EFFECTIVENESS STUDY OF HIB
VACCINATION FOR CHILDREN
YEARS IN JORDAN
done by the medical committee of Jordanian Meningitis Foundation
*Pediatrician, Member of the Medical Committee of Jordanian
Meningitis Foundation (JMF) , Amman- Jordan.
HIB-disease is a major cause of health problem in developed and
developing countries, and where the HIB-vaccine was introduced
within the routine immunization of infants and children, the
incidence of the disease declined significantly.
is conducted to estimate the incidence of HIB Meningitis and
HIB-Pneumonia in Jordan and its cost, revealing an incidence of HIB
— Meningitis ranging between 20 - 30/100.000 children <5 years and
HIB-Pneumonia of 75/100.000 children <5 years. Evaluating the
benefit and cost effectiveness which can be obtained if the
HIB vaccine was included within the EPJ of Jordan, we found that it
is profitable to introduce the anti HIB-vaccine within the routine
schedule of immunization of infants and children at risk to develop
the disease as soon as possible.
MATERIALS AND METHODS:
of several published papers, articles and researches reporting
unequivocal data and conclusion about the effectiveness and safety
of the conjugate HIB vaccines when introduced in routine
immunization schedule of small infants at the age of 2, 4, 6 and
Booster dose at the age of 15 months, resulting in dramatic decrease
in the incidence of meningitis and all invasive types of HIB disease
to less than 1/100.000 of children <5 years old within ito 4 years
of introduction of routine infant immunization. In several countries
using the vaccine for longer periods of time and which have achieved
relatively high coverage rates, the disease no longer occurs at all.
The ability of the vaccine to eliminate disease is due to
elimination of oropharyngeal carriage of the bacteria in well
immunized populations, leading to absence of exposure to the
bacteria even in un immunized children. The recent studies
demonstrate that HIB conjugate vaccines are as efficacious in
developing countries populations as they were in efficacy trials in
the industrialized world. In addition the studies showed that the
vaccine reduced all chest X-Ray documented pneumonia by more than
all available data about the HIB Meningitis and all HIB invasive
disease in several countries of the area like Syria, Kuwait, Qater
and others we found an incidence > 20/100.000 children <5
years. Same incidence is recorded when we reviewed data registered
in the Department of disease control in the Ministry of Health of
Jordan in the “ Master file of obligatory notification Diseases
Model”, Looking specifically after Bacterial Meningitis, (HIB
meningitis, meningococcal meningitis, puenmococcal Meningitis) and
others with negative results related to the demonstration of
presence of Bacteria in CSF, which is in part due to high percentage
of partial treated meningitis and inefficient laboratory tests.
different studies done during the 90's in two main hospitals in
Jordan with specialized and terminal pediatric services, the
incidence rate of HIB meningitis per year ranged between
21~30/100.000(18) (19), and the mortality percentage reported is
between 8-13%. Sequelaes detected in 21- 32% of survivors.
took to consideration the cost of treatment of diagnosed cases
during hospitalization, care of acute phase , prophylaxis and
obligatory follow up of close contacts in addition to the cost of
care required by diseased patients sequelaes, the fact of emotional,
familial and social serious disturbances in addition to the material
be avoided by administering the vaccine for highly risk groups of
infants and children < 5 years old >.
addition to Meningitis, there is great interest in addressing the
problem of Bacterial pneumonia, recognized in developing country as
a major cause of morbidity, mortality and a common cause of
admission for intrahospital treatment. To estimate the annual
mortality and morbidity rates of pneumonia due to HIB in Jordan we
applied the formula recommended by the Global program for vaccines
and immunization established by the WHO in the “Generic Protocol for
Population — based surveillance of Haemophilus influenza type B
studies on the impact of HIB vaccine on the incidence of invasive
disease after three doses was 95%, and for prevention of HIB
pneumonia after two to three doses was 100%reducing the total
incidence of pneumonia of different causes in 20%, this results
coincide with several data and studies suggesting that 20% of total
cases of pneumonia are caused by haemophilus influenza type B(13) .
for disease control and prevention (Atlanta, GA, USA) and the WHO
program for control of acute Respiratory infection (Geneva,
Switzerland) recently reviewed the epidemiology and etiology of
pneumonia in developing countries of the estimated 3.7 million acute
lower respiratory tract infection
deaths among children <5 years old in the developing world the CDC/
WHO review estimates that 342.000 (9%) are due to HiB(16) . This
estimate of HIB ALRI deaths is approximately ten times more than
that estimated number of HIB meningitis deaths among children < 5
years old in developing countries.
