The impact of routine infant immunization with Haemophilus influenzae type b conjugate vaccine in Malawi, a country with high human immunodeficiency virus prevalence

• Published in: Vaccine Vol. 24; no. 37; pp. 6232 - 6239
• Main Authors: Daza, Paul, Banda, Richard, Misoya, Keystoxe, Katsulukuta, Agnes, Gessner, Bradford D., Katsande, Reggis, Mhlanga, Bekithemba R., Mueller, Judith E., Nelson, Christopher B., Phiri, Amos, Molyneux, Elizabeth M., Molyneux, Malcolm E.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 11-09-2006; Elsevier
• Subjects: Age Factors; Applied microbiology; Bacteriology; Biological and medical sciences; Child, Preschool; Diphtheria-Tetanus-Pertussis Vaccine - immunology; Diphtheria-Tetanus-Pertussis Vaccine - therapeutic use; Female; Fundamental and applied biological sciences. Psychology; Haemophilus influenzae; Haemophilus influenzae type b - immunology; Haemophilus Vaccines - immunology; Haemophilus Vaccines - therapeutic use; Hepatitis B Vaccines - immunology; Hepatitis B Vaccines - therapeutic use; HIV - immunology; HIV Infections - epidemiology; HIV Infections - immunology; Human immunodeficiency virus; Humans; Incidence; Infant; Infant, Newborn; Malawi; Malawi - epidemiology; Male; Meningitis, Haemophilus - epidemiology; Meningitis, Haemophilus - microbiology; Meningitis, Haemophilus - prevention & control; Microbiology; Miscellaneous; Prevalence; Streptococcus pneumoniae; Vaccination - methods; Vaccine effectiveness; Vaccines, antisera, therapeutical immunoglobulins and monoclonal antibodies (general aspects); Virology; Malawi; Africa; Malawi; Haemophilus influenzae; Vaccine effectiveness; Human; Immunization; Prevalence; Retroviridae; Infant; Vaccine; Lentivirus; Epidemiology; Pasteurellaceae; Virus; Bacteria; Human immunodeficiency virus
• ISSN: 0264-410X; 1873-2518
• DOI: 10.1016/j.vaccine.2006.05.076

Malawi has extreme poverty and a high-human immunodeficiency virus (HIV) prevalence. Following
Haemophilus influenzae type b (Hib) conjugate vaccine introduction during 2002, we evaluated vaccine impact by reviewing hospital surveillance data for acute bacterial meningitis in Blantyre district among children age 1–59 months admitted during 1997–2005. Documented annual Hib meningitis incidence rates decreased from 20–40/100,000 to near zero among both rural and urban residents despite no change in pneumococcal meningitis incidence rates. Before vaccine introduction, an average of 10 children/year had Hib meningitis and HIV infection compared to 2/year during 2003–2004 and none during 2005. Vaccine effectiveness was high following two or more doses of vaccine. The most urgent future need is for a sustainable routine infant immunization program, including a less expensive vaccine that preferably is delivered in a multivalent form.