PEDIATRICS Vol. 77 No. 3 March 1986, pp. 289-295
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Haemophilus influenzae Type b Disease in an Amish Population: Studies of the Effects of Genetic Factors, Immunization, and Rifampin Prophylaxis on the Course of an Outbreak

Dan M. Granoff MD1, Thomas McKinney MD1, Eyla G. Boies MD1, Norman P. Steele MD1, John Oldfather PhD1, Janardan P. Pandey PhD1, and Brian K. Suarez PhD1

1 The Edward Mallinckrodt Department of Pediatrics, and Department of Psychiatry, Washington University School of Medicine; the Division of Infectious Diseases, St Louis Children's Hospital; the Missouri-Illinois Regional Red Cross Blood Services, St Louis, MO; and the Medical University of South Carolina, Charleston

In 1982, an outbreak of Haemophilus influenzae type b disease occurred in a 379-member Amish community. In an attempt to control the outbreak after the occurrence of the second case of disease, we investigated the combination of (1) rifampin chemoprophylaxis of all carriers of H influenzae type b and their household contacts from 1 month to 5 years of age and (2) H influenzae type b polysaccharide vaccine immunoprophylaxis of all community members 12 months of age and older. Despite our intervention, two additional cases of bacteremic H influenzae type b disease occurred in the ensuing 5 months, one in a 22-month-old infant who had been immunized at 19 months of age and the other in a child who had not been immunized because she was younger than 12 months of age. The outbreak ended following rifampin prophylaxis of all community members younger than 15 years of age. All of the children with disease were genetically related to one another, and three of the four were inbred. However, analysis of their coancestry revealed that neither the average level of kinship nor the average inbreeding level of the affected children differed significantly from those of the other children in the community. Furthermore, none of the four children with disease shared a human leukocyte antigen haplotype. Our observations suggest that inbreeding was not a risk factor in this community. Furthermore, the combination of selective rifampin chemoprophylaxis of carriers of H influenzae type b and community-wide immunization with H influenzae type b polysaccharide vaccine in individuals 12 months of age or older was not an effective strategy for control of H influenzae type b disease in this closed population.

Key Words: Haemophilus influenzae type b • immunization • genetics • rifampin • Amish

Submitted on April 29, 1985
Accepted on June 4, 1985




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