Globalisation of Hib vaccination—how far are we?

In Asia, the introduction of Haemophilus influenzae type b (Hib) vaccine into routine immunisation programmes has been hampered mainly by the high cost of the vaccine and the scarcity of population-based frequency data to verify the burden of Hib disease.1 In today's Lancet, Bradford Gessner and colleagues examine the contentious issue of using Hib vaccine in Asia. They did a double-blind randomised community trial in Lombok, Indonesia, to assess the vaccine's ability to protect against Hib meningitis and pneumonia. More than 55 000 children less than 2 years of age were enrolled to receive the Hib vaccine or diphtheria, pertussis, and tetanus (DPT) vaccine. The authors found an unexpectedly high absolute reduction of vaccine-preventable Hib meningitis. The rate, up to 158 cases per 100000 person-years, is one of the highest rates of Hib meningitis ever documented. The researchers recommend adding Hib vaccination to the course of routine infant immunisations because of the high rate of Hib meningitis and improvements in morbidity and mortality associated with Hib vaccine use. The only statistically significant endpoint the vaccine achieved for pneumonia was the prevention of 1561 cases of clinically defined pneumonia per 100 000 person-years.