Hong Kong Journal of Paediatrics [HK J Paediatr (New Series) 2001;6:129]

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HK J Paediatr (New Series)
Vol 6. No. 2, 2001

HK J Paediatr (New Series) 2001;6:129

Proceedings of The First Current Topic in Infectious Diseases

Factors to Consider in the Routine Use of Hib in Hong Kong

Thomas HF Tsang

HK J Paediatr (new series) 2001;6:127-132

Proceedings of The First Current Topic in Infectious Diseases: Consensus Meeting on Conjugate Vaccines of the Center of Infection
Faculty of Medicine, The University of Hong Kong (Selected Abstracts)

The routine use of conjugate Hib vaccine is a public health decision, which should only be made after a careful assessment of a number of factors, related to the disease and the vaccine. A major issue concerns the burden of invasive Hib disease in Hong Kong. Available data suggested that the disease is much less common locally than in other industrial countries such as the United States, Canada, Australia and Finland. Hib is not a notifiable disease. Notwithstanding this, the department of Health only received between one to six cases of Hib meningitis per year. The conjugate Hib vaccine is highly efficacious (>95%) with relative few and minor side effects (5-30%). It is accustomed to use one or more of the following quantitative tools to assess the cost and benefit of a vaccination program: cost-benefit analysis (CBA), cost-effectiveness analysis (CEA) and cost-utility analysis (CUA). Of the CBA performed overseas, the B:C ratio for routine Hib range between 1.2 to 5.1. In Australia, one study reported the cost per QALY saved of a routine Hib program to be between AUS $1231 to 9136. A CBA of routine Hib program in Hong Kong is difficult to perform because there is no local consensus on how to calculate the cost of some parameters such as the long term medical care, loss in productivity and death. On the basis of an estimated incidence of five invasive Hib per 100,000 children age <=5 years, the cost per case of invasive disease prevented is about 1.6 million. In conclusion, quantitative assessment of a routine Hib program in Hong Kong is difficult to perform, due mainly to the lack of certain data. A consensus economic model on which to base decision should be developed and validated.

Method and Process of Consensus Building

The consensus meeting on Consensus meeting on conjugate vaccines was held on February 17, 2001, as the first current topic in infectious diseases that was organized by the Centre of Infection, the University of Hong Kong. A panel of experts from the fields of Internal Medicine, Clinical Microbiology, Internal Medicine, Paediatrics and Public Health were provided with the latest scientific papers^1-8 and were invited to speak and discuss on various aspects concerning the topic.

After the formal presentation, panel discussion was held. All speakers, invited discussants from various aspects of the medical fields and audiences actively participated in the discussion with further elaboration on issues around S. pneumoniae and H. influenzae disease burden, antimicrobial resistance and conjugate vaccine.

Finally, conclusions were drawn on the basis of the current scientific information and views expressed by the panel and other participants. Drafts in progress and final copies of the manuscript were distributed to panel for comments before submission for publication.

Consensus Panel Members

Daniel CS Chiu, Pediatrician in private practice
Susan SS Chiu, Assistant Professor, Department of Paediatrics, The University of Hong Kong
CB Chow, Consultant, Department of Paediatrics, Princess Margaret Hospital
PL Ho, Associate Professor, Department of Microbiology, The University of Hong Kong
YL Lau, Chair Professor in Paediatrics, Department of Paediatrics, The University of Hong Kong
CW Leung, Consultant, Department of Paediatrics, Princess Margaret Hospital
Dominic NC Tsang, Consultant, Department of Clinical Pathology, Queen Elizabeth Hospital
Kenneth WT Tsang, Associate Professor, Department of Medicine, University of Hong Kong.
Thomas HF Tsang, Community Physician, Department of Health
Samson SY Wong, Assistant Professor, Department of Microbiology, University of Hong Kong.
YH Yang, Professor, Beijing Children's Hospital, Beijing
KY Yuen, Chair Professor in Infectious Diseases, Department of Microbiology, The University of Hong Kong

Consensus Statements

Disease burden of paediatric Haemophilus influenzae type b infections in Hong Kong

1. The incidence of Haemophilus influenzae type b (Hib) diseases in Hong Kong appears to be low. Multiple confounding factors, such as prior antibiotic usage, might be the causes for the apparent low recorded prevalence.

2. Further study to collect epidemiological data in Hong Kong would be difficult due to the following factors:

a) Some children might have been given Hib vaccination on an individual basis.

b) There are quite a number of patients taking antibiotics prior to collection of specimens for cultures and the recovery rate of any microorganisms in these situations is relatively low.

3. Gaps in existing data should be addressed in future studies using new research methodology, such as the WHO rapid assessment tool.

Use of conjugate Haemophilus influenzae type b vaccine

1. Conjugate Hib vaccine has proven safety and efficacy in prevention of invasive Hib disease.

2. Thorough cost-effective/benefit/utility analysis and comparison of existing program would be very helpful in supporting recommendation for universal vaccination in this locality. Broader discussion/consultation on what constitute the "acceptable" cost is required.

Disease burden of pneumococcal infections in Hong Kong

1. Disease burden of pneumococcal disease is still unclear and further study would be needed for different at-risk groups.

2. Penicillin-resistant and multiple antibiotic-resistant pneumococci are a major problem in Hong Kong.

Use of conjugate pneumococcal vaccine

1. The heptavalent conjugate vaccine provides good coverage of the serotypes causing invasive pneumococcal disease in Hong Kong at present.

2. Conjugate pneumococcal vaccine is effective in decreasing vaccine strain carriage, and preventing invasive pneumococcal disease in young children from published experience.

Acknowledgement

The meeting was sponsored by the Hong Kong Paediatric Foundation.

References

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