Haemophilus influenzae meningitis in Cuban children: a nineteen years follow up

Abstract

Despite the advances in antibiotic therapy and vaccines as well as the availability of sophisticated intensive care reached in the past century and the ongoing, community acquired Bacterial Meningitis (CABM) remains a serious threat to global health due to its high rates of morbidity and mortality (especially in infants),1 the serious permanent sequels in survivors2 as well as the variability in causative bacteria.3 Three species, Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae (Hi) are responsible for most cases of CABM occurring beyond the neonatal period, causing more than 80% of cases worldwide.4 Haemophilus influenza (Hi)is an important human pathogen that causes severe infections including meningitis, sepsis, bacteremia, pneumonia, sinusitis, epiglottitis and otitis mostly affecting young children.5 In the pre-vaccine era, H. influenzaeserotype b(Hib) was a leading cause of CABM, epiglottitis, and pneumonia, primarily in children under 5 years.6 Hib conjugate vaccines were introduced initially in the late 1980s for children aged 12 months or older, and later in the early 1990s for infants younger than 6 months old. Near elimination of Hib disease in children has occurred in countries that implemented pediatric Hib immunization programs.7 In Cuba Hib vaccination was introduced in 1999, decreasing the overall incidence of Hib meningitis from 1.3/105 population in 1998 to 0.6/105 population in 1999 (53.4% reduction), with the greatest proportion in infants (70.5 %).8 After this intervention public health authorities decided to continue routine Hib vaccination through the National Immunization Program.9 The aim of this study was to describe the main features of Hi meningitis in infants and young children, as well as to analyze the effects of continuing and massive vaccination on infant’s morbidity and mortality in the Cuban context.