Haemophilus influenzae: surface antigens and aspects of virulence.

Haemophilus influenzae type b is a major cause of bacterial meningitis and other invasive diseases in children under four years of age. One surface antigen, the type b capsular polysaccharide, polyribosylribitol phosphate (PRP), is a primary virulence factor of the organism. Antibody directed against PRP is protective; however, the purified polysaccharide is poorly immunogenic in young children. Polysaccharide-protein conjugate vaccines have been prepared which are significantly more immunogenic and efficacious in young children compared to the plain polysaccharide vaccine. Noncapsular surface antigens may also play a role in the virulence of H. influenzae. Some mutants (or phase variants) which differ in lipooligosaccharide (LOS) structure exhibit decreased virulence in the infant rat model of bacteremia. Proteins including the IgA protease, pili, a 98K outer membrane protein (OMP) as well as OMPs P1, P2 and P6 have also been examined in considerable detail, but whether they have a role in the virulence of the organism remains to be determined. However, antibody directed against the 98K OMP as well as P1, P2 and P6 is protective in the infant rat model of bacteremia. The role of antibody directed against LOS epitopes in protection is less clear, due at least in part, to phase variation in LOS antigens. Characterization of one surface antigen of H. influenzae type b, the capsular polysaccharide, already has led to the prevention of many cases of Haemophilus disease. Characterization of the noncapsular antigens together with a more detailed understanding of the mechanisms of virulence, most likely will permit development of even better vaccines, and possibly better treatment modalities, in the future.