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Ungbarnabólusetning á Íslandi gegn Haemophilus influenzae af hjúpgerð b : árangur eftir sex ára notkun PRP-D (ProHIBiT)

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Authors
Kristín E. Jónsdóttir
Halldór J. Hansen
Víkingur H. Arnórsson
Þröstur Laxdal
Magnús L. Stefánsson
Issue Date
1996-01-01

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Other Titles
Immunization against Haemophilus influenzae type b in Iceland. Results after six years use of PRP-D (ProHIBiT®)
Citation
Læknablaðið 1996, 82(1):32-8
Abstract
Haemophilus influenzae type b (Hib) causes meningitis bacteremia and epiglottitis, dangerous infections, which occur mainly in children under five years of age. Incidence of Hib meningitis in that age group in Iceland was 43/100.000 1974-1988. In the fall of 1988 Icelandic health authorities decided to offer infant immunisation against Hib with PRP-D (ProHIBiT®) vaccine, product of Connaught Ltd, Canada. Results are presented of this immunisation programme which has been running since spring 1989. The vaccine is administered at the age of three, four, six and 14 months. During the first year of the immunisation programme one dose was offered to children aged 15 months up to end of third year. During the 10 years 1980-1989, 92 children had Hib meningitis, 61 Hib bacteremia or arthritis and 21 acute epiglottitis. During the five years 1990-1994 no child had Hib meningitis or epiglottitis but three had Hib bacteremia. Hib strains were 10-16% of Haemophilus influenzae strains isolated from surface swabs from 0-5 years old children at different periods until spring 1991 but became very scarse after that. Anti-PRP antibodies in blood measured <0.15 u.g/ ml in 20% of children after three doses of vaccine but >1.0j.ig/ml in 95% after four doses. No fully immunized child has had invasive Hib disease, but one had meningitis and two bacteremia after one dose of vaccine and one bacteremia after three doses. In 1993 21 fully immunized three to four years old children received a booster dose of PRP-D. Geometric Mean Titer of anti-PRP was 1.11 jig/ml before and 137.11u.g/ml after the dose. Mean antibodies against diphtheria were 0.37 IU before and 11.69 IU after the dose. It remains uncertain how long anti-PRP will last in vaccinees when Hib strains disappear.
Haemophilus influenzae af hjúpgerð b (Hib) getur valdið hættulegum sýkingum í heilahimnum, blóði og barkaloki. Eru þær algengastar hjá börnum innan fimm ára aldurs en koma einnig fyrir hjá eldri börnum og fullorðnum. Tíðni heilahimnubólgu af völdum Hib í börnum yngri en fimm ára á Íslandi 1974-1988 var 43 á 100.000 (1). H. influenzae af öðrum hjúpgerðum (a,c,d,e,f) eða án hjúps veldur oft sýkingum í öndunarvegum og miðeyra, en mjög sjaldan í blóði eða heilahimnum. Síðla árs 1988 ákváðu heilbrigðisyfirvöld að bjóða upp á bóluefni gegn Hib fyrir ungbörn, PRP-D (ProHIBiT®, Connaught Ltd), eina bóluefnið sem þá var komið á markað af eggjahvítutengdum bóluefnum gegn Hib. Það er myndað úr fjölsykrungi í hjúpi bakteríunnar Polyribosyl- Ribitol Phosphate (PRP) tengdum Diphtheria toxoid (D), sama efni og er í barnaveikibófuefni. Aðalhvatningin til að taka það í notkun hér voru niðurstöður sem birtust 1987 úr könnun á árangri bólusetningar 30.000 barna með PRP-D í Finnlandi en þar hafði það veitt 87% vernd eftir þrjá skammta á fyrsta aldursári (2). Var byrjað að gefa það þriggja mánaða börnum hér á landi í maí-júní 1989 og skammtar endurteknir við fjögurra, sex og 14 mánaða aldur. Börnum frá 15 mánaða til loka þriggja ára aldurs var boðinn einn skammtur árið sem bólusetningin hófst (3). PRP-D hefur því verið í notkun hér í sex ár. Niðurstöður um árangur eftir þriggja og fjögurra ára notkun hafa birst (4,5). Hér verður skýrt frá fjölda sjúklinga með heilahimnubólgu, blóðsýkingu og barkaloksbólgu af völdum Hib á árunum 1980-1989 í samanburði við fjölda þeirra sem greindust 1990-1994 og þeim fjölda Hib stofna sem fundust í ýmiss konar sýnum frá börnum og fullorðnum á mismunandi tímabilum fyrir og eftir 1989. Loks verður getið um mótefnamælingar.
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