This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (37)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in JAMA  Topic Collections  • Immunization  • Public Health, Other  • Alert me on articles by topic  Social Bookmarking   What's this?

David G. Perdue, MD; Lisa R. Bulkow, MS; Bruce G. Gellin, MD; Michael Davidson, MD; Kenneth M. Petersen, MD; Rosalyn J. Singleton, MD; Alan J. Parkinson, PhD

JAMA. 2000;283:3089-3094.

Context  The introduction of Haemophilus influenzae type b (Hib) vaccination of children has led to a decline in incidence of Hib disease in young Alaskan children. However, the impact of vaccination on unimmunized Alaskan adolescents and adults has not been studied.

Objective  To characterize trends in incidence of and mortality due to invasive H influenzae disease in Alaskan residents aged 10 years and older prior to and after the introduction of a statewide Hib infant vaccination program.

Design and Setting  Population-based, descriptive correlational study conducted 1980-1996 in Alaska.

Subjects  One hundred twenty-nine individuals (31 Alaska Natives and 98 nonnative Alaska residents) aged 10 years and older in whom H influenzae was cultured from a normally sterile site.

Main Outcome Measures  Incidence of H influenzae infection before (1980-1990) vs after (1991-1996) vaccination program initiation; serotype, biotype, and -lactamase production of isolates.

Results  The overall annual incidence of invasive H influenzae in those aged 10 years and older declined 33%, from 2.1 per 100,000 persons per year to 1.4 per 100,000 persons per year (P=.03) after initiation of statewide infant Hib vaccination programs in 1991. This reduction appeared to be the result of a decrease in serotype b disease (82%; P<.001). Infection with other H influenzae serotypes and nontypeable strains increased from 0.5 per 100,000 persons per year to 1.1 per 100,000 persons per year (P=.01). Incidence declined from 4.2 per 100,000 persons per year to 1.2 per 100,000 persons per year in Alaska Natives (P=.005) and from 1.7 per 100,000 persons per year to 1.4 per 100,000 persons per year in nonnative Alaska residents (P=.37). Pneumonia (43%), sepsis (26%), and meningitis (16%) were the most common clinical presentations. Alcohol/drug abuse was comorbid in 15% of patients, while 13% of patients were pregnant women. -Lactamase production occurred in 35% of isolates and was stable throughout the surveillance. The overall case-fatality rate was 15%.

Conclusion  The overall statewide incidence of invasive H influenzae infections in unimmunized persons aged 10 years and older decreased after the initiation of an infant Hib vaccine program, perhaps by decreasing Hib carriage in child reservoirs. An increase in non–serotype b strains was observed. This trend justifies the need for continued surveillance of invasive disease caused by H influenzae.

Author Affiliations: University of Washington School of Medicine, Seattle (Dr Perdue); Arctic Investigations Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention (Ms Bulkow and Drs Petersen and Parkinson), Alaska Native Medical Center (Dr Davidson), and Alaska Native Tribal Health Consortium (Dr Singleton), Anchorage; and Vanderbilt University Medical Center, Nashville, Tenn (Dr Gellin). Dr Perdue is now with the Medicine/Pediatrics Residency Program, University of Minnesota School of Medicine, Minneapolis.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

RELATED ARTICLE

June 21, 2000
JAMA. 2000;283(23):3135.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Vaccine-induced pathogen strain replacement: what are the mechanisms?
Martcheva et al.
J R Soc Interface 2008;5:3-13.
ABSTRACT | FULL TEXT  

Haemophilus influenzae Type a Infection and Its Prevention
Jin et al.
Infect. Immun. 2007;75:2650-2654.
FULL TEXT  

Vaccination and the dynamics of immune evasion
Restif and Grenfell
J R Soc Interface 2007;4:143-153.
ABSTRACT | FULL TEXT  

The Alaska Haemophilus influenzae Type b Experience: Lessons in Controlling a Vaccine-Preventable Disease
Singleton et al.
Pediatrics 2006;118:e421-e429.
ABSTRACT | FULL TEXT  

Clonal relationship of recent invasive Haemophilus influenzae serotype f isolates from Denmark and the United States
Bruun et al.
J Med Microbiol 2004;53:1161-1165.
ABSTRACT | FULL TEXT  

pgi Genotyping Is a Surrogate for Serotyping of Encapsulated Haemophilus influenzae
Anyanwu et al.
J. Clin. Microbiol. 2003;41:2080-2083.
ABSTRACT | FULL TEXT  

Prevalence and Distribution of Adhesins in Invasive Non-Type b Encapsulated Haemophilus influenzae
Rodriguez et al.
Infect. Immun. 2003;71:1635-1642.
ABSTRACT | FULL TEXT  

Limited Genetic Diversity of Recent Invasive Isolates of Non-Serotype b Encapsulated Haemophilus influenzae
Omikunle et al.
J. Clin. Microbiol. 2002;40:1264-1270.
ABSTRACT | FULL TEXT  

Biotypes and serotypes of Haemophilus influenzae ocular isolates
Alrawi et al.
Br. J. Ophthalmol. 2002;86:276-277.
ABSTRACT | FULL TEXT  

A Pneumococcal Conjugate Vaccine and Acute Otitis Media
Lavin et al.
NEJM 2001;344:1719-1720.
FULL TEXT  

Hib Vaccine Has Reduced Adult Haemophilus Disease
JWatch Infect. Diseases 2000;2000:6-6.
FULL TEXT