Haemophilus influenzae meningitis was studied over a 2-year period in children <5 years of age in a population-based, prospective study in The Gambia, West Africa. A total of 77 cases were recorded. The incidence was 60 cases/l00,OOO children <5 years of age and 297 cases/l00,OOO children <1 year of age. The peak prevalence was at the age of 5 months; 83% of the children were <1 year old and 45% were <6 months old. Only 55% of cases recovered completely. The distance to the nearest hospital was an important predisposing factor for a fatal outcome. Two cases were secondary. Many patients were anemic and underweight. The observations show that H. influenzae meningitis in The Gambia has an incidence as high as that in the USA, but that it has 10-fold more devastating outcome. If the infection is to be prevented by vaccination in The Gambia, immunization will have to be given very early in life.

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