title: The impact of routine infant immunization with Haemophilus influenzae type b conjugate vaccine in Malawi, a country with high human immunodeficiency virus prevalence.
abstract: 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.
authors.affiliation: Mzuzu Central Hospital, Mzuzu, Malawi.
authors.forename: Paul
authors.initials: P
authors.lastname: Daza
authors.forename: Richard
authors.initials: R
authors.lastname: Banda
authors.forename: Keystoxe
authors.initials: K
authors.lastname: Misoya
authors.forename: Agnes
authors.initials: A
authors.lastname: Katsulukuta
authors.forename: Bradford D
authors.initials: BD
authors.lastname: Gessner
authors.forename: Reggis
authors.initials: R
authors.lastname: Katsande
authors.forename: Bekithemba R
authors.initials: BR
authors.lastname: Mhlanga
authors.forename: Judith E
authors.initials: JE
authors.lastname: Mueller
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Nelson
authors.forename: Amos
authors.initials: A
authors.lastname: Phiri
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Molyneux
authors.forename: Malcolm E
authors.initials: ME
authors.lastname: Molyneux
mesh_terms: D000367:Age Factors; D002675:Child, Preschool; D015721:Diphtheria-Tetanus-Pertussis Vaccine / Q000276:immunology / Q000627:therapeutic use*; D005260:Female; D006678:HIV / Q000276:immunology*; D015658:HIV Infections / Q000453:epidemiology / Q000276:immunology*; D018073:Haemophilus Vaccines / Q000276:immunology / Q000627:therapeutic use*; D019741:Haemophilus influenzae type b / Q000276:immunology*; D017325:Hepatitis B Vaccines / Q000276:immunology / Q000627:therapeutic use*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008583:Meningitis, Haemophilus / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D015995:Prevalence; D014611:Vaccination / Q000379:methods
chemical_list: D015721:Diphtheria-Tetanus-Pertussis Vaccine; D018073:Haemophilus Vaccines; D017325:Hepatitis B Vaccines; C122182:diphtheria-tetanus-acellular pertussis-Hib-hepatitis B vaccine