Author:
SARANGI J.,CARTWRIGHT K.,STUART J.,BROOKES S.,MORRIS R.,SLACK M.
Abstract
We reviewed retrospectively all invasive Haemophilus influenzae (Hi) infections in adults
ascertained from reference laboratory records and notifications from five NHS regions over the
5 years from 1 October 1990, a period encompassing the introduction of routine Hib childhood
immunization (October 1992). A total of 446 cases were identified, a rate of 0·73 infections per
105 adults per annum. Though numbers of Hib infections in adults fell after the introduction
of Hib vaccines for children (P = 0·035), and there was no increase in infections caused by
other capsulated Hi serotypes, total numbers of invasive Hi infections increased due to a large
rise in infections caused by non-capsulated Hi (ncHi) strains (P = 0·0067). There was an
unexpectedly low rate of infections in those aged 75 years or more (P < 0·0001). The
commonest clinical presentations were pneumonia with bacteraemia (227/350, 65%) and
bacteraemia alone (62/350, 18%) and the highest rates of disease were in the 65–74 years age
group (P < 0·0001). Clinical presentation was not influenced by the capsulation status of the
invading Hi strain. 103/350 cases (29%) died within 1 month, and 207/350 (59%) within 6
months of their Hi infection. Case fatality rates were high in all age groups. Pre-existing
diseases were noted in 220/350 cases and were associated with a higher case fatality rate (82%
vs. 21%, P < 0·0001). After the introduction of Hib immunization in children, invasive Hib
infections in unimmunized adults also declined, but the overall rate of invasive Hi disease in
adults increased, with most infections now caused by non-capsulated strains. Physicians and
microbiologists should be aware of the changing epidemiology, the high associated mortality
and high risk of underlying disease. Invasive haemophilus infections in adults should be
investigated and treated aggressively.
Publisher
Cambridge University Press (CUP)
Subject
Infectious Diseases,Epidemiology
Cited by
35 articles.
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