“…A vaccine consisting of PRP coupled to diphtheria toxoid (PRP-D) was initially licensed following a randomized controlled trial showing high efficacy in Finnish children (Eskola et al, 1990; Griffiths et al, 2012). However, PRP-D proved ineffective in preventing Hib carriage and disease in Alaskan Native infants (Siber et al, 1990; Ward et al, 1990; Mohle-Boetani et al, 1993; Galil et al, 1999; Lee et al, 2006; Singleton et al, 2006; Asturias et al, 2009). On the other hand, antibody responses (to a Hib-Tetanus conjugate) were found to be higher among Native South American Indian infants compared to infants in the USA, Europe, or Israel (Castillo de Febres et al, 1994; Levine et al, 1997; Hoppenbrouwers et al, 1998; Asturias et al, 2009).…”