Olowokure, Babatunde (1999) The impact of Hib conjugate vaccine on the epidemiology of invasive Haemophilus influenzae disease in the West Midlands and the effect of deprivation and other environmental risk factors : an ecological study, 1990-1994. PhD thesis, University of Warwick.

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Abstract

Objective: To describe the epidemiology of invasive Haemophilus influenzae (HI) disease,
and to explore the relationship between socioeconomic disadvantage and invasive HI disease
in the two years immediately before (October 1990 to September 1992), and following
(October 1992 to September 1994) the introduction of HI type b (Hib) conjugate vaccine.
Design: Multiple sources of case ascertainment were used to identify children with invasive
HI disease in the West Midlands Health Region (WMHR) and compile a case register. An
ecological study examined socioeconomic disadvantage using selected socioeconomic
census data for enumeration districts, and the Townsend index of material deprivation.
Setting: WMHR, England from October 1990 to September 1994.
Subjects: Children under 5 years of age with invasive HI present on the West Midlands
invasive HI case register (HICARE).
Results : The incidence of invasive HI disease in the WMHR fell from 28.3/105 (95%
CI=24.5 to 32.6) children <5 years of age in the pre-conjugate vaccine period to 5.4/105 (3.8
to 7.4) after the vaccine had been introduced. Nine vaccine failures were identified. Those
aged 6-11 months were most at risk in the pre-conjugate vaccine period (OR=2.69,95%
CI=1.14 to 6.55). In the post-conjugate vaccine period those aged 24-35 months were at
most risk (OR=2.64,1.16 to 5.94). More cases of meningitis were identified in girls than
boys but the difference was not statistically significant. Significantly more cases of invasive
HI seen in children of South Asian origin aged less than 12 months than in non-South Asian
children (OR=2.88,1.07 to 7.86). Children from affluent areas were at significantly reduced
risk of disease compared to children from the more deprived areas (OR=0.73,0.54 to 0.99).
In the second period of the study a number of significant risk factors were identified.
Children living in areas containing predominantly rented accommodation (p=0.0025), mobile
populations (p=0.013) and a low density of children aged <5 years per km2 (p=0.039) were
at increased risk of invasive HI disease. Following meningitis, children from deprived areas
were more likely to suffer sensorineural hearing loss (p=0.035). Case fatality was higher in
the second period of the study, although not significantly so (OR=3.64,0.88 to 15.05).
Conclusion: This four year study provides the first detailed account of the relationship
between deprivation,
, socioeconomic risk factors, ethnic group, and invasive HI disease in
Britain. The incidence of the disease fell dramatically in the post-conjugate vaccine period.
A number of socioeconomic risk factors were identified in the second period of the study.
The data suggest that although Hib conjugate vaccine has greatly reduced the incidence of
disease, children from deprived areas remain at greater risk than children in more affluent
areas. They also indicate that the disease is still responsible for considerable sequelae and
mortality.

Item Type:	Thesis (PhD)
Subjects:	R Medicine > RC Internal medicine
Library of Congress Subject Headings (LCSH):	Haemophilus influenzae -- Epidemiology, Haemophilus influenzae -- Vaccination, Sick children -- England -- West Midlands -- Social conditions, Children -- Health and hygiene -- Sociological aspects
Official Date:	July 1999
Dates:	Date Event July 1999 Submitted
Institution:	University of Warwick
Theses Department:	School of Postgraduate Medical Education
Thesis Type:	PhD
Publication Status:	Unpublished
Sponsors:	University of Warwick ; General Charities of the City of Coventry ; Warwickshire Child Health Group
Extent:	xviii, 342 p.
Language:	eng

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