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Brown NE, Blain AE, Burzlaff K, Harrison LH, Petit S, Schaffner W, Smelser C, Thomas A, Triden L, Watt JP, Pondo T, Whaley MJ, Hu F, Wang X, Oliver S, Soeters HM. Racial disparities in invasive Haemophilus influenzae disease - United States, 2008-2017. Clin Infect Dis 2021; 73:1617-1624. [PMID: 33993217 DOI: 10.1093/cid/ciab449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Since the introduction of Haemophilus influenzae serotype b (Hib) conjugate vaccines in the United States, invasive H. influenzae disease (Hi) epidemiology has changed and racial disparities have not been recently described. METHODS Active population- and laboratory-based surveillance for Hi was conducted through Active Bacterial Core surveillance (ABCs) at 10 U.S. sites. Data from 2008-2017 was used to estimate projected nationwide annual incidence in cases/100,000. RESULTS During 2008-2017, ABCs identified 7379 Hi cases. Of 6705 (90.9%) patients with reported race, 76.2% were White, 18.6% were Black, 2.8% were Asian/Pacific Islander (PI), and 2.4% were American Indian and Alaska Native (AI/AN). Nationwide annual incidence was 1.8 cases/100,000. By race, incidence was highest among AI/AN populations (3.1) and lowest among Asian/PI populations (0.8). Nontypeable Hi (NTHi) caused the largest incidence within all races (1.3), with no striking disparities identified. Among AI/AN children aged <5 years, incidence of Hi serotype a (Hia) was 16.7 times higher and Hib incidence was 22.4 times higher than among White children. Though Hia incidence was lower among White and Black populations compared to AI/AN, Hia incidence increased 13.6% annually among White children and 40.4% annually among Black children aged <5 years. CONCLUSIONS While NTHi causes the largest Hi burden overall, AI/AN populations experience disproportionately high rates of Hia and Hib, with the greatest disparity among AI/AN children aged <5 years. Prevention tools are needed to reduce disparities affecting AI/AN children and address increasing Hia incidence in other communities.
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Affiliation(s)
- Nicole E Brown
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, United States.,Epidemic Intelligence Service, CDC, Atlanta, GA, United States
| | - Amy E Blain
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, United States
| | - Kari Burzlaff
- New York State Department of Health, Albany, NY, United States
| | - Lee H Harrison
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Susan Petit
- Connecticut Department of Public Health, Hartford, CT, United States
| | - William Schaffner
- Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Chad Smelser
- New Mexico Department of Health, Santa Fe, NM, United States
| | - Ann Thomas
- Oregon Health Authority, Portland, OR, United States
| | - Lori Triden
- Minnesota Department of Health, St. Paul, MN, United States
| | - James P Watt
- California Department of Public Health, Richmond, CA, United States
| | - Tracy Pondo
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, United States
| | - Melissa J Whaley
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, United States
| | - Fang Hu
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, United States
| | - Xin Wang
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, United States
| | - Sara Oliver
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, United States
| | - Heidi M Soeters
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, United States
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Bozio CH, Blain A, Edge K, Farley MM, Harrison LH, Poissant T, Schaffner W, Scheuer T, Torres S, Triden L, Briere E, Oliver SE. Clinical characteristics and adverse clinical outcomes of invasive Haemophilus influenzae serotype a cases - United States, 2011-2015. Clin Infect Dis 2020; 73:e3670-e3676. [PMID: 32668450 DOI: 10.1093/cid/ciaa990] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Incidence of invasive disease due to H. influenzae serotype a (Hia) increased an average of 13% annually from 2002-2015. We described clinical characteristics and adverse clinical outcomes of U.S. invasive Hia cases detected through multi-state surveillance during 2011-2015. METHODS Medical record data were abstracted for cases reported in eight jurisdictions conducting active population- and laboratory-based surveillance for invasive Hia disease across the United States. Isolates from sterile sites were serotyped by real-time polymerase chain reaction. Adverse clinical outcomes were defined as any possible complication of meningitis, bacteremic pneumonia, or bacteremia (including hearing loss, developmental delay, and speech delay, but excluding death), and were assessed at hospital discharge and one-year post-disease onset. RESULTS During 2011-2015, 190 Hia cases were reported to the eight participating sites; 169 (88.9%) had data abstracted. Many patients were aged <5 years (42.6%) or ≥65 years (20.7%). Meningitis was the most common clinical presentation among <1 year olds (71.4%); bacteremic pneumonia was the most common presentation among persons aged ≥50 years (78.7%). Overall, 95.9% of patients were hospitalized: among those hospitalized, 47.5% were admitted to an intensive care unit, and 6.2% died during hospitalization. At hospital discharge and one-year post-disease onset, adverse outcomes were identified in 17.7% and 17.8% of patients overall, and in 43.9% and 48.5% of patients with meningitis (primarily children). CONCLUSIONS Hia infection can cause severe disease requiring hospitalization and may also cause short- and long-term adverse clinical outcomes, especially among children. Novel vaccines could prevent morbidity and mortality.
