Bamberger Ellen E, Ben-Shimol Shalom, Abu Raya Bahaa, Katz Amit, Givon-Lavi Noga, Dagan Ron, Srugo Isaac
From *The Pediatric Infectious Diseases Unit, Bnai-Zion Hospital, Haifa; and †The Pediatric Infectious Disease Unit, Soroka University Medical Center, and the Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel.
Pediatr Infect Dis J. 2014 May;33(5):477-81. doi: 10.1097/INF.0000000000000193.
The conjugated Haemophilus influenzae (Hi) type b vaccine caused a marked decrease in invasive Hi disease rates. Nonencapsulated Hi infection now constitutes most invasive Hi morbidity and mortality. This study examines invasive Hi infection incidence in Israel in the postvaccine era years, 2003-2012, and characterizes the epidemiology, clinical diagnosis and case fatality rates of invasive Hi disease in children <15 years of age.
An ongoing, nationwide prospective surveillance program for invasive Hi infections in Israel. Epidemiologic and clinical data were collected. Diagnoses were classified as meningitis, pneumonia, bacteremia/sepsis and other clinical foci.
Overall, 389 cases of invasive Hi infections were identified; 242 (62%) nontypable Hi (NTHi), 103 (26%) Hi type b (Hib) and 41 (11%) encapsulated non-b Hi (enbHi). Children <1 year of age accounted for 51% of the overall disease. Invasive Hi disease incidence in children <15 years of age was stable with a mean annual incidence (per 100,000) of 2.0 ± 0.4. The highest incidence of invasive Hi infections was among infants <1 year with rates of 6.2, 4.9, 1.6 and 12.7 for NTHi, Hib, enbHi and total Hi, respectively. The clinical diagnoses of NTHi and enbHi were similar, but differed from Hib with the former presenting mostly as isolated sepsis/bacteremia and the latter primarily as meningitis. Among children with invasive Hib infection, 40% were classified as vaccine failure.
In the post-Hib vaccination era, invasive Hi morbidity and mortality are largely attributed to NTHi sepsis. Still, with the changing epidemiology of invasive Hi, continued surveillance of all Hi strains is justified.
b型流感嗜血杆菌（Hi）结合疫苗使侵袭性Hi疾病发病率显著下降。非包膜Hi感染现已构成大多数侵袭性Hi发病和死亡原因。本研究调查了2003年至2012年疫苗接种后时代以色列侵袭性Hi感染的发病率，并描述了15岁以下儿童侵袭性Hi疾病的流行病学、临床诊断和病死率。
以色列正在进行一项全国性的侵袭性Hi感染前瞻性监测计划。收集了流行病学和临床数据。诊断分为脑膜炎、肺炎、菌血症/败血症和其他临床病灶。
总体上，共识别出389例侵袭性Hi感染病例；242例（62%）不可分型Hi（NTHi），103例（26%）b型Hi（Hib）和41例（11%）包膜非b型Hi（enbHi）。1岁以下儿童占全部病例的51%。15岁以下儿童侵袭性Hi疾病发病率稳定，年平均发病率（每10万）为2.0±0.4。侵袭性Hi感染发病率最高的是1岁以下婴儿，NTHi、Hib、enbHi和总Hi的发病率分别为6.2、4.9、1.6和12.7。NTHi和enbHi的临床诊断相似，但与Hib不同，前者主要表现为孤立性败血症/菌血症，后者主要表现为脑膜炎。在侵袭性Hib感染儿童中，40%被归类为疫苗接种失败。
在Hib疫苗接种后时代，侵袭性Hi发病和死亡主要归因于NTHi败血症。不过，随着侵袭性Hi流行病学的变化，对所有Hi菌株进行持续监测是合理的。
