What is the role of immunization in the prevention of Haemophilus influenzae type b (Hib) meningitis in developing countries?

Updated: Jul 09, 2018
  • Author: Prateek Lohia, MD, MHA; Chief Editor: Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM  more...
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Answer

Some of the current controversies and difficulties concerning establishment of immunization programs in developing nations have been discussed earlier. (See Epidemiology.)

In 2005, the Global Alliance for Vaccines and Immunization (GAVI) created the Hib Initiative, aiming to spend $37 million, over a 4-year period, for the funding of immunization programs in countries where immunization is inadequate. Institution of vaccination programs has been delayed not only by insufficient funding but also by considerations such as establishing current rates of infection and discerning which regions of the country contain children at greatest risk.

The importance of such immunization programs, irrespective of the controversies concerning regional annual incidence of Hib meningitis, is the fact that, in many targeted countries, Hib meningitis has much higher rates of morbidity and mortality than in wealthier nations with superior infrastructure, such as roads and hospitals. Thus, in rural Papua New Guinea, as many as 63% of children surviving meningitis (excluding a rather high rate of children lost to follow up) manifested major neurological sequelae.

The high rates of morbidity and mortality have been ascribed in part to the high rates of resistance to chloramphenicol and the unavailability of third-generation cephalosporins. However, the introduction of greater supplies of third-generation cephalosporins cannot be expected to significantly lower these rates, since nations such as Papua New Guinea, are unavoidably plagued by delayed presentation of sick children to centers capable of administering appropriate antibiotic treatment.

A major issue in Hib immunization is that the expense of vaccination, amounting to more than $2 US per person, is considerable for many nations. Accordingly, those who are on the front lines of this healthcare problem have pleaded for wealthier nations to assist in sponsoring vaccination and encouraging vaccine manufacturers to lower the costs of vaccines. [34]

Another issue is that the risk for severe outcomes from Hib infections may be increasing with the appearance of more examples of antibiotic-resistant strains. Treatment of these strains requires utilization of increasingly expensive antibiotics. In comparison with the growing cost of antimicrobial therapy, the relatively small expense of immunization may come to appear advantageous.

In order both to protect the children of developing countries and to limit the appearance of resistant strains, there seems every reason for the nations of the world to consider underwriting universal childhood immunization as a matter not just of international consideration but also of international self-interest. To date, however, this logical formulation has not resulted in adequate support from wealthier nations for such a program.

GAVI has approved 15 of 75 nations eligible for approval for vaccine introduction. Unfortunately, 26 countries that account in total for most of the world’s children have as yet provided too little data for consideration of approval for vaccine introduction.

Equally unfortunate is the fact that the officials of some countries that have received assistance for the introduction of Hib vaccines have expressed doubt as to whether the vaccine has proven beneficial and provided no practical plan for sustaining the administration of vaccines after introductory financial support was withdrawn, hence, the importance of gathering adequate information before and after the effective introduction of immunization.


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