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Affiliation(s)
- Catherine H Bozio
- Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, GA.,National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA
| | - Amy Blain
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA
| | - Karen Edge
- Colorado Department of Public Health and Environment, Colorado
| | - Monica M Farley
- Emory University School of Medicine, Atlanta, GA.,Atlanta VA Medical Center, Atlanta, GA
| | - Lee H Harrison
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | | | - Tara Scheuer
- California Emerging Infections Program, Oakland, CA
| | | | - Lori Triden
- Minnesota Department of Health, St. Paul, MN
| | - Elizabeth Briere
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA
| | - Sara E Oliver
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA
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Albrecht T, Poss K, Issaranggoon Na Ayuthaya S, Triden L, Schleiss KL, Schleiss MR. Case report of congenital asplenia presenting with Haemophilus influenzae type a (Hia) sepsis: an emerging pediatric infection in Minnesota. BMC Infect Dis 2019; 19:947. [PMID: 31703560 PMCID: PMC6842177 DOI: 10.1186/s12879-019-4572-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 10/16/2019] [Indexed: 01/26/2023] Open
Abstract
Background In the pre-vaccine era, invasive disease with Haemophilus influenzae, type b (Hib) commonly presented with osteoarticular involvement. Haemophilus influenzae, type a (Hia) sepsis is a rare but emerging problem in recent years. Here, we report a case of sepsis with concomitant osteoarthritis due to Hia that was the presenting infectious disease manifestation of isolated asplenia in a young child. This unique observation adds to our understanding of sepsis and asplenia in children. Case presentation A five-year-old girl developed acute Hia bacteremia and sepsis. The patient developed arthritis shortly after onset of septic shock. Arthrocentesis was culture-negative, but given the difficulty differentiating between septic and reactive arthritis, prolonged antibiotic administration was provided for presumed osteoarticular infection, and the patient had an uneventful recovery. The finding of Howell-Jolly bodies on blood smear at the time of presentation prompted an evaluation that revealed isolated congenital asplenia. Evaluation for known genetic causes of asplenia was unrevealing. Investigation by the Minnesota Department of Health revealed an emergence of Hia infections over the past 5 years, particularly in children with an American Indian background. Conclusions Hia is an important pathogen in the differential diagnosis of invasive bacterial infections in children and shares overlap in clinical presentation and pathogenesis with Hib. Invasive Hia disease can be a presenting manifestation of asplenia in children. Hia is an emerging pathogen in American Indian children.
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Affiliation(s)
- Tiffany Albrecht
- Department of Pediatrics, University of Minnesota Masonic Children's Hospital, 2450 Riverside Ave, Minneapolis, MN, 55454, USA
| | - Kristina Poss
- University of Minnesota Medical School, 420 Delaware Street SE, Minneapolis, MN, 55455, USA.,Present address: Department of Pediatrics, Lincoln Medical Center, 234 E 149th Street, The Bronx, NY, 10451, USA
| | - Satja Issaranggoon Na Ayuthaya
- Department of Pediatrics, University of Minnesota Masonic Children's Hospital, 2450 Riverside Ave, Minneapolis, MN, 55454, USA.,Present address: Children's National Medical Center, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Lori Triden
- Minnesota Department of Health, Infectious Diseases, Epidemiology and Control Division, 625 Robert Street N, Saint Paul, MN, 55155, USA
| | - Katherine L Schleiss
- Minnesota Department of Health, Infectious Diseases, Epidemiology and Control Division, 625 Robert Street N, Saint Paul, MN, 55155, USA
| | - Mark R Schleiss
- Department of Pediatrics, University of Minnesota Masonic Children's Hospital, 2450 Riverside Ave, Minneapolis, MN, 55454, USA.
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McNamara LA, Potts CC, Blain A, Topaz N, Apostol M, Alden NB, Petit S, Farley MM, Harrison LH, Triden L, Muse A, Poissant T, Wang X, MacNeil JR. Invasive Meningococcal Disease due to Nongroupable Neisseria meningitidis-Active Bacterial Core Surveillance Sites, 2011-2016. Open Forum Infect Dis 2019; 6:ofz190. [PMID: 31123695 DOI: 10.1093/ofid/ofz190] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 04/11/2019] [Indexed: 11/12/2022] Open
Abstract
We characterized 22 meningococcal disease cases due to nongroupable Neisseria meningitidis, a rare cause of invasive disease. Disease presentation and severity were similar to those for serogroupable meningococcal disease. However, 7 (32%) patients had complement deficiency or abnormal complement testing results, highlighting the importance of complement testing for nongroupable cases.
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Affiliation(s)
- Lucy A McNamara
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Caelin C Potts
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amy Blain
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nadav Topaz
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Nisha B Alden
- Emerging Infections Program, Communicable Disease Branch, Colorado Disease Control and Environmental Epidemiology Division, Denver, Colorado
| | - Susan Petit
- Connecticut Department of Public Health Epidemiology Program, Hartford, Connecticut
| | - Monica M Farley
- Emory University School of Medicine and the Atlanta VAMC, Atlanta, Georgia
| | - Lee H Harrison
- Departments of Epidemiology and Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lori Triden
- Emerging Infections Unit, Acute Disease Investigations and Control Section, Minnesota Department of Health, St. Paul, Minnesota
| | - Alison Muse
- New York State Department of Health Emerging Infections Program, Albany, New York
| | | | - Xin Wang
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jessica R MacNeil
- Office of the Director, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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