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Hib vaccine in India: A case for universal immunization
Vaccine 31 (2013) 3763–3765
Contents lists available at SciVerse ScienceDirect
Vaccine journal homepage: www.elsevier.com/locate/vaccine
Editorial
Hib vaccine in India: A case for universal immunization
Keywords: Hemophilus influenzae type b Vaccine Meningitis Pneumonia NTAGI recommendations
To the Editor, Hemophilus influenza type b (Hib) disease is a bacterial illness that causes potentially deadly brain infection (meningitis), pneumonia, blood stream infections, arthritis and infections in other organs of the body in young children. Hib is the leading cause of bacterial meningitis in children less than five years of age in countries not providing Hib vaccine to young children [1]. Hib is responsible for 8.1 million cases of serious illness and approximately 363,000 deaths worldwide each year in children less than 5 years of age in 2000 [1]. The disease caused by Hib may be transmitted through contact with mucus or droplets from the nose and throat of an infected person. WHO launched expanded programme on immunization (EPI) to control six childhood diseases such as tuberculosis, diphtheria, pertusis, polio, tetanus and measles in late 1980s and recommended for their use globally in 2006 [2]. The Centre for disease Control and prevention (CDC) recommended the use of Hib vaccine in lte 1980s. Hib vaccine has been adopted for almost 20 years in 171 of the 193 member States (89%) and has practically eliminated Hib disease in developed and its incidence has been reduced in developing countries where it has been introduced [1]. Hib vaccines were introduced in North American and Western Europe very quickly while in developing countries it was introduced very slowly due to programme sustainability, high cost, limited vaccine supply and non-availability of data on Hib burden [1]. In developing countries like Gambia, Uganda and Kenya where Hib vaccine was introduced, Hib diseases including pneumonia and menigitis were successfully reduced [3]. In Asia, three doses of Hib vaccine have reduced the risk of pneumonia by 17–44%, in a case control study from Bangladesh [4]. In Indonesia, in a hamlet-randomized controlled double blind vaccine probe study radiological pneumonia was not affected but cases of bacterial meningitis were reduced. A study in Indonesia also found that all pneumonias were reduced by 4% [5]. In India, approximately 408,000 deaths due to pneumonia were reported by Child Health Epidemiology Reference Group. The mortality rate of 69 per 1000 live births and 22% deaths due to pneumonia was reported in under five children in India [6].
0264-410X/$ – see front matter © 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.vaccine.2013.06.067
India has population of 1.22 billion. In India, the overall case fatality rate for Hib meningitis ranged from 20 to 29% whereas all invasive Hib disease had a case fatality rate of 16% [7]. The global burden of Hib disease is substantial and is vaccine preventable. H. influenzae is the second most common cause (Hib; 10–30% of cases) of childhood pneumonia [8]. About 156 million new episodes of pneumonia each year occur worldwide out of which 40 million cases occur in India [8] (Table 1). A total of 16 hospital based studies are published [9–24] from India where the Hib was found in 10.7% (0.5–29.5%) of the total cases and 32.6% (3.1–48.5%) of all invasive bacterial diseases in children less than 5 years of age. Meningitis due to Hib is the most severe form of disease and was found in 14% (5.3–29.5%) of all cases of meningitis and 35% (19.7–48.5%) of all bacterial causes of meningitis. However the prevalence of pneumonia due to Hib showed to be present in 3% of all cases of pneumonia and 10.2% of all bacterial causes of pneumonia. Hib pneumonia is more difficult to diagnose. Although blood cultures for Hib are highly specific, they have a sensitivity of 20% and high use of antibiotics prior to sampling for bacteriological diagnosis leads to underestimates the role of Hib as a cause of pneumonia [25]. Antibiotic resistant in H. influenzae for all antibiotics has been reported in various studies from India. Due to increased resistance to antibiotics, large number Indian children are thought to be at a high health risk who may get Hib disease [26] (NTAGI). The Hib vaccine can be given alone in combination as pentavalent vaccine including diphtheria, pertusis, tetanus, and Hep B vaccine which provide protection to children from five diseases in one shot. The Hib vaccines used in different parts of world are different in their presentations. Currently three types of conjugate vaccines are available utilizing different carrier proteins for conjugation process: mutant diphtheria protein inactivated tetanospasmin (also called tetanus toxoid) and meningococcal group B outer membrane protein. The new fully liquid, investigational hexavalent vaccine in the Expanded Programme on Immunization schedule, with/without hepatitis B at birth, is highly immunogenic and safe compared with control vaccines, warranting further development in the introduction of the vaccine in countries where it is not recommended. NTAGI (National Technical Advisory Group on Immunization in India) subcommittee on Hib vaccine reviewed the published and unpublished literature regarding the Hib disease burden in India, vaccine availability, cost effectiveness, safety and efficacy. They found that the disease burden is significantly high and Hib vaccine was found to be safe and efficacious in India. The committee also analyzed the sufficient supply of vaccine in India since it is manufactured by several pharmaceutical
3764
Editorial / Vaccine 31 (2013) 3763–3765
Table 1 Incidence and mortality of Hib disease.
