Clinical Infectious Diseases Advance Access published March 17, 2015 1
Neonatal invasive Haemophilus influenzae disease in England and
cr ipt
Wales: epidemiology, clinical characteristics and outcome
Sarah Collins1, David Litt2, Sally Flynn2, Mary Ramsay1, Mary P.E. Slack2, Shamez N. Ladhani1 1
Immunisation, Hepatitis and Blood Safety Department (IHBSD), Public Health England, 61
2
us
Respiratory and Vaccine Preventable Bacterial Reference Unit (RVPBRU), Public Health
England, 61 Colindale Avenue, London NW9 5EQ, UK
an
Corresponding author: Dr Shamez Ladhani; Public Health England, Immunisation, Hepatitis, and Blood Safety department; 61 Colindale Avenue; London NW9 5EQ, UK. Email:
M
[email protected] Tel: +44 20 8327 7155 Fax: +44 20 8327 7404
Alternate corresponding author: Sarah Collins; Public Health England, Immunisation, Hepatitis, and Blood Safety department; 61 Colindale Avenue; London NW9 5EQ, UK. Email:
pt ed
sarah,[email protected] Tel: +44 20 8327 7621 Fax: +44 20 8327 7404
Summary
Invasive NTHi disease is currently an under recognised neonatal pathogen. Neonatal
ce
invasive NTHi disease within the first 48 hours of life is strongly associated with premature
Ac
birth and is a cause of significant morbidity and mortality.
© The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: [email protected].
Downloaded from http://cid.oxfordjournals.org/ at SUNY Health Science Center at Brooklyn on April 4, 2015
Colindale Avenue, London NW9 5EQ, UK
2
Abstract Background
cr ipt
Non-typeable Haemophilus influenzae (NTHi) frequently causes non-invasive upper respiratory tract infections in children but can cause invasive disease, mainly in older adults.
An increased burden of invasive NTHi disease in the perinatal period has been reported by a number of studies. Here we describe the epidemiology, clinical characteristics and outcome
us
Methods
Public Health England conducts enhanced national surveillance of invasive H. influenzae
an
disease in England and Wales. Detailed clinical information was obtained for all laboratoryconfirmed cases in infants aged ≤31 days during 2009-2013. Results
M
Overall, 118 live-born neonates had laboratory-confirmed invasive H. influenzae disease; 115 (97%) were NTHi, two serotype f (Hif) and one serotype b (Hib). NTHi was isolated within 48 hours of birth (early-onset) in 110/115 (96%) cases and 70/110 (64%) presented
pt ed
with septicaemia. Only 17 mothers (15%) had suspected bacterial infection requiring antibiotics during labour. Few (8/110, 7%) neonates had co-morbidities. The incidence of early-onset NTHi increased exponentially with prematurity from 0.9/100,000 (95% CI, 0.61.4) in term neonates to 342/100,000 (95% CI, 233.9-482.7) in neonates born at 24 hours)
39 (35.5)
9.5%
24-48 hours
21 (19.1)
-
48-72 hours
9 (8.2)
-
>72 hours
9 (8.2)
-
Vaginal
72 (65.5)
62.2
Assisted (forceps)
5 (4.5)
6.3
Assisted (ventouse)
4 (3.6)
6.2
Elective Caesarian
-
10.1
2
ce
≥3
Ac
Delivery
Downloaded from http://cid.oxfordjournals.org/ at SUNY Health Science Center at Brooklyn on April 4, 2015
Ethnicity
cr ipt
Maternal age-group
18 Emergency Caesarian section*
29 (26.4)
14.8
Spontaneous
93 (84.5)
67.1
Induced
13 (11.8)
32.9
cr ipt
Onset of Labour
Liquor Clear
68 (61.8)
Meconium stained
26 (23.6)
Offensive
6 (5.5)
Chorioamnionitis
8 (7.3)
NK
2 (1.8)
