John T J, Cherian T, Raghupathy P
Indian Council of Medical Research, Tamil Nadu.
Pediatr Infect Dis J. 1998 Sep;17(9 Suppl):S169-71. doi: 10.1097/00006454-199809001-00015.
We review and summarize published information on diseases caused by Haemophilus influenzae in India and unpublished data from our center covering more than three decades.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.
我们回顾并总结了印度已发表的关于流感嗜血杆菌所致疾病的信息，以及我们中心三十多年来未发表的数据。自20世纪50年代中期以来，流感嗜血杆菌一直是我院收治儿童化脓性脑膜炎最常见的病因，占病例的三分之一至二分之一。印度其他中心的信息很少；一些中心研究中流感嗜血杆菌分离频率较低可能是由于培养基和培养方法不理想所致。我院每年因化脓性脑膜炎入院的人数与小儿麻痹症病例数非常相似。假设因这两种疾病住院的儿童数量相似表明社区发病率相似，并考虑到化脓性脑膜炎中流感嗜血杆菌的分离频率，我们估计每10万名5岁以下儿童中每年可能有多达75至100例由该病原体引起的脑膜炎。虽然在一些研究中已认识到流感嗜血杆菌引起的肺炎，但信息太少，无法估计发病率。流感嗜血杆菌引起的脓性感染很少见。流感嗜血杆菌引起的会厌炎在印度似乎不发生。近年来我们发现，大多数侵袭性流感嗜血杆菌感染是由b型流感嗜血杆菌（Hib）引起的；其他型别或不可分型菌株很少见。我院及其他地方已认识到对氯霉素和氨苄西林耐药性的患病率在增加。因此，从医院的角度来看，使用Hib疫苗进行一级预防似乎是一种合理且有益的干预措施。迫切需要开展基于社区的研究来衡量Hib的疾病负担，以便更满意地评估所有婴儿接种Hib疫苗的必要性和成本效益。
