title: Haemophilus influenzae type b meningitis in a vaccinated and immunocompetent child.
abstract: Invasive Haemophilus influenzae type b (Hib) disease decreased dramatically after the introduction of conjugate vaccine in routine immunization schedules. We report a case of a fifteen-months-old girl, previously healthy and vaccinated, admitted in the emergency room with fever and vomiting. She was irritable and the Brudzinski's sign was positive. The cerebrospinal fluid (CSF) analysis showed pleocytosis and high protein level. Empiric intravenous antibiotics (ceftriaxone and vancomycin) were administered for suspected bacterial meningitis during 10 days. Serotyping of the Haemophilus influenzae strain found in CSF revealed a serotype b. After one year of follow-up no Hib meningitis sequelae were noted. Despite vaccination compliance and absence of risk factors, invasive Hib disease can occur due to vaccine failure. Efforts to keep the low incidence of invasive Hib disease should be directed to the maintenance of high vaccination coverage rates, combined with the notification and surveillance strategies already implemented in each country.
authors.affiliation: Department of Pediatrics, São João Hospital, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal. Electronic address: anafalmeida@hotmail.com.
authors.forename: Ana F
authors.initials: AF
authors.lastname: Almeida
authors.affiliation: Department of Pediatrics, São João Hospital, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal. Electronic address: eunice_trindade@netcabo.pt.
authors.forename: Eunice
authors.initials: E
authors.lastname: Trindade
authors.affiliation: Department of Pediatrics, Infectious Diseases Unit, São João Hospital, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal. Electronic address: arturbonitovitor@gmail.com.
authors.forename: Artur
authors.initials: A
authors.lastname: B Vitor
authors.affiliation: Department of Pediatrics, Infectious Diseases Unit, São João Hospital, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal. Electronic address: margaridamtavares47@gmail.com.
authors.forename: Margarida
authors.initials: M
authors.lastname: Tavares
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002981:Clindamycin / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D018073:Haemophilus Vaccines / Q000276:immunology*; D019741:Haemophilus influenzae type b; D006801:Humans; D007223:Infant; D008583:Meningitis, Haemophilus / Q000188:drug therapy / Q000382:microbiology* / Q000517:prevention & control*; D014640:Vancomycin / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D018073:Haemophilus Vaccines; D002981:Clindamycin; D014640:Vancomycin
keywords: Children; Haemophilus influenzae type b; Haemophilus influenzae type b vaccine; Meningitis; Vaccine failure