Haemophilus influenzae type b meningitis: how much better is prevention than cure?

Haemophilus influenzae type b (Hib) is a major cause of meningitis and pneumonia in children. In Papua New Guinea (PNG) more than 20% of Hib are now resistant to chloramphenicol, and resistant Hib meningitis treated with chloramphenicol results in certain death or severe brain injury. Third-generation cephalosporins are a therapeutic option but are very expensive, while the Haemophilus influenzae type b conjugate vaccine would provide effective prevention. In a province of 380,000 people, using ceftriaxone as standard treatment for meningitis in all health facilities would only save an estimated 8 more lives per year than using chloramphenicol, and cost US dollars 1514 per additional life saved. Introduction of Hib vaccine would save, each year, 61 more lives than using chloramphenicol and 53 more lives than using ceftriaxone for meningitis treatment. The cost of a vaccination strategy for Hib meningitis would be US dollars 1216 for each of the 61 additional lives saved. Hib vaccine would be by far the most effective intervention to reduce mortality and severe neurological disability from Hib meningitis in PNG. Nationwide introduction of Hib vaccine is urgently needed, as antibiotics are now less effective in this disease than ever before.