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Free Content Haemophilus influenzae type b conjugate vaccine is highly effective in the Ugandan routine immunization program: a case–control study

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Abstract:

Summary Objective  To study the effectiveness of the type b (Hib) vaccination program in Uganda. Methods  Case–control study of Hib vaccine effectiveness against Hib meningitis. Cases were children hospitalized with Hib meningitis confirmed by culture and/or latex agglutination. Cases were identified retrospectively from July 2002 to July 2004, and prospectively from July 2004 to July 2005. Each case-patient was matched by age to three neighbourhood and three hospital controls; all children were eligible to receive Hib vaccine through the routine schedule. Vaccine effectiveness was evaluated by conditional logistic regression, controlling for confounding variables. Results  We enrolled 41 cases; their median age was 6 months. Only six (15%) cases, all HIV-negative, had received ≥2 doses of Hib vaccine, compared with 64% of neighbourhood controls and 70% of hospital controls. Controlling for maternal education, the only variable which remained in the multivariable model, vaccine effectiveness for two or three doses no dose was 99% [95% confidence intervals (CI) 92–100%] and 96% (95% CI 80–100%) when cases were compared with neighbourhood and hospital controls, respectively. Conclusion  In Uganda, Hib vaccine was highly effective in the context of the routine immunization schedule. Sustained routine use of Hib vaccine will contribute to the prevention of childhood morbidity and mortality.

French
Objectifs: 

Etudier l’efficacité du programme de vaccination Hib en Ouganda. Méthodes: 

Etude cas-témoins de l’efficacité du vaccin Hib contre la méningite à Hib. Les cas étaient des enfants hospitalisés avec une méningite à Hib confirmée par la culture et/ou l’agglutination au latex. Les cas ont été identifiés rétrospectivement de juillet 2002 à juillet 2004 et prospectivement de juillet 2004 à juillet 2005. Chaque cas de patient était assorti pour l’âge à des contrôles dans trois quartiers et trois hôpitaux. Tous les enfants étaient en mesure de recevoir la vaccination Hib selon la routine prévue. L’efficacité du vaccin a étéévaluée par régression logistique conditionnelle, en tenant compte de variables confusionnelles. Résultats: 

Nous avons recruté 41 cas, leur âge médian était de 6 mois. Seuls 6 (15%) des cas, tous séronégatifs, avaient reçu ≥ 2 doses du vaccin Hib, comparéà 64% des contrôles des quartiers et 70% des contrôles d’hôpitaux. En tenant compte de l’éducation maternelle, seule variable demeurant dans le modèle multivarié, l’efficacité du vaccin après deux ou trois doses par rapport à aucune prise, était de 99% (intervalles de confiance [IC]95%: 92-100%) et 96% (IC95%: 80-100%) lorsque les cas ont été comparés aux contrôles des quartiers et à ceux de l’hôpital, respectivement. Conclusions: 

En Ouganda, le vaccin contre l’Hib était très efficace dans le contexte du programme de vaccination de routine. Une utilisation maintenue de la vaccination Hib contribuera à la prévention de la morbidité et de la mortalité infantile.

Keywords: Haemophilus influenzae de type b; Haemophilus influenzae tipo b; Haemophilus influenzae type b; Ouganda; Uganda; efectividad vacuna; efficacité du vaccin; meningitis; méningite; vaccine effectiveness

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1365-3156.2008.02027.x

Affiliations: 1:  WHO, Kampala, Uganda 2:  Ugandan National Expanded Programme on Immunisation, Ministry of Health, Kampala, Uganda 3:  Department of Paediatrics, Mulago National Referral Hospital, Kampala, Uganda 4:  Division of Bacterial Diseases, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA 5:  Department of Immunization, Vaccines and Biologicals, WHO, Geneva, Switzerland

Publication date: April 1, 2008

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