India Bangladesh Gambia a
Cases of Hib disease in children (<5 years)
Pneumonia deaths (<5 years) [29]
Meningitis deaths (<5 years) [29]
7.1 per 100, 000 (In children 0–11 months – 32 per 100, 000) [21] 47% of meningitis casesa [27] (In 1990– 200 per 100,000 children) (In 2002- none per 100,000 children) [28]
57,349
14,164
8002 65
3762 21
The true incidence of Hib in Bangladesh is not available
companies in India itself [26]. The mission Steering Group (MSG), under the health ministry for National Rural Health Mission on April 2012 had approved inclusion of pentavalent vaccine under the Universal Immunization Program (UIP) in two states of Tamil Nadu and Kerala in December, 2011 and it has been introduced in six more states of Gujarat, Haryana, Goa, Karnataka, Pondicherry and Jammu and Kashmir (J & K single state). There is a need to include this vaccine for all the children of other states and UTs under UIP which comprises 81% of the total children population in India. Recommendations National and International expert committee have recommended the use of Hib vaccine in India. In 2004, Indian Academy of Paediatricians also recommended the use of Hib vaccine to all children. We support the recommendation of NTAGI and Health ministry, Govt. of India to include Hib vaccination in routine immunization programme. In low income countries, the major obstacles to introduce the Hib vaccine are their cost and the limited awareness of population about the impact of Hib disease. Even after a decade of use, the Hib vaccine is expensive and cost is approximately $ US. 2.50 per dose describing the need of external financial resources to procure the vaccine in most low income countries. The Global Alliance for Vaccines and Immunization (GAVI) is providing mechanism of financing Hib vaccine for 5 years to the 75 poorest countries through vaccine fund http://www.vaccinealliance. org/home/index.php). Despite this, only a few countries initially requested the vaccine through GAVI due to limited awareness about the burden of Hib disease. Secondly, there is no baseline data of Hib burden to assess the impact of the introduction of vaccine in the states where it has not been introduced. However, there the ample of evidence suggesting the use of Hib vaccine to reduce disease burden around the world. Numerous studies on immunogenicity have been performed in India where vaccine tested was shown to be highly immunogenic. Therefore, the Government should introduce the vaccine in routine immunization programme in all states of India. 1. Conflict of interest None stated. Acknowledgment Indian Council of Medical Research is acknowledged for financial support. References [1] Watt JP, Wolfson LJ, O’Brien KL, Henkle E, Deloria-Knoll M, McCall N, et al., Hib and Pneumococcal Global Burden of Disease Study Team. Burden of disease caused by Haemophilus influenzae type b in children younger than 5 years: global estimates. Lancet 2009;374(Sep 12 (9693)):903–11. [2] WHO position paper on Haemophilus influenzae type b conjugate vaccines. Wkly Epidemiol Rec 2006;47(Nov (24)):445–52.
