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Haemophilus influenzae disease in children in India: a hospital perspective
T J John1, T Cherian, P Raghupathy
1Indian Council of Medical Research, Tamil Nadu.
Insights
Haemophilus influenzae type b (Hib) causes significant childhood meningitis in India, with an estimated 75-100 cases per 100,000 children under five annually. Antibiotic resistance is rising, highlighting the need for Hib vaccination.
Area of Science:
- Medical Microbiology
- Pediatric Infectious Diseases
- Epidemiology
Background:
- Haemophilus influenzae is a significant pathogen causing pyogenic meningitis in Indian children.
- Data on H. influenzae infections in India is limited, with potential underdiagnosis due to suboptimal laboratory methods.
- Meningitis admissions due to H. influenzae parallel poliomyelitis cases, suggesting a high disease burden.
Purpose of the Study:
- To review and summarize existing data on H. influenzae diseases in India.
- To present three decades of unpublished data from a single center.
- To estimate the incidence of H. influenzae meningitis in young children in India.
Main Methods:
- Review of published literature on H. influenzae diseases in India.
- Analysis of unpublished hospital data spanning over 30 years.
- Estimation of meningitis incidence based on hospital admission rates and isolation frequencies.
Main Results:
- H. influenzae is the leading cause of bacterial meningitis in children, responsible for 33-50% of cases at the reporting center.
- An estimated 75-100 cases of H. influenzae meningitis per 100,000 children under five occur annually.
- Most invasive infections are caused by H. influenzae type b (Hib); increasing resistance to chloramphenicol and ampicillin is observed.
Conclusions:
- Primary prevention through Hib vaccination is a rational and beneficial intervention.
- Community-based studies are crucial to accurately assess the disease burden of Hib infections.
- Understanding the need and cost-benefit of infant Hib immunization requires further research.
Abstract:
We review and summarize published information on diseases caused by Haemophilus influenzae in India and unpublished data from our center covering more than three decades. Since the mid-1950s H. influenzae has been the most common cause of pyogenic meningitis in children admitted to our hospital, accounting for one-third to one-half of cases. Information from other centers in India has been scanty; the lower frequency of isolation of Haemophilus in studies in some centers may be caused by unsatisfactory media and culture methods. The annual numbers of admissions for pyogenic meningitis in our hospital have been quite similar to the numbers of cases of poliomyelitis. Assuming that the similar numbers of children hospitalized with these two diseases indicate similar incidence rates in the community and taking into account the frequency of Haemophilus isolations in pyogenic meningitis, we estimate that there may be as many as 75 to 100 cases of meningitis caused by this organism per year per 100000 children <5 years of age. Although pneumonia caused by H. influenzae has been recognized in a few studies, information is too scanty to attempt the estimation of incidence. Pus-producing infections caused by Haemophilus are rare. Epiglottitis caused by Haemophilus does not seem to occur in India. In recent years we have found that most invasive Haemophilus infections are caused by H. influenzae type b (Hib); other types or untypable strains are infrequent. An increasing prevalence of resistance to chloramphenicol and ampicillin has been recognized in our center and elsewhere. Thus from a hospital perspective, primary prevention by using Hib vaccine seems to be a rational and beneficial intervention. Community-based studies to measure the disease burden of Hib are urgently needed for a more satisfactory assessment of the need for, and cost benefit of, Hib immunization of all infants.