Haemophilus influenzae type b disease and vaccination in Latin America and the Caribbean

Conjugate vaccines are highly effective in preventing Haemophilus influenzae type b (Hib) diseases. Data on the epidemiology of Hib disease in Latin America and the Caribbean are not easily accessible, are incomplete and are deserving of critical analysis.

Relevant information in Spanish, English and Portuguese from over 20 regions in 16 countries was reviewed, with special attention to all Hib diseases and to children < 5 years because of their proneness to disease. Total number of cases and deaths were estimated from the incidence rates obtained from 10 studies.

Taking into account variation between among countries, the overall incidence of Hib meningitis at age 0 to 4 years was estimated as 35 per 100,000, which would imply 20,000 cases annually in the region. An estimated rate of 60 per 100,000 for all Hib disease suggests 33,000 cases per annum. In all age groups at least 40,000 annual cases and 5000 deaths occurred annually. Given that the true role of Hib pneumonia is unknown because of data are much lacking for nonbacteremic cases, these figures are probably underestimations. Because large scale vaccination programs are being implemented in only 3 countries, the impact on Hib epidemiology has been minimal.

Hib diseases are common in Latin America and the Caribbean, and use of conjugate vaccines is minor. Concurrently with better epidemiologic studies, their use should be extended, preferably in combination with other vaccines. Making Hib diseases notifiable would be one step for better recognition of their importance.