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Open Access Research article

Invasive Haemophilus influenzae infections in Germany: impact of non-type b serotypes in the post-vaccine era

Helen Kalies1*, Anette Siedler2, Britta Gröndahl3, Veit Grote1, Astrid Milde-Busch1 and Rüdiger von Kries1

Author Affiliations

1 Department Epidemiology, Institute for Social Pediatrics and Adolescent Medicine, Ludwig-Maximilians-University, Munich, Germany

2 Robert-Koch-Institute, Berlin, Germany

3 Division Paediatric Infectiology, Johannes-Gutenberg-University, Mainz, Germany

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BMC Infectious Diseases 2009, 9:45  doi:10.1186/1471-2334-9-45

Published: 20 April 2009

Abstract

Background

Haemophilus influenzae type b (Hib) vaccination led to a significant decrease in invasive bacterial infections in children. The aim of this study was to assess a potential shift to more non-type b invasive infections in a population with high Hib vaccination coverage and to compare the burden of suffering between children with Hib, capsulated non-b and non-capsulated Hi infections.

Methods

Cases with confirmed invasive Hi infections were ascertained through two independent nationwide active surveillance systems in 1998–2005. Information on possible predisposing conditions and clinical information was available from 2001 onwards.

Results

The total number of reported non-type b Hi cases varied between 10 cases in 1998, 27 in 2000 and 14 in 2005. In each year, non-capsulated serotypes outnumbered capsulated non-type b ones. 192 cases were detected in 2001–2005, more than one half was non-type b and 88% of the non-type b cases were non-capsulated. For cases with Hib/capsulated non-type b infections the most common clinical presentation was meningitis (67% each); 89%/78% had no potential predisposing condition, 75%/72% completely recovered from disease and 6% (each) died. In contrast, meningitis was diagnosed in 34% of the non-capsulated Hi infections, septicaemia in 28% and pneumonia 21%; 62% had no potential predisposing condition, 83% completely recovered and 3% died.

Conclusion

There was no increase in non-type b Hi invasive infections during 8 years of active surveillance in Germany. Invasive disease due to non-type b Hi is not confined to children with risk factors. In patients with capsulated non-type b Hi infections the proportion of meningitis cases is similar to Hib, but double as high as in non-capsulated Hi.