[3] Sharma HJ, Multani AS, Dutta AK, Joshi SM, Malik S, Bhardwaj S, et al. Safety and immunogenicity of an indigenously developed Haemophilus influenzae type b conjugate vaccine through various phases of clinical trials. Hum Vaccin 2009;5(Jul (7)):483–7. [4] Baqui AH, El Arifeen S, Saha SK, Persson L, Zaman K, Gessner BD, et al. Effectiveness of Haemophilus influenzae type B conjugatevaccine on prevention of pneumonia and meningitis in Bangladeshi children: acase-control study. Pediatr Infect Dis J 2007;26(Jul (7)):565–71. [5] Gessner BD, Sutanto A, Linehan M, Djelantik IG, Fletcher T, Gerudug IK, et al. Incidences of vaccine-preventable Haemophilus influenzae type b pneumonia and meningitis in Indonesian children: hamlet-randomised vaccine-probe trial. Lancet 2005;365(Jan 1–7 (9453)):43–52. [6] Registrar General of India. Report on causes of deaths 2001–03; 2012. Available from: http://censusindia.gov.in/Vital Statistics/Summary Report Death 01 03.pdf [last accessed 20.03.12.]. [7] Verma R, Khanna P, Chawla S, Bairwa M, Prinja S, Rajput M. Haemophilus influenzae type b (Hib) vaccine: an effective control strategy in India. Hum Vaccin 2011;7(Nov (11)):1158–60. [8] Igor Rudan, Cynthia Boschi-Pinto, Zrinka Biloglav, Kim Mulhollandd, Harry, Campbell. Epidemiology and etiology of childhood pneumonia. Bull World Health Organ 2008;86(May (5)):408–16. [9] Suvarna Devi P, Murthy SN, Nath Sharma KC, Murthy US. Etiological study of pyogenic meningitis in children by CIEP. Indian Pediatr 1982;19(Apr (4)):317–21. [10] John TJ, Cherian T, Steinhoff MC, Simoes EA, John M. Etiology of acute respiratory infections in children in tropical southern India. Rev Infect Dis 1991;13(May–Jun (Suppl. 6)):S463–9. [11] Deivanayagam N, Ashok TP, Nedunchelian K, Ahamed SS, Mala N. Bacterial meningitis: diagnosis by latex agglutination test and clinical features. Indian Pediatr 1993;30(Apr (4)):495–500. [12] Bahl R, Mishra S, Sharma D, Singhal A, Kumari S. A bacteriological study in hospitalized children with pneumonia. Ann Trop Paediatr 1995;15(Jun (2)): 173–7. [13] Patwari AK, Bisht S, Srinivasan A, Deb M, Chattopadhya D. Aetiology of pneumonia in hospitalized children. J Trop Pediatr 1996;42(Feb (1)):15–20. [14] Sahai S, Mahadevan S, Srinivasan S, Kanungo R. Childhood bacterial meningitis in Pondicherry, South India. Indian J Pediatr 2001;68(Sep (9)):839–41. [15] Invasive Bacterial Infections Surveillance (IBIS) Group of the International Clinical Epidemiology Network. Are Haemophilus influenzae infections a significant problem in India? A prospective study and review. Clin Infect Dis 2002;34(Apr 1 (7)):949–57. [16] Chinchankar N, Mane M, Bhave S, Bapat S, Bavdekar A, Pandit A, et al. Diagnosis and outcome of acute bacterial meningitis in early childhood. Indian Pediatr 2002;39(Oct (10)):914–21. [17] Singhi SC, Mohankumar D, Singhi PD, Sapru S, Ganguly NK. Evaluation of polymerase chain reaction (PCR) for diagnosing Haemophilus influenzae b meningitis. Ann Trop Paediatr 2002;22(Dec (4)):347–53. [18] Kabra SK, Lodha R, Broor S, Chaudhary R, Ghosh M, Maitreyi RS. Etiology of acute lower respiratory tract infection. Indian J Pediatr 2003;70(Jan (1)):33–6. [19] Viswanath G, Praveen Hanumanthappa AR, Chandrappa NR, Mahesh CB. Bacteriological study of pyogenic meningitis with special reference to latex agglutination. Indian J Pathol Microbiol 2007;50(Jan (1)):97–100. [20] Shameem S, Vinod Kumar CS, Neelagund YF. Bacterial meningitis: rapid diagnosis and microbial profile: a multicentered study. J Commun Dis 2008;40(Jun (2)):111–20. [21] Minz S, Balraj V, Lalitha MK, Murali N, Cherian T, Manoharan G, et al. Incidence of Haemophilus influenzae type b meningitis in India. Indian J Med Res 2008;128(Jul (1)):57–64. [22] Gupta M, Kumar R, Deb AK, Bhattacharya SK, Bose A, John J, et al. Hib study working group. Multi-center surveillance for pneumonia & meningitis among children (<2 yr) for Hib vaccine probe trial preparation in India. Indian J Med Res 2010;131(May):649–58. [23] John TJ, Cherian T, Raghupathy P. Haemophilus influenzae disease in children in India: a hospital perspective. Pediatr Infect Dis J 1998;17(Sep (9 Suppl.)):S169–71. [24] Mani R, Pradhan S, Nagarathna S, Wasiulla R, Chandramuki A. Bacteriological profile of community acquired acute bacterial meningitis: a ten-year retrospective study in a tertiary neurocare centre in South India. Indian J Med Microbiol 2007;25(Apr (2)):108–14. [25] Feikin DR, Nelson CB, Watt JP, Mohsni E, Wenger JD, Levine OS. Rapid assessment tool for Haemophilus influenzae type b disease in developing countries. Emerg Infect Dis 2004;10(Jul (7)):1270–6.
