influenzae type b (Hib) still causes a substantial number of deaths among children in developing countries, despite the availability of effective conjugate vaccines. A major obstacle in developing a Hib vaccine has been limited awareness about the impact of Hib disease. A tool was developed to estimate the national rates of Hib meningitis and pneumonia by assessing retrospective local data over 7 to 10 days. Data from 11 countries in Africa, the Middle East, and Asia were studied and showed rates of Hib meningitis from >50 cases per 100,000 children >5 years in Ghana and Uganda to <15 per 100,000 in Iran, Jordan, and Uzbekistan. Results were affected by the quality of available data. The Hib rapid assessment tool can be useful to countries that desire a timely assessment of Hib disease rates.
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Affiliation(s)
- Daniel R Feikin
- Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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26
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Martin M, Casellas JM, Madhi SA, Urquhart TJ, Delport SD, Ferrero F, Chamany S, Dayan GH, Rose CE, Levine OS, Klugman KP, Feikin DR. Impact of haemophilus influenzae type b conjugate vaccine in South Africa and Argentina. Pediatr Infect Dis J 2004; 23:842-7. [PMID: 15361724 DOI: 10.1097/01.inf.0000137575.82874.0c] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Haemophilus influenzae type b (Hib) persists as a major cause of pediatric meningitis and pneumonia in developing countries in which Hib conjugate vaccines are not used. Demonstration of decreases in severe Hib disease after countries introduce Hib conjugate vaccine will help justify the resources necessary to purchase and provide the vaccine. Because surveillance for culture-confirmed Hib meningitis is not available in many countries, alternative means to measure the impact of Hib conjugate vaccine would be useful. METHODS Laboratory records from the years before and after introduction of the Hib conjugate vaccine were reviewed at 4 hospitals, 2 in Argentina and 2 in South Africa. Potential indicators of bacterial meningitis including cerebrospinal fluid (CSF) culture, white blood cell count, appearance, protein and glucose were recorded. RESULTS After introduction of Hib conjugate vaccine, culture-confirmed Hib meningitis declined significantly at 3 of 4 hospitals (2 in Argentina and 1 in South Africa). In the same 3 hospitals, there was a significant decline after vaccine introduction in some of the following CSF indicators of bacterial meningitis: proportion of CSF specimens with white blood cell count > or = 100 x 10(6)/L, 500 x 10(6)/L and 1,000 x 10(6)/L; glucose <40 mg/dL; protein >100 mg/dL; and turbid appearance. CONCLUSIONS Culture-confirmed Hib meningitis declined at 3 of the 4 hospitals after Hib vaccine introduction. Surrogate indicators of bacterial meningitis also declined and might be useful measures of Hib conjugate vaccine impact at hospitals where capacity to culture Hib is not available.
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Affiliation(s)
- Michael Martin
- Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Abstract
BACKGROUND Haemophilus influenzae type b (Hib) infection has a high morbidity and mortality rate especially in children under 5 years of age. The incidence of Hib disease in Turkey is not known, and Hib vaccine is not included in the National Immunization Program. The aim of this study was to determine the natural immunity to Hib of children 6-60 months of age living in the Park Health Center region of Ankara, Turkey. METHODS A total of 270 children were selected by layered random sampling method, and 242 of them (89.6%) participated in the study. A questionnaire was given to the parents of the children who were included in the study and blood samples were taken from those children. Anti-Hib IgG antibody (anti-PRP) level was determined in the serum by using anti-Haemophilus influenzae IgG EIA kit and anti-PRP antibody levels of 0.15 microg/mL and over were accepted as the natural immunity. RESULTS Natural immunity was determined in 65.3% of the children. A relationship was determined statistically between the history of disease with possible Hib agent and with natural immunity. CONCLUSIONS The exposure rate of children with Hib was higher than expected, even in children who were just a few months old. Our data revealed that multicentric, national studies should be done to define the burden of Hib disease before making a decision for Hib vaccine to be included in the National Immunization Program.
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Affiliation(s)
- Esin Ocaktan
- Department of Public Health, Ankara University, School of Medicine, Ankara, Turkey.
