EFFECTIVENESS STUDY OF HIB
VACCINATION FOR CHILDREN
YEARS IN JORDAN
done by the medical committee of Jordanian Meningitis Foundation
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 introduced within
the routine immunization of infants and children, the incidence of
the disease declined significantly.
is conducted to estimate the incidence of HiBmeningitis 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 HiBvaccine included within
the EPJ of Jordan, we found that it is profitable to introduce the
anti H1B-vaccine within the routine Schedule of Immunization of
infants and children at risk to develop the disease, as soon as
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 20%.
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 registrated 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 and emotional.
deaths which all can 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 BiB 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.
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 children <
the lowest Expected incidence of the disease and lowest percentage of
Mortality and morbidity we obtained the following results:
of hospitalization and care of acute phase of HiB—Meningitis per
year is equal to 99.400 JD.
care cost increasing yearly by the amount of 72.000 JD in
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 ofHiB- 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 annually.
the data collected from the master file of obligatory Notification
Disease Model of the MOH of Jordan 1999/2000, reported Number
of HiB Meningitis cases from the area of Hai — Nazzal where the
pilot project of H1B 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 HiB —
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 Immunization.
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 HiBvaccine 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.