Editorial / Vaccine 31 (2013) 3763–3765 [26] NTAGI. Subcommittee on Introduction of Hib Vaccine in Universal Immunization Program, National Technical Advisory Group on Immunization, India. NTAGI subcommittee recommendations on Haemophilus influenzae type B (Hib) vaccine introduction in India. Indian Pediatr 2009;46(Nov (11)): 945–54. [27] Saha SK, Rikitomi N, Ruhulamin M, Watanabe K, Ahmed K, Biswas D, et al. The increasing burden of disease in Bangladeshi children due to Haemophilus influenzae type b meningitis. Ann Trop Paediatr 1997;17(Mar (1)):5–8. [28] Adegbola RA, Secka O, Lahai G, Lloyd-Evans N, Njie A, Usen S, et al. Elimination of Haemophilus influenzae type b (Hib) disease from The Gambia after the introduction of routine immunisation with a Hib conjugate vaccine: a prospective study. Lancet 2005;366(Jul 9–15 (9480)):144–50. [29] WHO www.who.int/immunization. . ./burden/GDB Hib Sp Results Database. xls; 2013.
Ajay Kumar Meenu Singh ∗ Kiran Kumar Thumburu Nishant Jaiswal
3765
Harpreet Kaur Shruti Sharma Amit Agarwal Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India ∗ Corresponding
author at: Department of Pediatrics, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India. Tel.: +91 172 2755306; fax: +91 172 2744401. E-mail addresses: [email protected], [email protected] (M. Singh) 18 March 2013 Available online 3 July 2013
Contents lists available at SciVerse ScienceDirect
Vaccine journal homepage: www.elsevier.com/locate/vaccine
Editorial
Hib vaccine in India: A case for universal immunization
Keywords: Hemophilus influenzae type b Vaccine Meningitis Pneumonia NTAGI recommendations
To the Editor, Hemophilus influenza type b (Hib) disease is a bacterial illness that causes potentially deadly brain infection (meningitis), pneumonia, blood stream infections, arthritis and infections in other organs of the body in young children. Hib is the leading cause of bacterial meningitis in children less than five years of age in countries not providing Hib vaccine to young children [1]. Hib is responsible for 8.1 million cases of serious illness and approximately 363,000 deaths worldwide each year in children less than 5 years of age in 2000 [1]. The disease caused by Hib may be transmitted through contact with mucus or droplets from the nose and throat of an infected person. WHO launched expanded programme on immunization (EPI) to control six childhood diseases such as tuberculosis, diphtheria, pertusis, polio, tetanus and measles in late 1980s and recommended for their use globally in 2006 [2]. The Centre for disease Control and prevention (CDC) recommended the use of Hib vaccine in lte 1980s. Hib vaccine has been adopted for almost 20 years in 171 of the 193 member States (89%) and has practically eliminated Hib disease in developed and its incidence has been reduced in developing countries where it has been introduced [1]. Hib vaccines were introduced in North American and Western Europe very quickly while in developing countries it was introduced very slowly due to programme sustainability, high cost, limited vaccine supply and non-availability of data on Hib burden [1]. In developing countries like Gambia, Uganda and Kenya where Hib vaccine was introduced, Hib diseases including pneumonia and menigitis were successfully reduced [3]. In Asia, three doses of Hib vaccine have reduced the risk of pneumonia by 17–44%, in a case control study from Bangladesh [4]. In Indonesia, in a hamlet-randomized controlled double blind vaccine probe study radiological pneumonia was not affected but cases of bacterial meningitis were reduced. A study in Indonesia also found that all pneumonias were reduced by 4% [5]. In India, approximately 408,000 deaths due to pneumonia were reported by Child Health Epidemiology Reference Group. The mortality rate of 69 per 1000 live births and 22% deaths due to pneumonia was reported in under five children in India [6].
