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Journal of Clinical Microbiology, February 2004, p. 524-529, Vol. 42, No. 2
0095-1137/04/$08.00+0     DOI: 10.1128/JCM.42.2.524-529.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.

Analysis of Invasive Haemophilus influenzae Infections after Extensive Vaccination against H. influenzae Type b

José Campos,1* Margarita Hernando,2 Federico Román,1 María Pérez-Vázquez,1 Belén Aracil,1 Jesús Oteo,1 Edurne Lázaro,3 Francisco de Abajo,3 and the Group of Invasive Haemophilus Infections of the Autonomous Community of Madrid, Spain{dagger}

Centro Nacional de Microbiología, Instituto de Salud Carlos III,1 División de Fármaco-Vigilancia, Agencia Española del Medicamento, Ministry of Health, Majadahonda,3 Instituto de Salud Pública, Consejería de Sanidad, Comunidad de Madrid, Madrid, Spain2

Received 6 October 2003/ Returned for modification 14 October 2003/ Accepted 21 October 2003

Little clinical and microbiological information is available about invasive Haemophilus influenzae infection after widespread vaccination against H. influenzae type b (Hib). We conducted an active community surveillance study on invasive H. influenzae during a 2-year period in a community of more than 5 million people after vaccination against Hib in children was introduced. The median incidence was 16.3 cases/100,000 persons per year in children less than 1-year-old and 4.41 cases/100,000 persons in children less than <5 years old. The highest incidence in adults was observed in patients greater than 70 years old. Clinical diagnoses included bacteremia, pneumonia, and meningitis. Of the H. influenzae-infected patients, 74.3% had underlying predisposing conditions, including impaired immunity and respiratory diseases. A total of 73.6% of the isolates were nontypeable and 16.5, 6.6, and 3.3% were types b, f, and e, respectively. Infections due to capsulated strains b, e, and f were evenly distributed between children and adults. Ampicillin and cotrimoxazole resistance occurred at frequencies of 24.2 and 48.4%, respectively. Antibiotic resistance was more prevalent in capsulated than in noncapsulated H. influenzae. Invasive isolates were highly resistant to antibiotics that were used infrequently in the community. Nontypeable H. influenzae were genetically much more heterogeneous than capsulated strains. Capsule-deficient mutants (b-) were not detected. Plasmid carriage was linked to antibiotic resistance and capsulated strains. Over the study period, the incidence of invasive H. influenzae infections, either encapsulated or not, did not increase. In the post-Hib vaccination era, most invasive infections were due to noncapsulated strains and occurred in the extreme ages of life in patients with predisposing conditions.

* Corresponding author. Mailing address: Centro Nacional de Microbiología, Instituto de Salud Carlos III, Carretera de Pozuelo sn, 28220 Majadahonda, Madrid, Spain. Phone: 34-91-822-3650. Fax: 34-91-509-91-7966. E-mail: jcampos{at}isciii.es.

{dagger} Contributing members of the Group of Invasive Haemophilus Infections of the Autonomous Community of Madrid, Spain, are listed in the Acknowledgments.

Journal of Clinical Microbiology, February 2004, p. 524-529, Vol. 42, No. 2
0095-1137/04/$08.00+0     DOI: 10.1128/JCM.42.2.524-529.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.



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