ANALYSIS AND RESULTS:
reviewing the last annual statistical report of the MOH of Jordan
(1998), there was no available information or data about deaths due
to HiB-pneumonia, So applied the garenne at al formula .
recommended by WHO when there is no specific available information
about mortality due to acute lower respiratory infection (ALRI), (2)
resulted in at least 4.5 deaths /100.000 children <5 years and a
total of at least 34 deaths per year from this age group.
HIB — pneumonia cases found to be at least equal to 75 cases/ 100.000
children <5 years and a total of at least 525 cases of
HIB-pneumonia per years of this age group with percentage of HIB-
Pneumonia mortality equal to 6.5% of the total number of children
and infant with established HIB- Pneumonia . The previous results
calculated up on crude death rate (per 1000 population) because no
available data on mortality rate per 1000 children <
5 years, inspite of that ,those results provided us with a very
useful data to calculate the minimal total cost of the two main
groups of i-JiB disease( HiB-Meningitis, HIB- pneumonia) in
Considering the lowest expected incidence of the disease and lowest
percentage of mortality and morbidity we obtained the following
of hospitalization and care of acute phase of HIB—Meningitis per
year is equal to 99.400 JD.
2.Sequelaes care cost increasing yearly by the amount of 72.000
JD in accumulative manner.
prophylaxis provided to close contacts persons is equal to 14.200
JD per year.
total Deaths due to meningitis per year is equal to 369.200 JD
HIB-pneumonia which need 3 weeks of antibiotics treatment at least
is equal to 551.250 JD per year.
6. Cost of
HIB- Pneumonia deaths per year is equal to 1.105.000 JD
total cost of HIB — Meningitis and HIB-pneumonia without
calculation of the cost of other forms of HIB
— invasive disease will
be at least equal to 2.211.050 JD per year.
of one dose of HIB —vaccine is equal or less than 2USD if covered by
Public Health Services. Knowing that the total need per year is
around 600.000 doses, the maximum total cost of vaccines needed per
year will be around 1.200.000 USD (600.000 x 2 = 1.200.000)
Equivalent to N 846.000 JD to protect all risk group <5years
Considering the data collected from the master file of obligatory
Notification Disease Model of the MOH of Jordan 1999/2000,
of HIB Meningitis cases from the area of Hai — Nazzal where the
pilot project of HIB vaccine Promoted by JMF and MOH which started
one year ago ( Jun 99), Covered all infants and children <3
years and extended during the last month ( May 2000) to new
areas of primary Health area of Amman, the safety efficacy, high
protective rate and lower cost meaning of the introduction of
vaccine in the routine Immunization program of Jordan would be
profitable, taking into account the economic point of view, eniotional, family and social serious disturbances due to
Hospitalization, sequalaes and deaths caused by this disease which
would he avoided and is perfectly preventable if the vaccine is
Introduced in the schedule of Jordanian National program of
CONCLUSIONS AND RECOMMENDATIONS:
HIB-disease is an important cause of Morbidity, Modality and
disabilities, affecting mainly infants and child's <5years old,
occurring with considerably important incidence in Jordan
approximately equal to other developing countries.
incidence rate reported in developed countries before the era of
HIB-Vaccine, declined dramatically after the introduction of
HIB vaccine in the schedule of Routine immunization of infants and
children to less than 1/100.000 children < 5years and the new cases
presented later on were only in infants and children not immunized
or not fully immunized for several reasons.
introduction of HIB-vaccine results in life saving, disabilities
prevention and materiaI cost reduction.
introduction of HIB — vaccine in routine immunization in Jordan is
advisable, because it will be of great benefit to decrease the
incidence of HIB-disease cases and its cost significantly. Therefore
We recommend the introduction of HIB — vaccine in the Expanded
Program of Immunization (EPI) of Jordan applying the schedule
recommended by the WHO for Anti-HiB vaccination.