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  HIB Vaccination and Incidence of Acute Bacterial Meningitis
  

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By: Karl-Reinhard Kummer
(Original title: HIB-Impfung und Zahl der eitrigen Meningitiden. Der Merkurstab 1996; 49: 238-9. English by A. R. Meuss, FIL, MTA.)

The Robert Koch Institute's Epidemiologic Bulletin No. 8/96 of 27 Feb. 1996 gives figures for the incidence of bacterial meningitides. Two trends may be noted:

1) Since 1991 the incidence of meningitis due to Haemophilus influenzae has greatly decreased.
2) The frequency of all forms of meningitis decreased by about half between 1987 and 1995.

Graphs show that this is only partly attributable to Haemophilus incidence. The figures for unknown pathogens decreased most of all, as did the number of pneumococcal meningitides and, to a lesser extent, those caused by E. coli. The reasons for this can only be guessed at.

In evaluating HIB vaccination it is important to note that the reduction in Haemophilus influenzae meningitides started before vaccination was introduced. In the case of E. coli meningitis the reduction may be assumed to be due to advances in intensive neonatal care. For the remaining organisms, it may be assumed that separate registration of Borreliae is partly responsible for the decrease. It is definite, however, that the reduction in the total incidence of acute bacterial menigitides is not a positive outcome of HIB vaccination.

It is important, however, to keep an eye open for a possible shift. The further rise in total incidence referred to by Baer et al. may happen. The period since the introduction of HIB vaccination is shorter in Germany than it is in Finland, where an intensive vaccination program started in 1987 and 1989. It appears that pneumococcal infections are becoming more frequent in Finland. Booy et al. actually assume a direct shift in organisms in the nasopharyngeal space that favors pneumococci, though they refuse to accept a causal link. Givner et al. refer to Listeria infection in connection with HIB vaccination.


References
Epideniiologisches Bulletin 8/96. Robert Koch Institut. Barer M, Vuento R, Vesikari T. Increase in bacteriaemic pneumococcal infections in children. Tin'
Lancet 1995; 345:661 (letter to the editor). Idem. Authors' reply. Tlie Lancet 1995; 345:1246. Booy R et al. Invasive pneumococcal infections in children. Tlie Lancet 1995; 345: 1245 f. (letter to
the editor). Givner L, Woods CR Jr, Abramson JS. The practice of pediatrics in the era of vaccines effective against Haemophilus influenzae type b. Pediatric 1994; 93: 680-1.





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