Desai Shalini, Jamieson Frances B, Patel Samir N, Seo Chi Yon, Dang Vica, Fediurek Jill, Navaranjan Debeka, Deeks Shelley L
Immunization and Vaccine Preventable Diseases Division, Public Health Ontario, Toronto, ON, Canada.
Public Health Ontario Laboratories, Public Health Ontario, Toronto, ON, Canada.
PLoS One. 2015 Nov 16;10(11):e0142179. doi: 10.1371/journal.pone.0142179. eCollection 2015.
Since the widespread use of Haemophilus influenzae (Hi) type b (Hib) vaccines among children aged <5 years, an increase in invasive non-Hib disease incidence has been reported internationally. We sought to describe the epidemiology of invasive non-Hib disease in Ontario, Canada (population ~13.5 million).
Confirmed invasive non-Hib cases (non-typeable [NTHi] and serotypes a, c, d, e, and f) were obtained from the provincial laboratory data system from 2004-2013. Data were deterministically linked to the provincial reportable disease system to provide further case information. Antibiotic resistance data were analysed separately from 2010-2014. Descriptive analyses included incidence rates, age group, serotype, site of specimen collection and resistance patterns; ethnicity data were not available. Temporal trends were evaluated by Poisson regression and p-values <0.05 were considered significant.
A total of 1307 cases of invasive non-Hib disease were included, increasing from 0.67 cases to 1.60 cases /100,000 from 2004 to 2013. Significant increases in the incidence of NTHi (0.50 to 1.28 cases/100 000 population), Hia (0.02 to 0.08 cases/100, 000) and Hif (0.13 to 0.18 cases/100, 000 population) were seen. Among persons aged 40-64 years, 3 Hi strains significantly increased over time; NTHi (0.22 to 0.99 cases/100, 000), Hia (0.00 to 0.06 cases/100, 000) and Hif (0.05 to 0.21 cases/100, 000). Among persons aged 65-84 years, there was a significant increase of NTHi (1.62 to 3.14 cases/100, 000) and Hia (0.00 to 0.34 cases/100, 000). Among persons aged 85+ years, only NTHi significantly increased from 4.89 to 10.28 cases/100, 000). Antimicrobial resistance (AMR) to ampicillin and clarithromycin was seen in greater than 25% of isolates but AMR did not increase over the duration of this study.
The incidence of invasive non-Hib disease has increased over time; NTHi, Hif and Hia are emerging pathogens, and should be monitored.
自从b型流感嗜血杆菌（Hi）疫苗在5岁以下儿童中广泛使用以来，国际上报告侵袭性非b型流感嗜血杆菌疾病的发病率有所上升。我们试图描述加拿大安大略省（人口约1350万）侵袭性非b型流感嗜血杆菌疾病的流行病学情况。
确诊的侵袭性非b型流感嗜血杆菌病例（不可分型[NTHi]以及a、c、d、e和f血清型）来自2004年至2013年的省级实验室数据系统。数据通过确定性链接与省级法定报告疾病系统相连，以提供更多病例信息。2010年至2014年对抗生素耐药性数据进行单独分析。描述性分析包括发病率、年龄组、血清型、标本采集部位和耐药模式；种族数据不可用。通过泊松回归评估时间趋势，p值<0.05被认为具有统计学意义。
共纳入1307例侵袭性非b型流感嗜血杆菌疾病病例，从2004年到2013年发病率从每10万人0.67例增至1.60例。不可分型流感嗜血杆菌（NTHi）（从每10万人口0.50例增至1.28例）、a型流感嗜血杆菌（Hia）（从每10万人口0.02例增至0.08例）和f型流感嗜血杆菌（Hif）（从每10万人口0.13例增至0.18例）的发病率显著上升。在40至64岁人群中，3种Hi菌株随时间显著增加；NTHi（从每10万人口0.22例增至0.99例）、Hia（从每10万人口0.00例增至0.06例）和Hif（从每10万人口0.05例增至0.21例）。在65至84岁人群中，NTHi（从每10万人口1.62例增至3.14例）和Hia（从每10万人口0.00例增至0.34例）显著增加。在85岁及以上人群中，只有NTHi显著增加，从每10万人口4.89例增至10.28例。超过25%的分离株对氨苄西林和克拉霉素有抗菌药物耐药性（AMR），但在本研究期间AMR没有增加。
侵袭性非b型流感嗜血杆菌疾病的发病率随时间增加；NTHi、Hif和Hia是新兴病原体，应予以监测。
