National Institute for Communicable Diseases (NICD) of the National Health Laboratory Service (NHLS), Johannesburg, South Africa.
Vaccine. 2012 Jan 11;30(3):565-71. doi: 10.1016/j.vaccine.2011.11.066. Epub 2011 Nov 26.
South Africa started routine infant immunization against Haemophilus influenzae serotype b (Hib) disease in 1999 with an accelerated three-dose schedule of Hib conjugate vaccine (HibCV) without a booster dose. Following initial declines in Hib disease, national surveillance has identified increasing numbers of Hib disease episodes in fully vaccinated children.
We reviewed national laboratory-based surveillance data from 2003 through 2009 for invasive Hib disease episodes among children <5 years, including HIV status and vaccination histories. We defined HibCV failures as invasive Hib disease in children at least four months of age who had received all recommended doses of HibCV.
Despite high HibCV vaccination coverage, detection rates of Hib disease in children <5 years increased from 0.7 per 100,000 population in 2003 to 1.3/100,000 in 2009 (p<0.001). Among 263 episodes of invasive Hib disease among children with known vaccination status, 135 (51%) were classified as vaccine failures. Of vaccine failures, 55% occurred among case patients ≥18 months old. HIV status was documented for 90 children with vaccine failure; 53% were not HIV infected.
Vaccine failures, which occurred in both HIV-infected and -uninfected children, comprised half of the rise in invasive Hib disease detected in South African children 10 years after national introduction of Hib vaccine. These findings suggest that HibCV recommendations may require revision. In November 2010, children in South Africa began receiving a booster dose of HibCV as part of a pentavalent vaccine.
南非于 1999 年开始对乙型流感嗜血杆菌（Hib）疾病进行常规婴儿免疫接种，采用加速的三联 Hib 结合疫苗（HibCV）免疫程序，无需加强剂量。在 Hib 疾病最初下降之后，国家监测发现完全接种疫苗的儿童中 Hib 疾病病例不断增加。
我们回顾了 2003 年至 2009 年期间全国基于实验室的监测数据，包括 HIV 状态和疫苗接种史，以确定 5 岁以下儿童侵袭性 Hib 疾病病例。我们将 HibCV 失败定义为至少 4 个月大的接受了所有推荐剂量 HibCV 的儿童发生侵袭性 Hib 疾病。
尽管 HibCV 疫苗接种率很高，但 5 岁以下儿童 Hib 疾病的检出率从 2003 年的每 10 万人 0.7 例增加到 2009 年的每 10 万人 1.3 例（p<0.001）。在已知疫苗接种情况的 263 例侵袭性 Hib 疾病病例中，有 135 例（51%）被归类为疫苗失败病例。疫苗失败病例中，55%发生在 18 个月以上的病例患者中。90 例疫苗失败病例记录了 HIV 状态，其中 53%未感染 HIV。
疫苗失败病例在 HIV 感染和未感染的儿童中均有发生，占南非儿童在全国 Hib 疫苗接种 10 年后发现侵袭性 Hib 疾病上升的一半。这些发现表明 HibCV 建议可能需要修改。2010 年 11 月，南非儿童开始接受 HibCV 加强剂量，作为五联疫苗的一部分。
