Simões Luciana Leite Pineli, Andrade Ana Lúcia S S, Laval Cristina A, Oliveira Renato M, Silva Simmone A, Martelli Celina M T, Alves Sueli L de A, Almeida Robmary M, Andrade João G
Hospital de Doenças Tropicais, Goiânia, GO, Brazil.
Rev Saude Publica. 2004 Oct;38(5):664-70. doi: 10.1590/s0034-89102004000500008. Epub 2004 Oct 18.
To assess the impact of the Haemophilus influenzae b (Hib) conjugate vaccine in reducing the incidence of meningitis among children under five years old.
A 'before-after' design was used to compare Hib meningitis incidence rates in the pre-vaccine (July 1995 - June 1999) and post-vaccine (July 1999 - June 2001) periods in the state of Goias, central Brazil. Bacterial meningitis case definition was based on World Health Organization criteria. Incidence rates of S. pneumoniae and N. meningitidis were used for comparison purposes. Chi-squared and Student's t tests were used for statistical analysis. P-values below 0.05 were considered as statistically significant.
979 children with acute bacterial meningitis were detected throughout the entire period. The incidence rate of Hib meningitis decreased from 10.8 (x10(5)) in the pre-vaccine period to 2.3 (x10(5)) in the 2nd year post vaccination, leading to a risk reduction of 78%, targeted to the 7-23 months age group (p<0.05). A total of 65 cases of Hib meningitis were prevented. An increase in S. pneumoniae meningitis was observed. Vaccine failure was detected in one child.
This study showed that mass immunization with Hib conjugate vaccine brought about an expressive decline in childhood Hib meningitis in Goias soon after the first year. Notwithstanding, an enhancement of surveillance using high-accuracy tools is essential to: (i) detect a possible reemergence of Hib; (ii) identify vaccine failure, and (iii) monitor changes in the H. influenzae serotype profile over time.
评估b型流感嗜血杆菌（Hib）结合疫苗对降低五岁以下儿童脑膜炎发病率的影响。
采用“前后”设计，比较巴西中部戈亚斯州疫苗接种前（1995年7月至1999年6月）和疫苗接种后（1999年7月至2001年6月）期间Hib脑膜炎发病率。细菌性脑膜炎病例定义基于世界卫生组织标准。使用肺炎链球菌和脑膜炎奈瑟菌的发病率进行比较。采用卡方检验和学生t检验进行统计分析。P值低于0.05被认为具有统计学意义。
在整个研究期间共检测到979例急性细菌性脑膜炎患儿。Hib脑膜炎发病率从疫苗接种前的10.8（x10(5)）降至接种后第2年的2.3（x10(5)），导致7至23个月龄组的风险降低了78%（p<0.05）。共预防了65例Hib脑膜炎病例。观察到肺炎链球菌脑膜炎有所增加。在一名儿童中检测到疫苗接种失败。
本研究表明，在戈亚斯州，大规模接种Hib结合疫苗在第一年之后不久使儿童Hib脑膜炎发病率显著下降。尽管如此，使用高精度工具加强监测对于：（i）检测Hib可能的再次出现；（ii）识别疫苗接种失败，以及（iii）长期监测流感嗜血杆菌血清型谱的变化至关重要。
