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[Meningitis caused by Haemophilus influenzae type b: its immunological prevention. A necessity?].


 This work argues that the vaccine used to control Haemophilus influenza type b (Hib) in the US should become a routine vaccination for infants in the Dominican Republic as well. Hib was the most common cause of meningitis in children under five years old in the US before the vaccine became available. Mortality from meningitis caused by Hib has declined from 90% before antibiotics became available to between 3 and 5%, but there has been no significant further decline in three decades despite development of powerful new antibiotics. Haemophilus influenza is the principal cause of meningitis at the Robert Reid Cabral Children's Hospital in Santo Domingo, accounting for 50-52% of cases. The great majority of patients are under 15 months old. The case fatality rate is 7% and serious sequelae are not uncommon. The impact of the conjugated vaccine against Hib was demonstrated in the US by an 85-90% decline in secondary infections due to Hib. The vaccine has also been highly effective in Finland, reducing the incidence of meningitis in infants aged 0-4 from a peak of 43/100,000 in the 1970s to 0 in 1991. In the US, the greatest decline in children under age 5 began in 1989, one year before the vaccine was approved for use in this age group. The reason for the timing of the decline is not clear, but transmission from immunized older children may have been reduced. The vaccine, in addition to its efficacy, appears to be associated with few secondary effects. The use of this vaccine despite its high cost in comparison to other routine vaccines is justified in the Dominican Republic.
