Ribeiro Guilherme S, Reis Joice N, Cordeiro Soraia M, Lima Josilene B T, Gouveia Edilane L, Petersen Maya, Salgado Kátia, Silva Hagamenon R, Zanella Rosemeire Cobo, Almeida Samanta C Grassi, Brandileone Maria Cristina, Reis Mitermayer G, Ko Albert I
Gonçalo Moniz Research Center, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador, Bahia, Brazil.
J Infect Dis. 2003 Jan 1;187(1):109-16. doi: 10.1086/345863. Epub 2002 Dec 13.
Surveillance for Haemophilus influenzae meningitis cases was performed in Salvador, Brazil, before and after introduction of H. influenzae type b (Hib) immunization. The incidence of Hib meningitis decreased 69% during the 1-year period after initiation of Hib immunization (from 2.62 to 0.81 cases/100,000 person-years; P<.001). In contrast, the incidence for H. influenzae type a meningitis increased 8-fold (from 0.02 to 0.16 cases/100,000 person-years; P=.008). Pulsed-field gel electrophoretic analysis demonstrated that H. influenzae type a isolates belonged to 2 clonally related groups, both of which were found before Hib immunization commenced. Therefore, Hib immunization contributed to an increased risk for H. influenzae type a meningitis through selection of circulating H. influenzae type a clones. The risk attributable to serotype replacement is small in comparison to the large reduction in Hib meningitis due to immunization. However, these findings highlight the need to maintain surveillance as the use of conjugate vaccines expands worldwide.
在巴西萨尔瓦多引入b型流感嗜血杆菌（Hib）免疫接种前后，对流感嗜血杆菌脑膜炎病例进行了监测。Hib脑膜炎的发病率在开始Hib免疫接种后的1年期间下降了69%（从每10万人年2.62例降至0.81例；P<0.001）。相比之下，a型流感嗜血杆菌脑膜炎的发病率增加了8倍（从每10万人年0.02例增至0.16例；P=0.008）。脉冲场凝胶电泳分析表明，a型流感嗜血杆菌分离株属于2个克隆相关组，这两个组在开始Hib免疫接种之前就已发现。因此，Hib免疫接种通过选择循环中的a型流感嗜血杆菌克隆，导致a型流感嗜血杆菌脑膜炎的风险增加。与免疫接种导致Hib脑膜炎大幅减少相比，血清型替换所致风险较小。然而，随着全球范围内结合疫苗使用的扩大，这些发现凸显了维持监测的必要性。
