Peltola H, Kilpi T, Anttila M
Children's Hospital, University of Helsinki, Finland.
Lancet. 1992 Sep 5;340(8819):592-4. doi: 10.1016/0140-6736(92)92117-x.
Mortality from meningitis caused by Haemophilus influenzae type b (Hib), a disease that affects mainly infants and young children, can reach 5% in industrialised countries and ten times that in non-industrialised countries. To determine the efficacy of vaccination against Hib, we carried out a retrospective survey of the incidence of Hib meningitis over five decades in the Greater Helsinki area of Finland, where all children with bacterial meningitis are treated in one of three centres. Except for a meningococcal epidemic in the early 1970s, Hib was the leading cause of childhood bacterial meningitis until the Hib conjugate vaccines changed the picture profoundly. In 1986-87 the polysaccharide-diphtheria toxoid conjugate (PRP-D) was given experimentally to 50% of infants. In 1988-89 all infants were vaccinated, 50% with PRP-D, 50% with another conjugate vaccine, the oligosaccharide-CRM197 protein conjugate (HbOC). Since 1990 a third conjugate vaccine, the polysaccharide-tetanus toxoid (PRP-T), has been administered routinely to all infants. The vaccines were administered at age 3-6 months, with a booster dose at 14-18 months. In the first 5 years of the Hib vaccination programme the number of cases of Hib meningitis in children aged 0-4 years fell sharply, from 30 in 1986 (the first year of the programme) to none in 1991. The decline contrasts sharply with the rising trend up to the mid 1980s. Vaccination seems to be the only explanation for the observed change in the epidemiology of Hib meningitis.
由b型流感嗜血杆菌（Hib）引起的脑膜炎主要影响婴幼儿，在工业化国家，其死亡率可达5%，在非工业化国家则是这一数字的十倍。为了确定Hib疫苗接种的效果，我们对芬兰大赫尔辛基地区五十年来Hib脑膜炎的发病率进行了回顾性调查，该地区所有细菌性脑膜炎患儿均在三个中心之一接受治疗。除了20世纪70年代初的一次脑膜炎球菌疫情外，在Hib结合疫苗深刻改变局面之前，Hib一直是儿童细菌性脑膜炎的主要病因。1986 - 1987年，50%的婴儿接受了多糖 - 白喉类毒素结合疫苗（PRP - D）的试验性接种。1988 - 1989年，所有婴儿都接种了疫苗，50%接种PRP - D，50%接种另一种结合疫苗，即寡糖 - CRM197蛋白结合疫苗（HbOC）。自1990年起，第三种结合疫苗，即多糖 - 破伤风类毒素（PRP - T）开始常规接种给所有婴儿。疫苗在3至6个月龄时接种，14至18个月龄时加强接种一剂。在Hib疫苗接种计划实施的头5年里，0至4岁儿童中Hib脑膜炎病例数急剧下降，从1986年（该计划实施的第一年）的30例降至1991年的零例。这一下降与20世纪80年代中期之前的上升趋势形成鲜明对比。疫苗接种似乎是Hib脑膜炎流行病学中观察到的这一变化的唯一解释。
