Haemophilus influenzae type b vaccine in Papua New Guinea: what can we expect and how should we determine priority for child health interventions? [editorial]

The Hemophilus influenzae protein conjugate vaccines are effective at preventing disease and death from Hemophilus influenza type b (Hib) pneumonia and meningitis in children in developing countries. Much of the early research that determined the etiology of pneumonia and meningitis and the central role of Hemophilus influenzae was done in Papua New Guinea (PNG). Until the 1990s the only defense against Hib disease was standard antibiotic treatment particularly chloramphenicol for severe infections. However current data on the incidence of chloramphenicol-resistant Hib in isolates from cerobrospinal fluid is as high as 30%. This paper discusses the role of Hib vaccines in reducing the child mortality rate in PNG. The author examined all available evidence and cost-benefit arguments that would help in estimating the magnitude of benefit of any health intervention including Hib vaccine. Finally the author suggests that health administrators and government need to see the paramount importance of pneumonia prevention and should recognize that this entails new and more obvious costs.