Invasive Haemophilus influenzae in the United States, 1999-2008: Epidemiology and outcomes

• Type of Material: Article
• Authors: Daniel J. Livorsi, Emory University; Jessica R. MacNeil, Centers for Disease Control and Prevention; Amanda C. Cohn, Centers for Disease Control and Prevention; Joseph Bareta, New Mexico Department of Health; Shelly Zansky, New York State Department of Health; Susan Petit, Connecticut Department of Public Health; Ken Gershman, Colorado Department of Public Health and Environment; Lee H. Harrison, Johns Hopkins University; Ruth Lynfield, Minnesota Department of Health; Arthur Reingold, University of California Berkeley; William Schaffner, Vanderbilt University; Ann Thomas, Oregon Department of Human Services; Monica Farley, Emory University
• Language: English
• Date: 2012-12-01
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2012 The British Infection Association.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jinf.2012.08.005
• Title of Journal or Parent Work: Journal of Infection
• ISSN: 0163-4453
• Volume: 65
• Issue: 6
• Start Page: 496
• End Page: 504
• Grant/Funding Information: This work was supported in part by the Atlanta Clinical and Translational Science Institute (National Institutes of Health/National Center for Research Resources UL1RR025008 to D.J.L.).; Funding for the ABCs population-based surveillance for invasive H. influenzae was provided by the Emerging Infections Program of the Centers for Disease Control and Prevention, Atlanta, GA.
• Keywords: Infectious Diseases; Life Sciences & Biomedicine; Science & Technology; NEONATAL SEPSIS; Mortality; INFECTIONS; DISEASE; Haemophilus influenzae; Multivariable analysis; SURVEILLANCE; United States; CHANGING EPIDEMIOLOGY
• Research Categories: Health Sciences, Immunology

Abstract

Objectives: Introduction of the Haemophilus influenzae type b (Hib) conjugate vaccine has resulted in a dramatic reduction of Hib disease in the U.S. and an increase in the relative importance of infections caused by nontypeable strains. The current project describes the characteristics and clinical outcomes of pediatric and adult patients with invasive H. influenzae (HI) and, through multivariable analysis, identifies risk factors for in-hospital mortality. Methods: HI cases were identified during 1999-2008 through active surveillance as part of Active Bacterial Core surveillance (ABCs). Multivariable analysis was performed with logistic regression to identify factors predictive of in-hospital death. Results: 4839 cases of HI were identified from 1999-2008. Children accounted for 17.1% of cases and adults 82.9%. Underlying conditions were present in 20.7% of children and 74.8% of adults. In-hospital mortality was highest in cases ≥65 years (21.9%) and <3 months (16.2%).The risk of in-hospital death in children <1 year was higher among those who were prematurely-born (<28 weeks, OR 7.1, 95% CI 3.2-15.6; 28-36 weeks OR 2.1, 95% CI 0.9-4.8) and, among children aged 1-17 years, higher in those with healthcare-associated onset and dialysis (OR 5.66, 95% CI 1.84-17.39; OR 18.11, 95% CI 2.77-118.65). In adults, age ≥40 was associated with death in nontypeable, but not encapsulated, infections. Infections with nontypeable strains increased the risk of death in cases ≥65 years (OR 1.81, 95% CI 1.31-2.52). Healthcare-associated HI, bacteremia without identifiable focus, bacteremic pneumonia, associated cirrhosis, cerebrovascular accident, dialysis, heart failure, and non-hematologic malignancy also increased the risk of death in adults. Conclusion: Prematurity in infants, advanced age and certain chronic diseases in adults were associated with an increased risk of in-hospital death. Nontypeable HI was associated with higher mortality in the elderly.