Abstract
During a 14 month period, 7 of 48 children attending a day care center developed HIb disease. Five infants developed meningitis, 1 septic arthritis and the 7th infant had pneumonia and septicemia. Surveillance studies showed that at least 58% of infants carried HIb in their nasopharynx on 1 occasion.Specific measures were instituted to control the outbreak; these included antimicrobial prophylaxis and immunization with HIb polysaccharide vaccine. Ampicillin (100 mg/kg/d) was administered to 6 asymptomatic carriers of ampicillin-susceptible HIb. At 1 and 7 days after therapy, HIb was isolated from 3 infants and at 14 days, 4 of 5 infants had positive cultures. HIb vaccine was administered subcutaneously to 34 children. Sera obtained prior to immunization showed detectable antibody in all infants. Only 9 (26%) infants had two-fold or greater rises in serum HIb antibody titers after vaccination. Antibody response was independent of age, pre-immunization antibody concentration and HIb carrier status. Vaccine was not only ineffective in reducing the carrier rate, it failed to prevent acquisition of the organism by non-carriers. An 18 month old infant previously identified as a carrier, developed meningitis 4 months after receiving and responding to the vaccine.HIb is a highly contageous agent capable of causing disease in closed populations of susceptible infants.
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