title: Action for child survival: elimination of Haemophilus influenzae type b meningitis in Uganda.
abstract: OBJECTIVE
  To guide immunization policy, we determined the public health benefit of introducing Haemophilus influenzae type b (Hib) vaccine in Uganda and estimated the vaccine effectiveness.
  
  
  METHODS
  Surveillance data for acute bacterial meningitis among children aged 0-59 months were reviewed from three hospital sentinel sites, for July 2001 to June 2007, to determine the incidence of Hib meningitis, the effectiveness of Hib vaccine with a case-control design, and the number of vaccine-preventable cases and deaths of Hib disease in Uganda.
  
  
  RESULTS
  Of the 13 978 children from 17 districts with suspected bacterial meningitis, 269 had confirmed Hib meningitis, declining from 69 patients in the prevaccine year (2001-2002) to three in 2006-2007. Hib meningitis incidence dropped from 88 cases per 100,000 children aged < 5 years in the year before vaccine introduction to 13 within 4 years, and to near zero in the fifth year. Vaccine effectiveness for 2 or more doses was 93% (95% confidence interval, CI: 69-99) against confirmed Hib meningitis and 53% (95% CI: 11-68) against purulent meningitis of unknown cause. In Uganda, Hib vaccine prevents an estimated 28 000 cases of pneumonia and meningitis, 5000 deaths and 1000 severe meningitis sequelae each year.
  
  
  CONCLUSIONS
  Infant immunization with Hib vaccine has virtually eliminated Hib meningitis in Uganda within 5 years. Ensuring long-term benefits of Hib vaccine urgently requires sustainable vaccine financing, high-quality ongoing surveillance, and a health sector able to deliver a robust immunization programme.
authors.affiliation: Uganda Country Office, World Health Organization, Kampala, Uganda. rosamund_lewis@yahoo.ca
authors.forename: Rosamund F
authors.initials: RF
authors.lastname: Lewis
authors.forename: Annet
authors.initials: A
authors.lastname: Kisakye
authors.forename: Bradford D
authors.initials: BD
authors.lastname: Gessner
authors.forename: Chaplain
authors.initials: C
authors.lastname: Duku
authors.forename: John Bosco
authors.initials: JB
authors.lastname: Odipio
authors.forename: Robert
authors.initials: R
authors.lastname: Iriso
authors.forename: Denis
authors.initials: D
authors.lastname: Nansera
authors.forename: Fiona
authors.initials: F
authors.lastname: Braka
authors.forename: Issa
authors.initials: I
authors.lastname: Makumbi
authors.forename: Addy
authors.initials: A
authors.lastname: Kekitiinwa
mesh_terms: D016667:Bacterial Capsules / Q000008:administration & dosage*; D002675:Child, Preschool; D018073:Haemophilus Vaccines / Q000008:administration & dosage*; D019741:Haemophilus influenzae type b / Q000276:immunology* / Q000302:isolation & purification; D006801:Humans; D017589:Immunization Programs; D007223:Infant; D007231:Infant, Newborn; D008583:Meningitis, Haemophilus / Q000453:epidemiology / Q000517:prevention & control* / Q000821:virology; D018410:Pneumonia, Bacterial / Q000453:epidemiology / Q000517:prevention & control / Q000821:virology; D011159:Population Surveillance; D014454:Uganda / Q000453:epidemiology
chemical_list: D018073:Haemophilus Vaccines; C044237:Haemophilus influenzae type b polysaccharide vaccine