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Brinsmead R, Hill S, Walker D. Are economic evaluations of vaccines useful to decision-makers? Case study of Haemophilus influenzae type b vaccines. Pediatr Infect Dis J 2004; 23:32-7. [PMID: 14743043 DOI: 10.1097/01.inf.0000105104.39284.a3] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND In concert with efforts to increase global provision, economic evaluations of newer and relatively costly vaccines have proliferated in the medical literature. The extent to which existing vaccine evaluations are useful to decision makers is not clear. We conducted a systematic review of published economic evaluations of conjugate Haemophilus influenzae type b (Hib) vaccine, anticipating that their usefulness to past and present decision makers would be limited by the quality of the analyses and by the extent to which the results were transferable to other settings. METHODS We systematically identified economic evaluations of conjugate Hib vaccine. We appraised their quality according to a customized checklist and assessed the extent of and reasons for variability of the results. RESULTS Quality assessment of the available economic evaluations disclosed a number of shortcomings, including the failure across all models to derive systematic estimates of vaccine efficacy as well as a lack of transparency in the costing of Hib disease treatment. Wide variations in results appeared to be caused primarily by epidemiologic and health system differences between settings and secondarily to methodologic differences between models. The generalizability of model results appeared low. CONCLUSIONS There is scope for improving the overall quality of economic evaluations of Hib vaccination. Relevance to decision makers may also be increased by addressing local budget constraints and vaccine price. There is a need to better understand the decision process, particularly at the national level, to ensure the role of future economic evaluations as important decision tools in the implementation of new vaccines.
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Affiliation(s)
- Regina Brinsmead
- Clinical Pharmacology, School of Medical Practice and Population Health, Faculty of Health, University of Newcastle, Newcastle, Australia.
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29
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Dominguez SR, Daum RS. Toward Global Haemophilus influenzae Type b Immunization. Clin Infect Dis 2003; 37:1600-2. [PMID: 14689338 DOI: 10.1086/379721] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2003] [Accepted: 09/05/2003] [Indexed: 11/03/2022] Open
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Miranzi SDSC, Camacho LAB, Valente JG. Haemophilus influenzae tipo b: situação epidemiológica no Estado de Minas Gerais, Brasil, 1993 a 1997. CAD SAUDE PUBLICA 2003; 19:1267-75. [PMID: 14666208 DOI: 10.1590/s0102-311x2003000500005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Entre as doenças invasivas causadas pelo Haemophilus influenzae tipo b (Hib), destacam-se, pela freqüência e gravidade, as pneumonias e as meningites. No período de 1993 a 1997, foram notificados, em Minas Gerais, 720 casos de meningites por Hib, sendo a causa mais freqüente de meningite bacteriana em menores de um ano e a segunda causa no total de meningites. Entretanto, estimou-se uma ocorrência total de 1.160 casos considerando as meningites bacterianas não especificadas. O total de casos estimados de doença invasiva por Hib parece justificar a recente inclusão da vacina no esquema básico de imunizações. O alto custo da vacina reforça a necessidade de melhorar a vigilância epidemiológica da meningite, que constitui uma das fragilidades das ações de controle desta doença.
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Zanella RC, Casagrande ST, Bokermann S, Almeida SCG, Brandileone MCC. Characterization of haemophilus influenzae isolated from invasive disease in Brazil from 1990 to 1999. Microb Drug Resist 2002; 8:67-72. [PMID: 12002652 DOI: 10.1089/10766290252913782] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The Haemophilus influenzae serotype b (Hib) conjugate vaccine was introduced in the National Immunization Program in Brazil in the second half of 1999. A retrospective analysis on serotypes, biotypes, and antimicrobial resistance of Hi invasive strains obtained through Hi survey was conducted to document the characteristics of this pathogenic agent during a decade prior the use of Hib vaccine. A total 3,204 strains from 1990 to 1999 were studied, being 88.2% isolated from cerebrospinal fluid, 10.7% from blood, and 1.1% from pleural fluid. The rate of 90.9% of strains was obtained from children up to 4 years old, and the age group >6 months old to 1 year was the higher risk to Hi infection. Type b was, by far, the most common type (97.8%), followed in frequency by type a (0.5%); only 1.5% was a nontypable strain. Biotypes I and II accounted for 97.8% of isolates. Resistance to ampicillin (AM) and chloramphenicol (CO) was detected at rates of 18.1% and 19.1%, respectively, whereas simultaneous resistance to AM and CO was identified in 13.9% of strains. Total concordance was found between AM resistance and beta-lactamase production. No strain showed resistance to ceftriaxone and rifampicin. In conclusion, the data generated through this laboratory-based surveillance should serve as a reference for assessing the impact of Hib vaccination and to detect changes on the pattern of Hi diseases in the country.
