Makintubee S, Istre G R, Ward J I
J Pediatr. 1987 Aug;111(2):180-6. doi: 10.1016/s0022-3476(87)80064-1.
We prospectively studied the risk of secondary transmission of invasive Haemophilus influenzae type b (Hib) disease among children in day care in Oklahoma. We established a statewide surveillance system for the reporting of all forms of invasive Hib disease from physicians, clinical laboratories, county health departments, and infection control practitioners from all hospitals in and bordering Oklahoma. For the 2-year period March 15, 1984, to March 15, 1986, there were 409 culture-confirmed cases of invasive Hib disease in children 12 years of age or younger; 147 (37%) case-patients attended day care. When a case-patient attended day care during the week before illness, we prospectively identified and observed all classroom contacts (n = 2147) for the next 60 days. Of 1253 classroom contacts younger than 4 years of age, seven (0.6%) secondary cases were identified. Isolates from all paired index and secondary cases had identical outer membrane protein (OMP) patterns. Strains causing primary disease were indistinguishable by OMP distribution from those causing secondary disease. Of 685 classroom contacts younger than 2 years of age from whom rifampin use was ascertained, five (1.7%) of 292 who did not receive rifampin became secondary cases, compared with one (0.3%) of 393 who received rifampin (rate ratio 6.7; 95% confidence limits 1.1, 42.5; P less than 0.05). Of 495 classroom contacts 24 to 47 months of age for whom rifampin use was ascertained, one (0.5%) of 194 who did not receive rifampin became a secondary case, compared with none of 301 who received rifampin. This experience indicates that secondary transmission of invasive Hib disease can be appreciable in day care settings, particularly in children younger than 2 years of age, and that rifampin prophylaxis reduces this risk.
我们前瞻性地研究了俄克拉何马州日托中心儿童中侵袭性b型流感嗜血杆菌（Hib）疾病二次传播的风险。我们建立了一个全州范围的监测系统，用于收集来自俄克拉何马州境内及周边所有医院的医生、临床实验室、县卫生部门和感染控制从业人员报告的所有形式的侵袭性Hib疾病。在1984年3月15日至1986年3月15日的两年期间，12岁及以下儿童中有409例经培养确诊的侵袭性Hib疾病病例；147例（37%）病例患儿曾接受日托服务。当病例患儿在发病前一周接受日托服务时，我们前瞻性地确定并观察了接下来60天内所有的班级接触者（n = 2147）。在1253名4岁以下的班级接触者中，发现了7例（0.6%）二次病例。所有配对的首例和二次病例的分离株具有相同的外膜蛋白（OMP）模式。引起原发性疾病的菌株在外膜蛋白分布上与引起继发性疾病的菌株无法区分。在685名2岁以下且已确定是否使用利福平的班级接触者中，292名未接受利福平治疗的儿童中有5例（1.7%）成为二次病例，而393名接受利福平治疗的儿童中有1例（0.3%）成为二次病例（率比6.7；95%置信区间1.1, 42.5；P < 0.05）。在495名24至47个月且已确定是否使用利福平的班级接触者中，194名未接受利福平治疗的儿童中有1例（0.5%）成为二次病例，而301名接受利福平治疗的儿童中无一例成为二次病例。这一经验表明，侵袭性Hib疾病的二次传播在日托环境中可能相当可观，尤其是在2岁以下的儿童中，并且利福平预防可降低这种风险。
