BMJ  2004;329:655-658 (18 September), doi:10.1136/bmj.329.7467.655

Paper

Trends in Haemophilus influenzae type b infections in adults in England and Wales: surveillance study

¹ Immunisation Department, Health Protection Agency Communicable Disease Surveillance Centre, London NW9 5EQ, ² Statistics, Modelling and Economics Department, Health Protection Agency Communicable Disease Surveillance Centre, ³ Health Protection Agency Specialist and Reference Microbiology Division, Haemophilus Reference Unit, John Radcliffe Hospital, Oxford OX3 9DU

Objective To describe invasive Haemophilus influenzae type b (Hib) infections in individuals aged 15 years or older in England and Wales between 1991 and 2003.

Design Prospective, laboratory based surveillance of invasive Hib infections and cross sectional seroprevalence study.

Setting England and Wales.

Participants Cases were confirmed by isolation of H influenzae from a normally sterile site, or from a non-sterile site in cases with a diagnosis of epiglottitis. Excess serum samples collected from English 30-39 year olds as part of a national serosurvey were identified for the years 1990, 1994, 1997, 2000, and 2002.

Main outcome measures The number of invasive Hib infections from 1991 to 2003. Population immunity to H influenzae type b in English adults was also measured.

Results After routine infant immunisation was introduced in October 1992, adult Hib infections decreased initially but then rose from a low in 1998 to reach prevaccine levels in 2003. An associated fall in median Hib antibody concentrations occurred, from 1.29 µg/ml (95% confidence interval 0.90 to 1.64) in 1991 to 0.70 µg/ml (0.57 to 0.89) in 1994 (P = 0.006), with no significant change observed thereafter.

Conclusions Although immunisation of infants resulted in an initial decline in Hib infections in adults, a resurgence in reported cases occurred in 2002-3. This rise was associated with an increase in cases in children and evidence of reduced immunity in older unimmunised cohorts. Childhood immunisation programmes may have unanticipated effects on the epidemiology of disease in older age groups, and surveillance strategies must be targeted at entire populations.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

Relevant Article

Hib infections are as common as ever
BMJ 2004 329: 0. [Full Text]

This article has been cited by other articles:

• Kelly, D. F., Moxon, E. R., Yu, L.-M., Pollard, A. J. (2009). Anti-Polyribosylribitol Phosphate Antibody Concentrations and Avidities in Children since the Start of Haemophilus influenzae Type b Immunization of Infants in the United Kingdom. CVI 16: 246-252 [Abstract] [Full text]  
• Trotter, C. L., Borrow, R., Findlow, J., Holland, A., Frankland, S., Andrews, N. J., Miller, E. (2008). Seroprevalence of Antibodies against Serogroup C Meningococci in England in the Postvaccination Era. CVI 15: 1694-1698 [Abstract] [Full text]  
• Milde-Busch, A., Kalies, H., Ruckinger, S., Siedler, A., Rosenbauer, J., von Kries, R. (2008). Surveillance for Rare Infectious Diseases: is one passive data source enough for Haemophilus influenzae?. Eur J Public Health 18: 371-375 [Abstract] [Full text]  
• Ladhani, S, Slack, M P, Heys, M, White, J, Ramsay, M E (2008). Fall in Haemophilus influenzae serotype b (Hib) disease following implementation of a booster campaign. Arch. Dis. Child. 93: 665-669 [Abstract] [Full text]  
• Southern, J., McVernon, J., Gelb, D., Andrews, N., Morris, R., Crowley-Luke, A., Goldblatt, D., Miller, E. (2007). Immunogenicity of a Fourth Dose of Haemophilus influenzae Type b (Hib) Conjugate Vaccine and Antibody Persistence in Young Children from the United Kingdom Who Were Primed with Acellular or Whole-Cell Pertussis Component-Containing Hib Combinations in Infancy. CVI 14: 1328-1333 [Abstract] [Full text]  
• Sacchi, C. T., Alber, D., Dull, P., Mothershed, E. A., Whitney, A. M., Barnett, G. A., Popovic, T., Mayer, L. W. (2005). High Level of Sequence Diversity in the 16S rRNA Genes of Haemophilus influenzae Isolates Is Useful for Molecular Subtyping. J. Clin. Microbiol. 43: 3734-3742 [Abstract] [Full text]  
• Schouls, L. M., van der Ende, A., van de Pol, I., Schot, C., Spanjaard, L., Vauterin, P., Wilderbeek, D., Witteveen, S. (2005). Increase in Genetic Diversity of Haemophilus influenzae Serotype b (Hib) Strains after Introduction of Hib Vaccination in The Netherlands. J. Clin. Microbiol. 43: 2741-2749 [Abstract] [Full text]  

Rapid Responses:

Read all Rapid Responses

Dogs chasing tails

Jayne LM Donegan
bmj.com, 23 Sep 2004 [Full text]

Low Haemophilus Influenzae type b and pneumococcal antibodies among adults with chronic respiratory disease

Harmesh Moudgil, et al.
bmj.com, 14 Oct 2004 [Full text]

Re: Low Haemophilus Influenzae type b and pneumococcal antibodies among adults with chronic respiratory disease

Denise L. Rogers
bmj.com, 12 Feb 2005 [Full text]

Online poll

Find out more on doc2doc >>