Long-term complications and risk of other serious infections following invasive Haemophilus influenzae serotype b disease in vaccinated children.
This study describes the long-term complications in children with Haemophilus influenzae serotype b (Hib) vaccine failure and to determine their risk of other serious infections. The families of 323 children with invasive Hib disease after appropriate vaccination (i.e. vaccine failure) were contacted to complete a questionnaire relating to their health and 260 (80.5%) completed the questionnaire. Of the 124 children with meningitis, 18.5% reported serious long-term sequelae and a further 12.1% of parents attributed other problems to Hib meningitis. Overall, 14% (32/231 cases) of otherwise healthy children and 59% (17/29 cases) of children with an underlying condition developed at least one other serious infection requiring hospital admission. In a Poisson regression model, the risk of another serious infection was independently associated with the presence of an underlying medical condition (incidence risk ratio (IRR) 7.6, 95% CI 4.8-12.1; p<0.0001), both parents having had a serious infection (IRR 4.1, 95% CI 1.6-10.3; p=0.003), requirement of more than two antibiotic courses per year (IRR 2.3, 95% CI 1.4-3.6; p=0.001) and the presence of a long-term complication after Hib infection (IRR 1.8, 95% CI 1.1-3.1; p=0.03). Thus, rates of long-term sequelae in children with vaccine failure who developed Hib meningitis are similar to those in unvaccinated children in the pre-vaccine era. One in seven otherwise healthy children (14%) with Hib vaccine failure will go on to suffer another serious infection requiring hospital admission in childhood, which is higher than would be expected for the UK paediatric population.
Ladhani
Shamez
S
Academic Unit of Paediatrics, Barts and The London School of Medicine and Dentistry, London, United Kingdom. Electronic address: shamez.ladhani@hpa.org.uk.
Heath
Paul T
PT
Vaccine Institute and Division of Child Health, St George's, University of London, United Kingdom.
Aibara
Rashna J
RJ
Department of Paediatrics, Central Middlesex Hospital, London, United Kingdom.
Ramsay
Mary E
ME
Centre for Infections, Health Protection Agency, London, United Kingdom.
Slack
Mary P E
MPE
Centre for Infections, Health Protection Agency, London, United Kingdom.
Hibberd
Martin L
ML
Infectious Diseases Unit, Genome Institute of Singapore, Republic of Singapore.
Pollard
Andrew J
AJ
Oxford Vaccine Group, Department of Paediatrics, University of Oxford, United Kingdom.
Moxon
E Richard
ER
Oxford Vaccine Group, Department of Paediatrics, University of Oxford, United Kingdom.
Booy
Robert
R
Academic Unit of Paediatrics, Barts and The London School of Medicine and Dentistry, London, United Kingdom; National Centre for Immunisation Research & Surveillance, University of Sydney, Australia.
D000293:Adolescent; D016667:Bacterial Capsules / Q000008:administration & dosage* / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006192:Haemophilus Infections / Q000150:complications* / Q000382:microbiology*; D018073:Haemophilus Vaccines / Q000008:administration & dosage* / Q000276:immunology*; D019741:Haemophilus influenzae type b / Q000302:isolation & purification*; D006801:Humans; D007223:Infant; D008297:Male; D012307:Risk Factors; D011795:Surveys and Questionnaires; D017211:Treatment Failure; D006113:United Kingdom
D018073:Haemophilus Vaccines; C044237:Haemophilus influenzae type b polysaccharide vaccine