Vaccine Prevention of Paediatric Chronic Lung Disease: Targeting Haemophilus

Abstract

Abstract Background Chronic Suppurative Lung Disease (CSLD) is an emerging term encompassing a spectrum of chronic childhood respiratory disease. Characterised by early and severe infections and recurrent exacerbations, it is associated with progressive deterioration in lung function and quality of life. CSLD is highly unequally distributed and largely preventable, and is a major contributor to the global burden of chronic paediatric respiratory disease. Relatively few pathogens comprise the main culprit organisms identified in the aetiology of CSLD, over which Non-Typeable Haemophilus influenzae (NTHi) predominates. Methods We review developments that establish the role of NTHi in disease progression, focusing on high-risk population subgroups with an established CSLD burden. We consider current studies examining the role of prenatal NTHi and pneumococcal vaccination in preventing CSLD through reducing infections in high-risk populations, and discuss current directions in future research, including the need for precise identification of the pulmonary microbiome in CSLD. Results Early, repeated NTHi infections are clearly implicated in the aetiology of CLSD. Early results of current studies indicate NTHi vaccination may reduce the frequency of causal infections in high-risk groups. Clinical and immunological data show vaccination also reduces frequency of exacerbations and antibiotic usage in CSLD. Conclusions We provide the first clinical and immunological data for H. influenzae vaccination in children with CSLD. Targeted vaccination strategies may prevent CSLD establishment, slow progression, and potentially reduce morbidity, healthcare presentations and antibiotic consumption. This implicates vaccination as a potential aid in both antimicrobial stewardship and prevention of chronic disease. In the face of threats posed to health systems by antimicrobial resistance and the growing burden of chronic disease, vaccination is again emerging as a uniquely powerful public health tool. Key messages Hi vaccination can reduce infective exacerbations and antibiotic use in children with CSL. Vaccines may have a role in preventing chronic disease progression and reducing antibiotic reliance.