1 - From the Infectious Diseases and Immunodeficiency's Unit, Department of Pediatrics, Centro Hospitalar Universitário Lisboa Norte, Lisbon.
2 - Department of Pediatrics, Faculdade de Medicina da Universidade de Lisboa, Lisboa.
3 - Pediatric Department, Hospital de Vila Franca de Xira, Vila Franca de Xira.
4 - Haemophilus influenzae Reference Laboratory, Department of Infectious Diseases, National Institute of Health, Lisboa, Portugal.
- Pediatr Infect Dis J. 2023 Sep 1;42(9):824-828
Background: Despite the high effectiveness of the Haemophilus influenzae type b (Hib) vaccine in preventing invasive disease (ID) in children, Hib vaccine failures (VFs) cases may still occur. This study aimed to characterize the Hib-VF cases in Portugal in a 12-year period and trying to identify the possible associated risk factors.
Methods: Prospective descriptive nationwide surveillance study. Bacteriologic and molecular studies were performed at the same Reference Laboratory. Clinical data were collected by the referring pediatrician.
Results: Hib was identified in 41 children with ID and 26 (63%) were considered VF. Nineteen (73%) cases occurred in children less than 5 years old; 12 (46%) occurred before the Hib vaccine booster dose at 18 months of age. Comparing the first and the last 6-year periods of the study, the incidence rate of Hib, VF and total H. influenzae (Hi) ID significantly raised ( P < 0.05). VF cases corresponded, respectively, to 13.5% (7/52) and 22% (19/88) of total Hi-ID cases ( P = 0.232). Two children died due to epiglottitis and 1 acquired sensorineural hearing loss. Only 1 child had an inborn error of immunity. The immunologic workup performed in 9 children revealed no significant abnormalities. All 25 Hib-VF strains analyzed belonged to the same clonal complex 6.
Conclusions: In Portugal, more than 95% of children are vaccinated against Hib, but severe Hib-ID cases still occur. No predisposing factors were clearly identified to justify the increased number of VF in recent years. Along with continued Hi-ID surveillance, Hib colonization and serologic studies should be implemented.
Palavras Chave: Falência, Haemophilus, vacina