National HIB vaccination program urgent: Study
Sari P. Setiogi, The Jakarta Post, Jakarta
People's lack of access to Haemophilus influenzae type B (Hib) vaccination is placing Indonesian children under five years of age at higher risk of meningitis, a survey warned.
The research, conducted recently in Lombok, West Nusa Tenggara, also indicated that one in every 33 children aged under two years would develop meningitis or pneumonia as a result of Hib infection.
American pediatrician Bradford D. Gessner, who carried out the research, said the prevalence rate for Hib meningitis in Lombok stood at 158 per 100,000 children under five years old, one of the highest figures ever recorded.
The Philippines has reported 18 cases per 100,000 children, while Vietnam 25.7 per 100,000 children.
"Other countries, such as India, Australia and Pacific Island nations have rates similar to those documented in Indonesia. All of this meningitis is preventable with the Hib vaccine," said Gessner.
Meningitis is an inflammation of the 'lining' (meninges) of the cerebral cortex and spinal cord caused by Hib bacteria. It mainly affects the under fives, but particularly those aged three months to three years.
The Center for Disease Control and Prevention said the global incidence among children under two years stands at between 0.5 and five per 100,000 children per year.
"Lombok, which is a rural, relatively poor and agrarian area and records a high infant mortality rate is thought to represent conditions under which the majority of Asian children live," Gessner told The Jakarta Post.
Hib usually strikes children under five years old, manifesting as pneumonia and nonbacterial meningitis. It can also cause serious complications, including paralysis, mental retardation and deafness, and in severe cases it can cause death.
The World Health Organization has estimated that Hib causes serious disease in at least three million children, and the death of about 400,000 to 700,000 others, each year worldwide.
In 2002, Malaysia became the first country in Asia -- and the only Southeast Asian country -- to adopt Hib vaccination as part of its routine immunization program.
After two years, Malaysia successfully halved the death rate resulting from the disease.
Hib vaccine is apparently only accessible to middle- and upper-class people in Indonesia, as it costs Rp 175,000 (US$19) for each dose. The vaccination is commonly given three times at two months of age, then again at four months, six months, and 15 months.
As Hib disease is rarely found among children older than five years, Hib vaccine is not routinely recommended for children in that age group.
Despite its relatively expensive price, the government has not listed Hib in its Immunization Development Program (PPI), as has been recommended by the Indonesian Pediatric Association (IDAI).
"The lack of access to vaccination programs has led to Hib infection emerging as a leading cause of death and disability among children," Asia Pacific Pediatric Association (APPA) Secretary General Mohd. Sham Kasim said.
Director of the Health Systems Program at the Department of International Health and Pediatrics, John Hopkins University, Mathuram Santhosam, said there was proof that vaccination dramatically reduced cases of Hib meningitis.
"We have evidence that the Hib vaccine is effective. Safe and effective vaccines to prevent Hib infection are widely available in developed countries," he said
However, he said only 25 percent of the world's children had access to the vaccination.
"We urge health authorities and governments to consider implementing Hib vaccinations because only when national immunization schedules are enacted can there be an eradication of this infectious disease," he said.
The first Hib vaccine was licensed in the United States in 1985. However, it was not very effective, and an improved vaccine was licensed in December 1987.