Invasive Haemophilus influenzae disease in children less than 5 years of age in Manhiça, a rural area of southern Mozambique.
OBJECTIVE
To measure the disease burden and epidemiological characteristics of invasive Haemophilus influenzae in rural Mozambican children.


METHODS
As part of the clinical management of children admitted to Manhiça District Hospital, blood and cerebrospinal fluid samples were collected between May 2001 and April 2005 for children aged <5 years. The level of antibiotic resistance of the isolates was analysed.


RESULTS
During the surveillance period, there were 106 episodes of invasive H. influenzae disease. The estimated minimum incidence rate of invasive disease among children <5 years of age was 125/100,000 per child-year-at-risk. Fifty-six (59/106) per cent of cases were infants aged 3 to <12 months. Confirmed meningitis explained 16% of the episodes (n = 17) but was probably underestimated, as meningitis surveillance was not well implemented in the setting during the study. The case-fatality-rate was 21%, being highest among children with meningitis (odds ratio = 4.38, P = 0.011). Resistance to the antibiotics most commonly used in Mozambique was high--chloramphenicol 39%, ampicillin 35% and cotrimoxazol 74%-- and had increased over the years (P < 0.001 for chloramphenicol).


CONCLUSIONS
Invasive H. influenzae disease is of considerable public health importance in Mozambique; implementing H. influenzae type b vaccination in sub-Saharan Africa has the potential to increase child survival.
Roca
Anna
A
Centre de Recerca en Salut Internacional de Barcelona, Universitat de Barcelona, Barcelona, Spain. aroca@clinic.ub.es
Quintó
Llorenç
L
Abacassamo
Fatima
F
Morais
Luis
L
Vallès
Xavi
X
Espasa
Mateu
M
Sigaúque
Betuel
B
Sacarlal
Jahit
J
Macete
Eusebio
E
Nhacolo
Ariel
A
Mandomando
Inacio
I
Levine
Myron M
MM
Alonso
Pedro L
PL
D017677:Age Distribution; D002675:Child, Preschool; D024881:Drug Resistance, Bacterial; D005260:Female; D006192:Haemophilus Infections / Q000188:drug therapy / Q000453:epidemiology*; D006193:Haemophilus influenzae / Q000187:drug effects / Q000302:isolation & purification*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008826:Microbial Sensitivity Tests; D009073:Mozambique / Q000453:epidemiology; D012423:Rural Health / Q000706:statistics & numerical data; D017678:Sex Distribution