title: Incidences of vaccine-preventable Haemophilus influenzae type b pneumonia and meningitis in Indonesian children: hamlet-randomised vaccine-probe trial.
abstract: BACKGROUND
  Most studies of Haemophilus influenzae type b (Hib) disease in Asia have found low rates, and few Asian countries use Hib vaccine in routine immunisation programmes. Whether Hib disease truly is rare or whether many cases remain undetected is unclear.
  
  
  METHODS
  To estimate incidences of vaccine-preventable Hib pneumonia and meningitis among children younger than 2 years in Lombok, Indonesia, during 1998-2002, we undertook a hamlet-randomised, controlled, double-blind vaccine-probe study (818 hamlets). Children were immunised (WHO schedule) with diphtheria, tetanus, pertussis (DTP) or DTP-PRP-T (Hib conjugate) vaccine. Vaccine-preventable disease incidences were calculated as the difference in rates of clinical outcomes between DTP and DTP-PRP-T groups. Analyses included all children who received at least one vaccine dose.
  
  
  RESULTS
  We enrolled 55073 children: 28147 were assigned DTP-PRP-T and 26926 DTP. The proportion of pneumonia outcomes prevented by vaccine ranged from less than 0 to 4.8%. Calculated incidences of vaccine-preventable Hib disease (per 10(5) child-years of observation) for outcome categories were: substantial alveolar consolidation or effusion, less than zero (-43 [95% CI -185 to 98]); all severe pneumonia, 264 (95% CI less than zero to 629); all clinical pneumonia, 1561 (270 to 2853); confirmed Hib meningitis, 16 (1.4 to 31); meningitis with cerebrospinal-fluid findings consistent with a bacterial aetiology, 67 (22 to 112); and admission for suspected meningitis or presenting to a clinic with convulsions, 158 (42 to 273).
  
  
  CONCLUSIONS
  Hib vaccine did not prevent the great majority of pneumonia cases, including those with alveolar consolidation. These results do not support a major role for Hib vaccine in overall pneumonia-prevention programmes. Nevertheless, the study identified high incidences of Hib meningitis and pneumonia; inclusion of Hib vaccine in routine infant immunisation programmes in Asia deserves consideration.
authors.affiliation: Association Pour l'Aide à la Médecine Préventive, Paris, France. 106617.3011@compuserve.com
authors.forename: Bradford D
authors.initials: BD
authors.lastname: Gessner
authors.forename: Agustinus
authors.initials: A
authors.lastname: Sutanto
authors.forename: Mary
authors.initials: M
authors.lastname: Linehan
authors.forename: I Gusti Gede
authors.initials: IG
authors.lastname: Djelantik
authors.forename: Tracy
authors.initials: T
authors.lastname: Fletcher
authors.forename: I Komang
authors.initials: IK
authors.lastname: Gerudug
authors.lastname: Ingerani
authors.forename: David
authors.initials: D
authors.lastname: Mercer
authors.forename: Vanda
authors.initials: V
authors.lastname: Moniaga
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Moulton
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Moulton
authors.forename: Kim
authors.initials: K
authors.lastname: Mulholland
authors.forename: Carib
authors.initials: C
authors.lastname: Nelson
authors.forename: Soewignjo
authors.initials: S
authors.lastname: Soemohardjo
authors.forename: Mark
authors.initials: M
authors.lastname: Steinhoff
authors.forename: Anton
authors.initials: A
authors.lastname: Widjaya
authors.forename: Philippe
authors.initials: P
authors.lastname: Stoeckel
authors.forename: James
authors.initials: J
authors.lastname: Maynard
authors.forename: Soemarjati
authors.initials: S
authors.lastname: Arjoso
mesh_terms: D016667:Bacterial Capsules; D015721:Diphtheria-Tetanus-Pertussis Vaccine / Q000008:administration & dosage; D004311:Double-Blind Method; D005260:Female; D006192:Haemophilus Infections / Q000453:epidemiology / Q000517:prevention & control*; D018073:Haemophilus Vaccines / Q000008:administration & dosage; D006801:Humans; D017589:Immunization Programs; D015994:Incidence; D007214:Indonesia / Q000453:epidemiology; D007223:Infant; D008297:Male; D008583:Meningitis, Haemophilus / Q000453:epidemiology / Q000517:prevention & control*; D018410:Pneumonia, Bacterial / Q000453:epidemiology / Q000517:prevention & control*; D011135:Polysaccharides, Bacterial; D013745:Tetanus Toxoid / Q000008:administration & dosage; D018074:Vaccines, Conjugate
chemical_list: D015721:Diphtheria-Tetanus-Pertussis Vaccine; D018073:Haemophilus Vaccines; C055753:Haemophilus influenza type b polysaccharide vaccine-tetanus toxin conjugate; C044237:Haemophilus influenzae type b polysaccharide vaccine; D011135:Polysaccharides, Bacterial; D013745:Tetanus Toxoid; D018074:Vaccines, Conjugate