title: Invasive Haemophilus influenzae disease in children less than 5 years of age in Manhiça, a rural area of southern Mozambique.
abstract: 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.
authors.affiliation: Centre de Recerca en Salut Internacional de Barcelona, Universitat de Barcelona, Barcelona, Spain. aroca@clinic.ub.es
authors.forename: Anna
authors.initials: A
authors.lastname: Roca
authors.forename: Llorenç
authors.initials: L
authors.lastname: Quintó
authors.forename: Fatima
authors.initials: F
authors.lastname: Abacassamo
authors.forename: Luis
authors.initials: L
authors.lastname: Morais
authors.forename: Xavi
authors.initials: X
authors.lastname: Vallès
authors.forename: Mateu
authors.initials: M
authors.lastname: Espasa
authors.forename: Betuel
authors.initials: B
authors.lastname: Sigaúque
authors.forename: Jahit
authors.initials: J
authors.lastname: Sacarlal
authors.forename: Eusebio
authors.initials: E
authors.lastname: Macete
authors.forename: Ariel
authors.initials: A
authors.lastname: Nhacolo
authors.forename: Inacio
authors.initials: I
authors.lastname: Mandomando
authors.forename: Myron M
authors.initials: MM
authors.lastname: Levine
authors.forename: Pedro L
authors.initials: PL
authors.lastname: Alonso
mesh_terms: 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