Steven Black

Global challenges of Haemophilus vaccinations quarter of a century after the Hib project In 2000, 8.13 million children contracted invasive Haemophilus infection globally, 0.37 million of which died. These were unnecessary disease cases and deaths that would have been preventable with the Hib vaccine. The vaccine was developed during the 1980's. During its application for more than twenty years, the vaccine has proven to be effective, safe and cost-effective. The wide application of the Hib vaccine has led to the eradication of life-threatening Haemophilus diseases from the industrialized countries, whereas in developing countries the vaccine should be permanently included in national vaccination programs.

Streptococcus pneumoniae is a leading cause of pneumonia and meningitis worldwide, and >1 million children die because of pneumococcal infections globally each year [1]. Such infections are due to various pneumococcal serotypes, and the serotypes responsible for these infections vary with time and geography. Although children are generally at the highest risk for both pneumonia and invasive disease, in some populations in the world, this risk is much higher. Such populations include Native American Indians, Alaskan indigenous populations, and the Australian Aboriginals. In the White Mountain Apache (WMA) population, the risk of invasive pneumococcal disease was 8-fold higher prior to vaccine introduction, than it was in the general US population. Although the reasons for this elevated risk are still not completely understood, this elevated risk has resulted in extensive study of the WMA population. In this issue of Clinical Infectious Diseases, Lacapa et al. [2] report on the impact of the introduction of 7-valent pneumococcal conjugate vaccine into the WMA population in Arizona. This study is very beneficial to our understanding of the dynamics of pneumococcal epidemiology in general and of the impact, both positive and negative, that vaccine introduction may have in a population.