Surveillance of Hib invasive infections in Slovakia

MUDr. Elena NovákováNational reference laboratory for

haemophilus infections

Žilina Slovakia20/4/2007, Plovdiv

CLASSIFICATION

• GENUS HAEMOPHILUS

• SPECIES H.influenzae H.parainfluenzae

H.aegyptius

H.(par)afrophilus

H.(para)haemolyticus

• STRAIN Hi encapsulated Hi nonencapsulated

• TYPE Hib Hi a,c,d,e,f

PATOGENESIS

CONTACT ADHESION COLONISATION

URT NORMAL FLORA MANIFESTATION

NON INVASIVE PROCESS INVASIVE PROCESS

H.i.non encapsulated, H.parai. encapsulated (H.i.b)

URTI, sinusitis, otitis Bacteraemia - pneumonia

superinfection - epiglotitis

- artritis

- meningitis

INFECTIONS OF INTEREST IN SURVEILLANCE

HEMOFILUS INFLUENZAE

type b (95%), typ a,c,d,e,f (5%)

BACTERAEMIA:

Meningitis

Epiglotitis

Artritis

Celulitis Phlegmóna

Death

HEMOFILUS INFLUENZE

NON ENCAPSULATED

URTI

Otitis media

Laryngitis

Pneumonia

Conjunctivitis

MICROBIOLOGICAL

DIAGNOSIS

SAMPLES / HIB positive

• 1674 samples received in laboratories• CSF 96/85• BLOOD 34/25 • SECTION 14/10• PUNCTION 56/12 • NOSE+THROAT 1474/386 – not relevant for invasive infection

68%

1%

1%

25%

1%3%

1%

1234567

THROAT

EAR

BLOOD

CSF

OTHERS

SECTION

NOSE

DISTRIBUTION OF SAMPLES

65%2%

2%1%3%

1%

26%12

34

56

7

Laryngitis

Others

Death

Otitis

Meningitis

Pneumonia

Epiglotitis

PROPORTION OF DIAGNOSIS

49%

11%3%

2%

11%

15%

9%1

2

3

4

5

6

7

Haemophilus influenzae type b

Haemophilus influenzae NT

Heaemophilus influenzae type a

Haemophilus influenzae type c

Haemophilus parainfluenzae

Haemophilus influenzae type f

Other

PROPORTION OF HAEMOPHILUS STRAINS

HEMOFILUS INFLUENZAE TYPE BIN DIFFERENT SAMPLING PLACE

0%

100%

42%

58%

EAR CSF, BLOOD, SECTION

NOSE,THROAT,

LARYNGITIS

50%50%

1

2

PNEUNONIA

49%51%

OTITIS

0%

100%

OTHER DIAGNOSIS

33%

67%

EPIGLOTITIS, MENINGITIS, DEATH

0%

100%

HAEMOPHILUS INFLUENZAE TYPE B IN DIFFERENT DIAGNOSIS

*OTHER HAEMOPHILUS

* H.i.b

0

50

100

150

200

Rad1

Rad3

Rad5

Rad7

Rad9

Rad11

Age group 0 1-4 5-9 10-14 15+ years

cases

diagnosis

epiglotitis

meningitis

pneumonia

death

other

laryngitis

HAEMOPHILUS INFLUENZAE B INVASIVE INFECTIONS IN DIFFERENT AGE GROUPS OF

CHILDREN

INCIDENCE OF HIB MENINGITIS IN CHILDREN IN SLOVAKIA BASED ON

DIFFERENT SURVEY SYSTEM

0

5

10

15

20

25

30

9.8/100 000

1993 sure possible Europe

:

4,3 17,3 19,8 29,2 19,0

Surveillance HIB in SR

E.Nováková, B.D.Gessner, V.: Oleár Incidence of Hib meningitis .....in Slovakia, Eur.J.Clin.Microbiol.Infect.Dis. (1999),18:409-413

76%

14%

3%

4%

3%

1

2

3

4

5

NO

DEATH

NOT KNOWN

NOT SEARCHED

YES

SEQUELLAE OF HIB MENINGITIS IN CHILDREN, SLOVAKIA, 1991-1999

SEQUELLAE OF HIB MENINGITIS

OTHERS

HEARING

SIGHT

MOT.RETARD.

ATAXIA

ORG. CNS DISEASE

SPEAKING

PSYCHOMOT

PSYCHIC

NEURASTENIA

HYDROCEPHALUS

COMMUNICATION

6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34

Zone of inhibition in mms

0

10

20

30

40

Incidence of strains %Azitromycin/96-97

Azitromycín/98-99

Azitromycín/01-02

Citlivé kmene

ATB SUSCEPTIBILITY

PREDICTION OF DEVELOPMENT

7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35

Zone of inhibition in mms

0

5

10

15

20

25

30

35

Incidence of strains % Ampicilín/96

Ampicilín/97

Ampicilín/98 R I S

9% 4% 87% n=121

17% 1% 82% n=221

22% 4% 74% n=201

ATB SUSCEPTIBILITY

Haemophilus45,9%

Meningokoky35,1%

Iné5,4%

Pneumokoky8,1%neobjasnené

5,4%

AETIOLOGICAL AGENS OF BACTERIAL MENINGITIS

INCIDENCE OF HIB MENINGITIS IN SLOVAKIA, 1988-2002

1988 1998 2002ActHib

ALL BACTERIAL MENINGITIS

HIB MENINGITIS IN CHILDREN

OTHER BACTERIAL MENINGITIS IN CHILDREN

0

5

10

15

20

1 2 3 4 5 6 7 8 9

ALL

0 YEAR

1- 4 YEARS

0

50 000

100 000

150 000

200 000

1

´94 ´95 ´96 ´97 ´98 ´99 ´00 ´01 ´02

INCIDENCE OF HIB MENINGITIS INFLUENCE BY NUMBER OF APPLICATED DOSES OF VACCINE

WHAT WE COULD WAIT

• DISAPPEARANCE OF HIB MENINGITIS AND INVASIVE DISEASES

• Disappearance of NT Haemophilus URTI

• Disappearance of Haemophilus in microbiological samples

• Disappearance of HIB carriag

WHAT CHANGED

INCIDENCE OF HIB INVASIVE DISEASES: ONLY IN NON-VACCINATED CHILD POPULATION

AIMS OF SURVEILLANCE (Public opinion on vaccination,questions about autoimmunity, IBD, DM1, shift in age groups, strains)

THANK YOU