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Surveillance of Hib invasive infections in Slovakia

Surveillance of Hib invasive infections in Slovakia. MUDr. Elena Nováková National reference laboratory for haemophilus infections Žilina Slovakia 20/4/2007, Plovdiv. CLASSIFICATION. GENUS HAEMOPHILUS SPECIES H.influenzae H.parainfluenzae H.aegyptius

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Surveillance of Hib invasive infections in Slovakia

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  1. Surveillance of Hib invasive infections in Slovakia MUDr. Elena Nováková National reference laboratory for haemophilus infections Žilina Slovakia 20/4/2007, Plovdiv

  2. CLASSIFICATION • GENUS HAEMOPHILUS • SPECIES H.influenzaeH.parainfluenzae H.aegyptius H.(par)afrophilus H.(para)haemolyticus • STRAIN Hi encapsulatedHi nonencapsulated • TYPE HibHi a,c,d,e,f

  3. 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

  4. 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

  5. MICROBIOLOGICAL DIAGNOSIS

  6. 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

  7. DISTRIBUTION OF SAMPLES THROAT EAR BLOOD CSF OTHERS SECTION NOSE

  8. PROPORTION OF DIAGNOSIS Laryngitis Others Death Otitis Meningitis Pneumonia Epiglotitis

  9. PROPORTION OF HAEMOPHILUS STRAINS Haemophilus influenzae type b Haemophilus influenzae NT Heaemophilus influenzae type a Haemophilus influenzae type c Haemophilus parainfluenzae Haemophilus influenzae type f Other

  10. HEMOFILUS INFLUENZAE TYPE BIN DIFFERENT SAMPLING PLACE EAR CSF, BLOOD, SECTION NOSE,THROAT,

  11. HAEMOPHILUS INFLUENZAE TYPE B IN DIFFERENT DIAGNOSIS *OTHER HAEMOPHILUS * H.i.b

  12. HAEMOPHILUS INFLUENZAE B INVASIVE INFECTIONS IN DIFFERENT AGE GROUPS OF CHILDREN cases epiglotitis meningitis pneumonia death other diagnosis laryngitis Age group 0 1-4 5-9 10-14 15+ years

  13. INCIDENCE OF HIB MENINGITIS IN CHILDREN IN SLOVAKIA BASED ON DIFFERENT SURVEY SYSTEM Surveillance HIB in SR 4,3 17,3 19,8 29,2 19,0 9.8/100 000 • sure possible Europe : E.Nováková, B.D.Gessner, V.: Oleár Incidence of Hib meningitis .....in Slovakia, Eur.J.Clin.Microbiol.Infect.Dis. (1999),18:409-413

  14. SEQUELLAE OF HIB MENINGITIS IN CHILDREN, SLOVAKIA, 1991-1999 NO DEATH NOT KNOWN NOT SEARCHED YES

  15. SEQUELLAE OF HIB MENINGITIS OTHERS HEARING SIGHT MOT.RETARD. ATAXIA ORG. CNS DISEASE SPEAKING PSYCHOMOT PSYCHIC NEURASTENIA HYDROCEPHALUS COMMUNICATION

  16. ATB SUSCEPTIBILITY PREDICTION OF DEVELOPMENT Incidence of strains % Azitromycin/96-97 Azitromycín/98-99 Azitromycín/01-02 Citlivé kmene 40 30 20 10 0 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

  17. ATB SUSCEPTIBILITY Incidence of strains % Ampicilín/96 Ampicilín/97 Ampicilín/98 R I S 22% 4% 74% n=201 35 30 17% 1% 82% n=221 25 20 15 10 5 9% 4% 87% n=121 0 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

  18. AETIOLOGICAL AGENS OF BACTERIAL MENINGITIS

  19. INCIDENCE OF HIB MENINGITIS IN SLOVAKIA, 1988-2002 ALL BACTERIAL MENINGITIS HIB MENINGITIS IN CHILDREN 1988 1998 2002 OTHER BACTERIAL MENINGITIS IN CHILDREN ActHib

  20. INCIDENCE OF HIB MENINGITIS INFLUENCE BY NUMBER OF APPLICATED DOSES OF VACCINE ALL 0 YEAR 1- 4 YEARS ´94 ´95 ´96 ´97 ´98 ´99 ´00 ´01 ´02

  21. 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

  22. 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)

  23. THANK YOU

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