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Effectiveness of Haemophilus influenzae Type B Conjugate Vaccine on Prevention of Pneumonia and Meningitis in Bangladeshi Children: A Case–Control Study

Baqui, Abdullah H. MBBS, MPH, DrPH*; El Arifeen, Shams MBBS, MPH, DrPH; Saha, Samir K. PhD; Persson, LarsÅke MD§; Zaman, K MBBS, PhD; Gessner, Bradford D. MD; Moulton, Lawrence H. PhD*; Black, Robert E. MD, MPH*; Santosham, Mathuram MD, MPH*

The Pediatric Infectious Disease Journal: July 2007 - Volume 26 - Issue 7 - p 565-571
doi: 10.1097/INF.0b013e31806166a0
Original Studies

Background: Few Asian countries have introduced Haemophilus influenzae type b (Hib) conjugate vaccine because of its cost and uncertainty regarding disease burden.

Methods: To estimate the effectiveness of Hib conjugate vaccine in preventing pneumonia and meningitis in children age <2 years, an incident case–control study was conducted in a birth cohort of about 68,000 infants in Dhaka city, Bangladesh. DPT vaccine was systematically replaced by a combined Hib-DPT vaccine in selected immunization centers of the study area. Four matched community- and 2 hospital-controls were randomly selected for each confirmed case of pneumonia and meningitis from the study area.

Results: About 35% of the infants received each of the 3 doses of Hib-DPT vaccine. There were 2679 children who had a chest roentgenogram. For 475 children, a radiologist and a pediatrician independently identified substantial alveolar consolidation. Following at least 2 doses of Hib vaccine, the preventable fractions [95% confidence intervals (CI)] using community and hospital controls were 17% (−10% to 38%) and 35% (13% to 52%) respectively. Of these 475 cases, 2 radiologists with the World Health Organization concurred with the findings for 343 patients, yielding preventable fractions of 34% (6% to 53%) and 44% (20% to 61%). Fifteen confirmed Hib meningitis cases were identified; the preventable fractions (95% CI) using community and hospital controls, respectively, were 89% (28% to 100%) and 93% (53% to 100%).

Conclusions: The study documented that significant fractions of pneumonia and meningitis in Bangladeshi children age <2 years can be prevented by the Hib conjugate vaccine.

From the *Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; †Child Health Program, ICDDR,B, Dhaka, Bangladesh; ‡Department of Microbiology, Dhaka Shishu Hospital, Shamoli, Dhaka, Bangladesh; §International Maternal and Child Health, Uppsala University, Uppsala, Sweden; ∥Association Pour l'Aide a la Medicine Preventive, Paris, France.

Accepted for publication March 22, 2007.

Address for correspondence: Abdullah H. Baqui, Johns Hopkins Bloomberg School of Public Health, Room E-8138, 615 N. Wolfe Street, Baltimore, MD 21205. E-mail:

© 2007 Lippincott Williams & Wilkins, Inc.