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1、HaemophilusinfluenzaetypebUsingvaccinestomeasurediseaseburden:ATaleofTwoStudiesPresentationtoPABIO550DiseasesofPublicHealthImportanceandTheirControlDavidMercer,Ph.D.Hib-characteristicsGramnegativecocco-bacillicarriedby3%to15%ofyoungchildrenintheworldcausesdiseaseinyoungchildrenm
2、eningitispneumoniaepiglottitissepticarthritisHibdiseaseIndustrializedcountriesmedianage1-2yearsmostmeningitisthenepiglottitis?meningitismortalityunder5%affects1-2/1000childrenDevelopingcountries(Africa)medianage6-9monthsmostpneumonia,thenmeningitismeningitismortality20-50%affect
3、s10/1000children?GambianPRP-Ttrial42,000infantsrandomizedtoreceivePRP-Torplaceboat2,3and4monthsofagepopulationstudiedfor:HibmeningitisHibpneumoniaallpneumoniaHibcarriageGambiaslidescourtesyofKimMulholland,MDUniversityofMelbourneStudydesignindividuallyrandomized,doubleblindstudym
4、ajorefforttodetectHibpneumoniarandomizationin10groupsnumbered0through9:DTP+PRP-TDTP+placeboat2,3and4monthsofage5numbers5numbersFinalresults,March1996 42,848infantsenrolledPRP-Tgroup21,490infants1272possibleHibdisease616chestradiographs173lumbarpunctures71lungaspiratesControlgrou
5、p21,358infants1342possibleHibdisease653chestradiographs192lumbarpunctures75lungaspiratesDidthevaccineactuallypreventpneumonia?*cough+fastbreathingorlowerchestwallindrawingWhatdidtheGambiatrialtellusabouttheepidemiologyofHibpneumoniainWestAfrica?Hibisresponsibleforabout20%ofradio
6、logicalpneumoniainGambianinfantsPreviousstudieshadsuggested5-10%ofpneumoniaduetoHibVerylittle“WHOpneumonia”whichisnotradiologicallyobviousisduetoHibConclusionsPRP-TeffectivelypreventedmeningitisandpneumoniaduetoHibinTheGambiaHibvaccineshavebeenproveninFinland,USA,UK,Chileandothe
7、rcountries…Whyaren’tHibvaccinesusedeverywhere?WhyareHibvaccinesnotusedallovertheworld?costvaries,currently$2perdoseaffordableformostAsiancountriesunderstandingofburdenofdiseaseisthemajorprobleminAsiaAsiaManyAsiancountriescanaffordHibvaccineHibwasknowntobeanimportantcauseofbacter
8、ialmeningitisinAsiaBut:Microbiologicallyconfirm
