Hong Kong Journal of Paediatrics [HK J Paediatr (New Series) 2001;6:128]

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HK J Paediatr (New Series)
Vol 6. No. 2, 2001

HK J Paediatr (New Series) 2001;6:128

Proceedings of The First Current Topic in Infectious Diseases

Overview and Disease Burden of Haemophilus Influenzae Type b in China

YH Yang

HK J Paediatr (new series) 2001;6:127-132

Proceedings of The First Current Topic in Infectious Diseases: Consensus Meeting on Conjugate Vaccines of the Center of Infection
Faculty of Medicine, The University of Hong Kong (Selected Abstracts)

Haemophilus influenzae type b (Hib) infections have been documented in China previously. However, the data are scanty and incomplete. Hib meningitis accounted for up to 16% of all pyogenic meningitis during the 1950s. In the 1900s, it accounted for 30% to 50% of bacterial meningitis in China. The incidence of Hib meningitis in Hefei City was 10.4 per 100,000 children < 5 years old.⁹ A study, supported by the World Health Organization, on the epidemiologic information of bacterial meningitis in infants and children with special emphasis on Hib in Beijing Children's Hospital (BCH) and Hefei City was completed in 1992. It has studied 128 patients clinically diagnosed to have bacterial meningitis in BCH from 1988 to 1989. Hib was diagnosed in 37 (29%) of the 128 cases and 84% was < 2 years old. Most of the cases occurred in winter and spring. The study done in Hefei City from 1990 to 1992, including 13 hospitals in Hefei City, found that Hib was the most common cause of bacterial meningitis, accounting for 52% of total cases. The incidence of Hib meningitis was 10.4 per 100,000 in children < 5 years old. For pneumonia, the yield of culture has been consistently low due mainly to the prior use of antibiotics. By detection of antigens, two studies at BCH found evidence of Hib infection in about one quarter of children with pneumonia.¹⁰ The role of Hib in childhood pneumonia was further highlighted by the finding of a recent study.¹¹ Of 100 children admitted to the BCH for acute lower respiratory infections, 8% of them had serological evidence for Hib etiology. There was no report on other Hib diseases like epiglottitis, sepsis, pyogenic arthritis and osteomyelitis available for China. Further surveillance study in China would be needed in the future.

Method and Process of Consensus Building

The consensus meeting on Consensus meeting on conjugate vaccines was held on February 17, 2001, as the first current topic in infectious diseases that was organized by the Centre of Infection, the University of Hong Kong. A panel of experts from the fields of Internal Medicine, Clinical Microbiology, Internal Medicine, Paediatrics and Public Health were provided with the latest scientific papers^1-8 and were invited to speak and discuss on various aspects concerning the topic.

After the formal presentation, panel discussion was held. All speakers, invited discussants from various aspects of the medical fields and audiences actively participated in the discussion with further elaboration on issues around S. pneumoniae and H. influenzae disease burden, antimicrobial resistance and conjugate vaccine.

Finally, conclusions were drawn on the basis of the current scientific information and views expressed by the panel and other participants. Drafts in progress and final copies of the manuscript were distributed to panel for comments before submission for publication.

Consensus Panel Members

Daniel CS Chiu, Pediatrician in private practice
Susan SS Chiu, Assistant Professor, Department of Paediatrics, The University of Hong Kong
CB Chow, Consultant, Department of Paediatrics, Princess Margaret Hospital
PL Ho, Associate Professor, Department of Microbiology, The University of Hong Kong
YL Lau, Chair Professor in Paediatrics, Department of Paediatrics, The University of Hong Kong
CW Leung, Consultant, Department of Paediatrics, Princess Margaret Hospital
Dominic NC Tsang, Consultant, Department of Clinical Pathology, Queen Elizabeth Hospital
Kenneth WT Tsang, Associate Professor, Department of Medicine, University of Hong Kong.
Thomas HF Tsang, Community Physician, Department of Health
Samson SY Wong, Assistant Professor, Department of Microbiology, University of Hong Kong.
YH Yang, Professor, Beijing Children's Hospital, Beijing
KY Yuen, Chair Professor in Infectious Diseases, Department of Microbiology, The University of Hong Kong

Consensus Statements

Disease burden of paediatric Haemophilus influenzae type b infections in Hong Kong

1. The incidence of Haemophilus influenzae type b (Hib) diseases in Hong Kong appears to be low. Multiple confounding factors, such as prior antibiotic usage, might be the causes for the apparent low recorded prevalence.

2. Further study to collect epidemiological data in Hong Kong would be difficult due to the following factors:

a) Some children might have been given Hib vaccination on an individual basis.

b) There are quite a number of patients taking antibiotics prior to collection of specimens for cultures and the recovery rate of any microorganisms in these situations is relatively low.

3. Gaps in existing data should be addressed in future studies using new research methodology, such as the WHO rapid assessment tool.

Use of conjugate Haemophilus influenzae type b vaccine

1. Conjugate Hib vaccine has proven safety and efficacy in prevention of invasive Hib disease.

2. Thorough cost-effective/benefit/utility analysis and comparison of existing program would be very helpful in supporting recommendation for universal vaccination in this locality. Broader discussion/consultation on what constitute the "acceptable" cost is required.

Disease burden of pneumococcal infections in Hong Kong

1. Disease burden of pneumococcal disease is still unclear and further study would be needed for different at-risk groups.

2. Penicillin-resistant and multiple antibiotic-resistant pneumococci are a major problem in Hong Kong.

Use of conjugate pneumococcal vaccine

1. The heptavalent conjugate vaccine provides good coverage of the serotypes causing invasive pneumococcal disease in Hong Kong at present.

2. Conjugate pneumococcal vaccine is effective in decreasing vaccine strain carriage, and preventing invasive pneumococcal disease in young children from published experience.

Acknowledgement

The meeting was sponsored by the Hong Kong Paediatric Foundation.

References

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