Hammond G W, Rutherford B E, Malazdrewicz R, MacFarlane N, Pillay N, Tate R B, Nicolle L E, Postl B D, Stiver H G
Department of Community and Northern Medicine, University of Manitoba, Winnipeg.
CMAJ. 1988 Oct 15;139(8):743-7.
A community-based surveillance study of all central nervous system infections was carried out in Manitoba and the Keewatin District, NWT, between Apr. 1, 1981, and Mar. 31, 1984. There were 201 cases of bacterial meningitis in Manitoba over the study period, 81 (40%) caused by Haemophilus influenzae; all but one isolate tested were type b (Hib). There were nine cases of H. influenzae meningitis in the Keewatin District. The overall annual incidence rate of H. influenzae meningitis in Manitoba was 2.5/100,000; for children under 5 years the rate was 32.1/100,000. For the Keewatin District the corresponding rates were 69.6/100,000 and 530/100,000. A total of 85% and 100% of the cases of H. influenzae meningitis occurred by 24 months of age in Manitoba and the Keewatin District respectively. The age at onset was earlier in native Indian children (22 cases) and Inuit children (9 cases) than in non-native children (59 cases) (p less than 0.005); thus, vaccine prevention of Hib meningitis will likely be more difficult in native Indian and Métis children. Without evaluating the increased potential of H. influenzae vaccines to prevent nonmeningitic forms of disease, we concluded that mass childhood vaccination with polyribosylribitolphosphate (PRP) vaccine is not warranted in Manitoba or the Keewatin District. Immunogenicity studies suggest that administration of conjugated Hib vaccines such as PRP-D in infancy may prevent approximately one-third to two-thirds of cases of H. influenzae meningitis; these vaccines warrant consideration for use in mass childhood vaccination programs.
1981年4月1日至1984年3月31日期间，在马尼托巴省和西北地区的基韦廷区开展了一项基于社区的所有中枢神经系统感染监测研究。在研究期间，马尼托巴省有201例细菌性脑膜炎病例，其中81例（40%）由流感嗜血杆菌引起；除1株检测菌株外，其余均为b型（Hib）。基韦廷区有9例流感嗜血杆菌脑膜炎病例。马尼托巴省流感嗜血杆菌脑膜炎的总体年发病率为2.5/10万；5岁以下儿童的发病率为32.1/10万。基韦廷区的相应发病率分别为69.6/10万和530/10万。马尼托巴省和基韦廷区分别有85%和100%的流感嗜血杆菌脑膜炎病例发生在24月龄之前。原住民印第安儿童（22例）和因纽特儿童（9例）的发病年龄早于非原住民儿童（59例）（p<0.005）；因此，在原住民印第安和梅蒂斯儿童中预防Hib脑膜炎疫苗可能更困难。在未评估流感嗜血杆菌疫苗预防非脑膜炎形式疾病的潜在增加效果的情况下，我们得出结论，在马尼托巴省或基韦廷区不建议对儿童进行多聚核糖磷酸核糖醇（PRP）疫苗大规模接种。免疫原性研究表明，婴儿期接种PRP-D等结合型Hib疫苗可预防约三分之一至三分之二的流感嗜血杆菌脑膜炎病例；这些疫苗值得在儿童大规模疫苗接种计划中考虑使用。