Infant Premature (Any)
88 (80.0)
Neonatal invasive Haemophilus influenzae disease in England and
cr ipt
Wales: epidemiology, clinical characteristics and outcome
Sarah Collins1, David Litt2, Sally Flynn2, Mary Ramsay1, Mary P.E. Slack2, Shamez N. Ladhani1 1
Immunisation, Hepatitis and Blood Safety Department (IHBSD), Public Health England, 61
2
us
Respiratory and Vaccine Preventable Bacterial Reference Unit (RVPBRU), Public Health
England, 61 Colindale Avenue, London NW9 5EQ, UK
an
Corresponding author: Dr Shamez Ladhani; Public Health England, Immunisation, Hepatitis, and Blood Safety department; 61 Colindale Avenue; London NW9 5EQ, UK. Email:
M
[email protected] Tel: +44 20 8327 7155 Fax: +44 20 8327 7404
Alternate corresponding author: Sarah Collins; Public Health England, Immunisation, Hepatitis, and Blood Safety department; 61 Colindale Avenue; London NW9 5EQ, UK. Email:
pt ed
sarah,[email protected] Tel: +44 20 8327 7621 Fax: +44 20 8327 7404
Summary
Invasive NTHi disease is currently an under recognised neonatal pathogen. Neonatal
ce
invasive NTHi disease within the first 48 hours of life is strongly associated with premature
Ac
birth and is a cause of significant morbidity and mortality.
© The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: [email protected].
Downloaded from http://cid.oxfordjournals.org/ at SUNY Health Science Center at Brooklyn on April 4, 2015
Colindale Avenue, London NW9 5EQ, UK
2
Abstract Background
cr ipt
Non-typeable Haemophilus influenzae (NTHi) frequently causes non-invasive upper respiratory tract infections in children but can cause invasive disease, mainly in older adults.
An increased burden of invasive NTHi disease in the perinatal period has been reported by a number of studies. Here we describe the epidemiology, clinical characteristics and outcome
us
Methods
Public Health England conducts enhanced national surveillance of invasive H. influenzae
an
disease in England and Wales. Detailed clinical information was obtained for all laboratoryconfirmed cases in infants aged ≤31 days during 2009-2013. Results
M
Overall, 118 live-born neonates had laboratory-confirmed invasive H. influenzae disease; 115 (97%) were NTHi, two serotype f (Hif) and one serotype b (Hib). NTHi was isolated within 48 hours of birth (early-onset) in 110/115 (96%) cases and 70/110 (64%) presented
pt ed
with septicaemia. Only 17 mothers (15%) had suspected bacterial infection requiring antibiotics during labour. Few (8/110, 7%) neonates had co-morbidities. The incidence of early-onset NTHi increased exponentially with prematurity from 0.9/100,000 (95% CI, 0.61.4) in term neonates to 342/100,000 (95% CI, 233.9-482.7) in neonates born at 24 hours)
39 (35.5)
9.5%
24-48 hours
21 (19.1)
-
48-72 hours
9 (8.2)
-
>72 hours
9 (8.2)
-
Vaginal
72 (65.5)
62.2
Assisted (forceps)
5 (4.5)
6.3
Assisted (ventouse)
4 (3.6)
6.2
Elective Caesarian
-
10.1
2
ce
≥3
Ac
Delivery
Downloaded from http://cid.oxfordjournals.org/ at SUNY Health Science Center at Brooklyn on April 4, 2015
Ethnicity
cr ipt
Maternal age-group
18 Emergency Caesarian section*
29 (26.4)
14.8
Spontaneous
93 (84.5)
67.1
Induced
13 (11.8)
32.9
cr ipt
Onset of Labour
Liquor Clear
68 (61.8)
Meconium stained
26 (23.6)
Offensive
6 (5.5)
Chorioamnionitis
8 (7.3)
NK
2 (1.8)
Infant Premature (Any)
88 (80.0)