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Puliyel JM, Agarwal KS, Abed Abass F. Natural immunity to Haemophilus influenza b in infancy in Indian children. Vaccine 2001; 19:4592-4. [PMID: 11535305 DOI: 10.1016/s0264-410x(01)00222-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- J M Puliyel
- Department of Pediatrics, St Stephens Hospital, Tis Hazari, 110054, Delhi, India.
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Beck JG, Low KH, Burnett M, Xu L, Suleyman S, Thompson KM, Sullivan L, Natvig JB, George V. Analysis of 'natural' and vaccine-induced haemophilus influenzae type B capsular polysaccharide serum antibodies for 3H1, a V3-23-associated idiotope. Immunol Lett 2000; 72:171-7. [PMID: 10880838 DOI: 10.1016/s0165-2478(00)00185-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The variable (V-) region repertoire of antibodies (Abs) to Haemophilus influenzae capsular polysaccharide (Hib PS) has been extensively studied in individuals vaccinated against the microbe, but to a lesser extent in subjects who generated such Abs in response to a 'natural' encounter with this microbe or its antigenic mimics. To gain an insight into the repertoire of Hib PS-reactive Abs in vaccinated and non-vaccinated individuals, we used a monoclonal Ab, 3H1, which detects an idiotypic marker associated with an Ab V-region gene, V3-23. We show here that Hib PS-reactive Abs with detectable 3H1 idiotope can be quantified by an indirect inimunoezymatic assay in serum samples of non-vaccinated healthy adults as well as of recently vaccinated healthy infants. The percentage of Abs that was simultaneously Hib PS-reactive and 3H1-positive ranged widely (from 0 to 68%) among individual serum samples from both groups of subjects. No dramatic differences in the expression of 3H1 idiotope on Hib PS-reactive Abs were found between vaccinated and non-vaccinated individuals. Our results are consistent with the hypothesis that the utilization of V-region genes in Hib PS-reactive Abs that individuals generate after a 'natural' encounter with Hib PS or its mimics is similar to that in these Abs elicited by Hib PS conjugate vaccines.
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Affiliation(s)
- J G Beck
- Department of Biological Sciences, PO Drawer GY, Mississippi State University, MS 39762, USA
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Lee YS, Kumarasinghe G, Chow C, Khor E, Lee BW. Invasive Haemophilus influenzae type b infections in Singapore children: a hospital-based study. J Paediatr Child Health 2000; 36:125-7. [PMID: 10760009 DOI: 10.1046/j.1440-1754.2000.00459.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE A 6-year (1990-95) hospital-based retrospective study was carried out to investigate the pattern of invasive Haemophilus influenzae type b (Hib) disease. METHODOLOGY Cases with Hib isolated from sterile sites (blood, cerebrospinal fluid, or joint aspirate) were identified from the hospital's microbiological records, and their reviewed case records. Patients with pyogenic meningitis in the same study period were also identified to estimate the incidence of Hib meningitis. RESULTS Twelve patients had positive cultures from sterile sites, of whom nine children were less than 5 years of age. These included seven cases of meningitis, one patient with acute epiglottitis, and one case of pneumonia. Three of the seven patients with meningitis had significant long-term sequelae. Our data also suggests a relatively low proportion of ethnic Chinese children with invasive disease. It was estimated that 18.4% to 41.1% of pyogenic meningitis in children admitted to the National University Hospital were due to Hib. The estimated annual attack rate of invasive Hib disease was at most 3.3 per 100 000 children aged less than 5 years (95% confidence interval: 2.6-3.5/100 000). CONCLUSION : Invasive Hib infections are relatively uncommon in our community. This justifies the need for a cost effectiveness study before a universal Hib vaccination program is implemented.
