The impact of routine infant immunization with Haemophilus influenzae type b conjugate vaccine in Malawi, a country with high human immunodeficiency virus prevalence
Mzuzu Central Hospital, Mzuzu, Malawi; World Health Organization, Lilongwe, Malawi; Queen Elizabeth Central Hospital, Blantyre, Malawi; National EPI Programme, Ministry of Health, Lilongwe, Malawi; Agence de Médecine Préventive a l'Institut Pasteur, 28 rue du Docteur Roux, 75015 Paris, France; African Regional Office, World Health Organization, Harare, Zimbabwe; World Health Organization, Geneva, Switzerland; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, Blantyre, Malawi; Paediatrics Department, College of Medicine, Blantyre, Malawi
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. © 2006 Elsevier Ltd. All rights reserved.
amoxicillin; chloramphenicol; diphtheria pertussis tetanus vaccine; Haemophilus influenzae type b vaccine; penicillin G; acute disease; antibiotic resistance; antibiotic therapy; article; bacterial meningitis; clinical assessment; controlled study; diphtheria; dose response; drug cost; drug efficacy; groups by age; Haemophilus influenzae type b; hospital; hospital admission; human; Human immunodeficiency virus; Human immunodeficiency virus infection; immunization; incidence; infant; infection prevention; major clinical study; Malawi; medical documentation; medical record; pertussis; preschool child; prevalence; priority journal; rural area; tetanus; treatment outcome; urban area; Age Factors; Child, Preschool; Diphtheria-Tetanus-Pertussis Vaccine; Female; Haemophilus influenzae type b; Haemophilus Vaccines; Hepatitis B Vaccines; HIV; HIV Infections; Humans; Incidence; Infant; Infant, Newborn; Malawi; Male; Meningitis, Haemophilus; Prevalence; Vaccination