title: A systematic review and critical evaluation of invasive Haemophilus influenzae type B disease burden studies in Asia from the last decade: lessons learned for invasive bacterial disease surveillance.
abstract: In Asia, questions regarding the burden of Haemophilus influenzae type b (Hib) disease have delayed decision-making on introduction of Hib vaccine. However, over the past decade many studies have been published regarding Hib disease burden in Asia. We conducted a systematic literature review of all reports of Hib disease burden in Asia between 1998 and 2009, and critically reviewed their methods and data quality. We identified 94 studies from 28 countries in Asia presenting data on Hib disease burden. Of the 94 studies reviewed, 49 (52%) used a case definition consistent with World Health Organization standards, and 47 (50%) described laboratory methodology used. Twenty-seven surveillance studies presented data on incidence of Hib disease, with 8 (30%) accounting for missed cases, 6 (15%) accounting for cases with missed diagnostic tests, and 2 (7%) that considered prior antibiotic use. Of the 21 studies that provided incidence data for Hib meningitis, 10 (48%) used active, prospective, population-based surveillance, and found unadjusted incidence rates of Hib meningitis ranging from a low of 0.98 per 100,000 child-years in children aged less than 5 years in China to a high of 28 per 100,000 child-years in children less than 5 years in Mongolia. Of 49 studies that reported the etiology of bacterial meningitis, 30 (60%) identified Hib as the most common cause. This review highlights the importance of using rigorous methodologies, including standardized surveillance methods and appropriate laboratory diagnostic tests, when conducting studies measuring the burden of invasive bacterial diseases including those caused by Hib. When poorly conducted, studies can underestimate disease burden and lead to inappropriate decisions about vaccine introduction.
authors.affiliation: National Center for Preparedness, Detection, and Control of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA. acq1@cdc.gov
authors.forename: Sharmila
authors.initials: S
authors.lastname: Shetty
authors.forename: Adam L
authors.initials: AL
authors.lastname: Cohen
authors.forename: Karen
authors.initials: K
authors.lastname: Edmond
authors.forename: Linda
authors.initials: L
authors.lastname: Ojo
authors.forename: Jennifer
authors.initials: J
authors.lastname: Loo
authors.forename: Rosalyn
authors.initials: R
authors.lastname: O'Loughlin
authors.forename: Rana
authors.initials: R
authors.lastname: Hajjeh
mesh_terms: D001208:Asia / Q000453:epidemiology; D002675:Child, Preschool; D004784:Environmental Monitoring / Q000592:standards; D004812:Epidemiologic Methods; D062665:Epidemiological Monitoring; D006192:Haemophilus Infections / Q000453:epidemiology* / Q000382:microbiology; D019741:Haemophilus influenzae type b / Q000302:isolation & purification*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn