Proceedings of The First Current Topic in Infectious Diseases
Invasive Haemophilus Influenzae b Disease: Overview and Disease Burden in Hong Kong
In a position paper on Hib conjugate vaccine, WHO made the following qualified statement: "In view of the demonstrated safety and efficacy of the Hib conjugate vaccines, Hib vaccine should be included, as appropriate to national capacities and priorities, in routine infant immunization programmes." This statement highlights the two major barriers to the implementation of routine infant Hib immunization in Asia: the cost of Hib vaccine and its administration which has to be accommodated by "national capacities"; and the absolute disease burden of Hib diseases and its relative burden in the broader context of total disease burden, which will determine the "national priorities". The disease burden of Hib diseases varies greatly from one country to another in Asia but on a whole may be less than that in North America. Better documentation of burden of disease is not just of academic interest but indispensable as part of a very complex strategy to introduce novel but relatively expensive vaccines, such as Hib and pneumococcal conjugate vaccines. Currently, the high-income countries in Asia should address this issue of whether or not to introduce routine Hib immunization of infants because their "national capacities" could easily accommodate the cost of the vaccine and its administration; and even if the incidence of Hib disease in these countries is low, the benefits of such routine immunization could be substantial because the indirect medical costs and long-term treatment costs of Hib morbidity increase with per capita gross national product (GNP). For example, in Hong Kong Special Administrative Region of China, where the estimated incidence of Hib meningitis and bacteremic pneumonia is only about three per 100,000 children aged under five years; there would still be about 10 cases per year, with perhaps one death and two children suffering sustained permanent neurological sequelae but surviving for decades, and thus in need of long-term health care. The net Hib immunization programme cost could be offset by the savings made in not having to provide care for these handicapped children for the rest of their lives as well as the life saved. However, for low-income countries, the absolute cost involved will be high enough to prohibit implementation of routine Hib infant immunization, despite the demonstrated cost-effectiveness of such programs.
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