0264-410X/$ – see front matter © 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.vaccine.2013.06.067
India has population of 1.22 billion. In India, the overall case fatality rate for Hib meningitis ranged from 20 to 29% whereas all invasive Hib disease had a case fatality rate of 16% [7]. The global burden of Hib disease is substantial and is vaccine preventable. H. influenzae is the second most common cause (Hib; 10–30% of cases) of childhood pneumonia [8]. About 156 million new episodes of pneumonia each year occur worldwide out of which 40 million cases occur in India [8] (Table 1). A total of 16 hospital based studies are published [9–24] from India where the Hib was found in 10.7% (0.5–29.5%) of the total cases and 32.6% (3.1–48.5%) of all invasive bacterial diseases in children less than 5 years of age. Meningitis due to Hib is the most severe form of disease and was found in 14% (5.3–29.5%) of all cases of meningitis and 35% (19.7–48.5%) of all bacterial causes of meningitis. However the prevalence of pneumonia due to Hib showed to be present in 3% of all cases of pneumonia and 10.2% of all bacterial causes of pneumonia. Hib pneumonia is more difficult to diagnose. Although blood cultures for Hib are highly specific, they have a sensitivity of 20% and high use of antibiotics prior to sampling for bacteriological diagnosis leads to underestimates the role of Hib as a cause of pneumonia [25]. Antibiotic resistant in H. influenzae for all antibiotics has been reported in various studies from India. Due to increased resistance to antibiotics, large number Indian children are thought to be at a high health risk who may get Hib disease [26] (NTAGI). The Hib vaccine can be given alone in combination as pentavalent vaccine including diphtheria, pertusis, tetanus, and Hep B vaccine which provide protection to children from five diseases in one shot. The Hib vaccines used in different parts of world are different in their presentations. Currently three types of conjugate vaccines are available utilizing different carrier proteins for conjugation process: mutant diphtheria protein inactivated tetanospasmin (also called tetanus toxoid) and meningococcal group B outer membrane protein. The new fully liquid, investigational hexavalent vaccine in the Expanded Programme on Immunization schedule, with/without hepatitis B at birth, is highly immunogenic and safe compared with control vaccines, warranting further development in the introduction of the vaccine in countries where it is not recommended. NTAGI (National Technical Advisory Group on Immunization in India) subcommittee on Hib vaccine reviewed the published and unpublished literature regarding the Hib disease burden in India, vaccine availability, cost effectiveness, safety and efficacy. They found that the disease burden is significantly high and Hib vaccine was found to be safe and efficacious in India. The committee also analyzed the sufficient supply of vaccine in India since it is manufactured by several pharmaceutical
3764
Editorial / Vaccine 31 (2013) 3763–3765
Table 1 Incidence and mortality of Hib disease.
India Bangladesh Gambia a
Cases of Hib disease in children (<5 years)
Pneumonia deaths (<5 years) [29]
Meningitis deaths (<5 years) [29]
7.1 per 100, 000 (In children 0–11 months – 32 per 100, 000) [21] 47% of meningitis casesa [27] (In 1990– 200 per 100,000 children) (In 2002- none per 100,000 children) [28]
57,349
14,164
8002 65
3762 21
The true incidence of Hib in Bangladesh is not available