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Affiliation(s)
- Y S Lee
- Department of Paediatrics and Division of Microbiology, Department of Laboratory Medicine, National University Hospital, Singapore
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Moustaoui N, Aitmhand R, Elmdaghri N, Benbachir M. Serotypes, biotypes and antimicrobial susceptibilities of Haemophilus influenzae isolated from invasive disease in children in Casablanca. Clin Microbiol Infect 2000; 6:48-9. [PMID: 11168038 DOI: 10.1046/j.1469-0691.2000.00015-3.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- N Moustaoui
- Microbiology Laboratory, Faculte de Medecine, IbnRochd University Hospital, BP 9154, Casablanca, Morocco
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Levine OS, Liu G, Garman RL, Dowell SF, Yu S, Yang YH. Haemophilus influenzae type b and Streptococcus pneumoniae as causes of pneumonia among children in Beijing, China. Emerg Infect Dis 2000; 6:165-70. [PMID: 10756150 PMCID: PMC2640844 DOI: 10.3201/eid0602.000209] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
To determine if Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae could be identified more often from the nasopharynx of patients with pneumonia than from control patients, we obtained nasopharyngeal swab specimens from 96 patients with chest x-ray-confirmed pneumonia and 214 age-matched control patients with diarrhea or dermatitis from the outpatient department at Beijing Children's Hospital. Pneumonia patients were more likely to be colonized with Hib and S. pneumoniae than control patients, even after the data were adjusted for possible confounding factors such as day-care attendance, the presence of other children in the household, and recent antibiotic use. In China, where blood cultures from pneumonia patients are rarely positive, the results of these nasopharyngeal cultures provide supporting evidence for the role of Hib and S. pneumoniae as causes of childhood pneumonia.
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Affiliation(s)
- O S Levine
- Respiratory Diseases Branch, National Institute of Allergy and Infectious Diseases, Bethesda, MD 20892-7630, USA.
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Levine OS, Lagos R, Muñoz A, Villaroel J, Alvarez AM, Abrego P, Levine MM. Defining the burden of pneumonia in children preventable by vaccination against Haemophilus influenzae type b. Pediatr Infect Dis J 1999; 18:1060-4. [PMID: 10608624 DOI: 10.1097/00006454-199912000-00006] [Citation(s) in RCA: 91] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine the burden of pneumonia requiring hospitalization in infants and young children preventable by vaccination against Haemophilus influenzae type b (Hib). DESIGN Vaccination centers in Santiago, Chile, were randomly selected to administer PRP-T, an Hib conjugate vaccine, combined with diphtheria-tetanus toxoids-pertussis (DTP) vaccine or DTP alone. SUBJECTS Infants who received > or =2 doses of DTP or DTP and Hib conjugate vaccine combined. MAIN OUTCOME MEASURES Pneumonia episodes leading to hospitalization accompanied by indicators of likely bacterial infection including radiologic evidence of alveolar consolidation or pleural effusion, an elevated erythrocyte sedimentation rate (> or =40 mm/h) or bronchial breath sounds on auscultation. RESULTS In participants age 4 to 23 months, PRP-T reduced the incidence of pneumonia associated with alveolar consolidation or pleural effusion by 22% (95% confidence interval, -7 to 43) from 5.0 to 3.9 episodes per 1000 children per year. When the pneumonia case definition included any of the following, alveolar consolidation, pleural effusion, erythrocyte sedimentation rate > or =40 mm/h or bronchial breath sounds, PRP-T provided 26% protection (95% confidence interval, 7 to 44) and prevented 2.5 episodes per 1000 children per year. CONCLUSIONS Hib vaccine provides substantial protection against nonbacteremic pneumonia, particularly those cases with alveolar consolidation, pleural effusion or other signs of likely bacterial infection. Hib vaccination prevented approximately 5 times as many nonbacteremic pneumonia cases in infants as meningitis cases, thus indicating that the largest part of the effect of Hib vaccination might be undetectable by routine culture methods.
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Affiliation(s)
- O S Levine
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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