companies in India itself [26]. The mission Steering Group (MSG), under the health ministry for National Rural Health Mission on April 2012 had approved inclusion of pentavalent vaccine under the Universal Immunization Program (UIP) in two states of Tamil Nadu and Kerala in December, 2011 and it has been introduced in six more states of Gujarat, Haryana, Goa, Karnataka, Pondicherry and Jammu and Kashmir (J & K single state). There is a need to include this vaccine for all the children of other states and UTs under UIP which comprises 81% of the total children population in India. Recommendations National and International expert committee have recommended the use of Hib vaccine in India. In 2004, Indian Academy of Paediatricians also recommended the use of Hib vaccine to all children. We support the recommendation of NTAGI and Health ministry, Govt. of India to include Hib vaccination in routine immunization programme. In low income countries, the major obstacles to introduce the Hib vaccine are their cost and the limited awareness of population about the impact of Hib disease. Even after a decade of use, the Hib vaccine is expensive and cost is approximately $ US. 2.50 per dose describing the need of external financial resources to procure the vaccine in most low income countries. The Global Alliance for Vaccines and Immunization (GAVI) is providing mechanism of financing Hib vaccine for 5 years to the 75 poorest countries through vaccine fund http://www.vaccinealliance. org/home/index.php). Despite this, only a few countries initially requested the vaccine through GAVI due to limited awareness about the burden of Hib disease. Secondly, there is no baseline data of Hib burden to assess the impact of the introduction of vaccine in the states where it has not been introduced. However, there the ample of evidence suggesting the use of Hib vaccine to reduce disease burden around the world. Numerous studies on immunogenicity have been performed in India where vaccine tested was shown to be highly immunogenic. Therefore, the Government should introduce the vaccine in routine immunization programme in all states of India. 1. Conflict of interest None stated. Acknowledgment Indian Council of Medical Research is acknowledged for financial support. References [1] Watt JP, Wolfson LJ, O’Brien KL, Henkle E, Deloria-Knoll M, McCall N, et al., Hib and Pneumococcal Global Burden of Disease Study Team. Burden of disease caused by Haemophilus influenzae type b in children younger than 5 years: global estimates. Lancet 2009;374(Sep 12 (9693)):903–11. [2] WHO position paper on Haemophilus influenzae type b conjugate vaccines. Wkly Epidemiol Rec 2006;47(Nov (24)):445–52.
[3] Sharma HJ, Multani AS, Dutta AK, Joshi SM, Malik S, Bhardwaj S, et al. Safety and immunogenicity of an indigenously developed Haemophilus influenzae type b conjugate vaccine through various phases of clinical trials. Hum Vaccin 2009;5(Jul (7)):483–7. [4] Baqui AH, El Arifeen S, Saha SK, Persson L, Zaman K, Gessner BD, et al. Effectiveness of Haemophilus influenzae type B conjugatevaccine on prevention of pneumonia and meningitis in Bangladeshi children: acase-control study. Pediatr Infect Dis J 2007;26(Jul (7)):565–71. [5] Gessner BD, Sutanto A, Linehan M, Djelantik IG, Fletcher T, Gerudug IK, et al. Incidences of vaccine-preventable Haemophilus influenzae type b pneumonia and meningitis in Indonesian children: hamlet-randomised vaccine-probe trial. Lancet 2005;365(Jan 1–7 (9453)):43–52. [6] Registrar General of India. Report on causes of deaths 2001–03; 2012. Available from: http://censusindia.gov.in/Vital Statistics/Summary Report Death 01 03.pdf [last accessed 20.03.12.]. [7] Verma R, Khanna P, Chawla S, Bairwa M, Prinja S, Rajput M. Haemophilus influenzae type b (Hib) vaccine: an effective control strategy in India. Hum Vaccin 2011;7(Nov (11)):1158–60. [8] Igor Rudan, Cynthia Boschi-Pinto, Zrinka Biloglav, Kim Mulhollandd, Harry, Campbell. Epidemiology and etiology of childhood pneumonia. Bull World Health Organ 2008;86(May (5)):408–16. [9] Suvarna Devi P, Murthy SN, Nath Sharma KC, Murthy US. Etiological study of pyogenic meningitis in children by CIEP. Indian Pediatr 1982;19(Apr (4)):317–21. [10] John TJ, Cherian T, Steinhoff MC, Simoes EA, John M. Etiology of acute respiratory infections in children in tropical southern India. Rev Infect Dis 1991;13(May–Jun (Suppl. 6)):S463–9. [11] Deivanayagam N, Ashok TP, Nedunchelian K, Ahamed SS, Mala N. Bacterial meningitis: diagnosis by latex agglutination test and clinical features. Indian Pediatr 1993;30(Apr (4)):495–500. [12] Bahl R, Mishra S, Sharma D, Singhal A, Kumari S. A bacteriological study in hospitalized children with pneumonia. Ann Trop Paediatr 1995;15(Jun (2)): 173–7. [13] Patwari AK, Bisht S, Srinivasan A, Deb M, Chattopadhya D. Aetiology of pneumonia in hospitalized children. J Trop Pediatr 1996;42(Feb (1)):15–20. [14] Sahai S, Mahadevan S, Srinivasan S, Kanungo R. Childhood bacterial meningitis in Pondicherry, South India. Indian J Pediatr 2001;68(Sep (9)):839–41. [15] Invasive Bacterial Infections Surveillance (IBIS) Group of the International Clinical Epidemiology Network. Are Haemophilus influenzae infections a significant problem in India? A prospective study and review. Clin Infect Dis 2002;34(Apr 1 (7)):949–57. [16] Chinchankar N, Mane M, Bhave S, Bapat S, Bavdekar A, Pandit A, et al. Diagnosis and outcome of acute bacterial meningitis in early childhood. Indian Pediatr 2002;39(Oct (10)):914–21. [17] Singhi SC, Mohankumar D, Singhi PD, Sapru S, Ganguly NK. Evaluation of polymerase chain reaction (PCR) for diagnosing Haemophilus influenzae b meningitis. Ann Trop Paediatr 2002;22(Dec (4)):347–53. [18] Kabra SK, Lodha R, Broor S, Chaudhary R, Ghosh M, Maitreyi RS. Etiology of acute lower respiratory tract infection. Indian J Pediatr 2003;70(Jan (1)):33–6. [19] Viswanath G, Praveen Hanumanthappa AR, Chandrappa NR, Mahesh CB. Bacteriological study of pyogenic meningitis with special reference to latex agglutination. Indian J Pathol Microbiol 2007;50(Jan (1)):97–100. [20] Shameem S, Vinod Kumar CS, Neelagund YF. Bacterial meningitis: rapid diagnosis and microbial profile: a multicentered study. J Commun Dis 2008;40(Jun (2)):111–20. [21] Minz S, Balraj V, Lalitha MK, Murali N, Cherian T, Manoharan G, et al. Incidence of Haemophilus influenzae type b meningitis in India. Indian J Med Res 2008;128(Jul (1)):57–64. [22] Gupta M, Kumar R, Deb AK, Bhattacharya SK, Bose A, John J, et al. Hib study working group. Multi-center surveillance for pneumonia & meningitis among children (<2 yr) for Hib vaccine probe trial preparation in India. Indian J Med Res 2010;131(May):649–58. [23] John TJ, Cherian T, Raghupathy P. Haemophilus influenzae disease in children in India: a hospital perspective. Pediatr Infect Dis J 1998;17(Sep (9 Suppl.)):S169–71. [24] Mani R, Pradhan S, Nagarathna S, Wasiulla R, Chandramuki A. Bacteriological profile of community acquired acute bacterial meningitis: a ten-year retrospective study in a tertiary neurocare centre in South India. Indian J Med Microbiol 2007;25(Apr (2)):108–14. [25] Feikin DR, Nelson CB, Watt JP, Mohsni E, Wenger JD, Levine OS. Rapid assessment tool for Haemophilus influenzae type b disease in developing countries. Emerg Infect Dis 2004;10(Jul (7)):1270–6.
Editorial / Vaccine 31 (2013) 3763–3765 [26] NTAGI. Subcommittee on Introduction of Hib Vaccine in Universal Immunization Program, National Technical Advisory Group on Immunization, India. NTAGI subcommittee recommendations on Haemophilus influenzae type B (Hib) vaccine introduction in India. Indian Pediatr 2009;46(Nov (11)): 945–54. [27] Saha SK, Rikitomi N, Ruhulamin M, Watanabe K, Ahmed K, Biswas D, et al. The increasing burden of disease in Bangladeshi children due to Haemophilus influenzae type b meningitis. Ann Trop Paediatr 1997;17(Mar (1)):5–8. [28] Adegbola RA, Secka O, Lahai G, Lloyd-Evans N, Njie A, Usen S, et al. Elimination of Haemophilus influenzae type b (Hib) disease from The Gambia after the introduction of routine immunisation with a Hib conjugate vaccine: a prospective study. Lancet 2005;366(Jul 9–15 (9480)):144–50. [29] WHO www.who.int/immunization. . ./burden/GDB Hib Sp Results Database. xls; 2013.
Ajay Kumar Meenu Singh ∗ Kiran Kumar Thumburu Nishant Jaiswal
3765
Harpreet Kaur Shruti Sharma Amit Agarwal Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India ∗ Corresponding
author at: Department of Pediatrics, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India. Tel.: +91 172 2755306; fax: +91 172 2744401. E-mail addresses: [email protected], [email protected] (M. Singh) 18 March 2013 Available online 3 July 2013