Yushi Hachisu1,2, Kosuke Tamura3, Koichi Murakami4, Jiro Fujita5, Hiroshi Watanabe6, Yoshinari Tanabe7, Koji Kuronuma8, Tetsuya Kubota9, Kengo Oshima10, Takaya Maruyama11, Kei Kasahara12, Junichiro Nishi13, Shuichi Abe14, Masahiko Nakamura3, Mayumi Kubota15, Shinichiro Hirai4, Taisei Ishioka16, Chiaki Ikenoue2,17, Munehisa Fukusumi2,17, Tomimasa Sunagawa17, Motoi Suzuki18, Yukihiro Akeda19, Kazunori Oishi20. 1. Chiba Prefectural Institute of Public Health, Chiba, Japan. 2. Field Epidemiology Training Program, Infectious Diseases Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan. 3. Toyama Institute of Health, 17-1, Nakataikouyama, Imizu, Toyama, 939-0363, Japan. 4. Center for Emergency Preparedness and Response, National Institute of Infectious Diseases, Tokyo, Japan. 5. Department of Infectious, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan. 6. Department of Infection Control and Prevention, Kurume University School of Medicine, Fukuoka, Japan. 7. Department of Respiratory Medicine, Niigata Prefectural Shibata Hospital, Niigata, Japan. 8. Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Hokkaido, Japan. 9. Department of Respiratory Medicine and Allergology, Kochi Medical School, Kochi University, Kochi, Japan. 10. Department of Infectious Diseases, Tohoku University Hospital, Miyagi, Japan. 11. Mie Prefectural Ichishi Hospital, Mie, Japan. 12. Center for Infectious Diseases, Nara Medical University, Nara, Japan. 13. Department of Microbiology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan. 14. Department of Infectious Disease and Infection Control, Yamagata Prefectural Central Hospital, Yamagata, Japan. 15. Department of Bacteriology II, National Institute of Infectious Diseases, Tokyo, Japan. 16. Department of Applied Biological Science, Faculty of Agriculture, Takasaki University of Health and Welfare, Takasaki, Japan. 17. Center for Field Epidemic Intelligence, Research and Professional Development, National Institute of Infectious Diseases, Tokyo, Japan. 18. Center for Surveillance, Immunization, and Epidemiologic Research, National Institute of Infectious Diseases, Tokyo, Japan. 19. Department of Bacteriology I, National Institute of Infectious Diseases, Tokyo, Japan. 20. Toyama Institute of Health, 17-1, Nakataikouyama, Imizu, Toyama, 939-0363, Japan. toyamaeiken1@chic.ocn.ne.jp.
Abstract
PURPOSE: We describe the epidemiology of invasive Haemophilus influenzae disease (IHD) among adults in Japan. METHODS: Data for 200 adult IHD patients in 2014-2018 were analyzed. The capsular type of H. influenzae was determined by bacterial agglutination and polymerase chain reaction (PCR), and non-typeable Haemophilus influenzae (NTHi) was identified by PCR. RESULTS: The annual incidence of IHD (cases per 100,000 population) was 0.12 for age 15-64 years and 0.88 for age ≥ 65 years in 2018. The median age was 77 years, and 73.5% were aged ≥ 65 years. About one-fourth of patients were associated with immunocompromising condition. The major presentations were pneumonia, followed by bacteremia, meningitis and other than pneumonia or meningitis (other diseases). The case fatality rate (CFR) was 21.2% for all cases, and was significantly higher in the ≥ 65-year group (26.1%) than in the 15-64-year group (7.5%) (p = 0.013). The percentage of cases with pneumonia was significantly higher in the ≥ 65-year group than in the 15-64-year group (p < 0.001). The percentage of cases with bacteremia was significantly higher in the 15-64-year group than in the ≥ 65-year group (p = 0.027). Of 200 isolates, 190 (95.0%) were NTHi strains, and the other strains were encapsulated strains. 71 (35.5%) were resistant to ampicillin, but all were susceptible to ceftriaxone. CONCLUSION: The clinical presentations of adult IHD patients varied widely; about three-fourths of patients were age ≥ 65 years and their CFR was high. Our findings support preventing strategies for IHD among older adults, including the development of NTHi vaccine.
PURPOSE: We describe the epidemiology of invasive Haemophilus influenzae disease (IHD) among adults in Japan. METHODS: Data for 200 adult IHD patients in 2014-2018 were analyzed. The capsular type of H. influenzae was determined by bacterial agglutination and polymerase chain reaction (PCR), and non-typeable Haemophilus influenzae (NTHi) was identified by PCR. RESULTS: The annual incidence of IHD (cases per 100,000 population) was 0.12 for age 15-64 years and 0.88 for age ≥ 65 years in 2018. The median age was 77 years, and 73.5% were aged ≥ 65 years. About one-fourth of patients were associated with immunocompromising condition. The major presentations were pneumonia, followed by bacteremia, meningitis and other than pneumonia or meningitis (other diseases). The case fatality rate (CFR) was 21.2% for all cases, and was significantly higher in the ≥ 65-year group (26.1%) than in the 15-64-year group (7.5%) (p = 0.013). The percentage of cases with pneumonia was significantly higher in the ≥ 65-year group than in the 15-64-year group (p < 0.001). The percentage of cases with bacteremia was significantly higher in the 15-64-year group than in the ≥ 65-year group (p = 0.027). Of 200 isolates, 190 (95.0%) were NTHi strains, and the other strains were encapsulated strains. 71 (35.5%) were resistant to ampicillin, but all were susceptible to ceftriaxone. CONCLUSION: The clinical presentations of adult IHD patients varied widely; about three-fourths of patients were age ≥ 65 years and their CFR was high. Our findings support preventing strategies for IHD among older adults, including the development of NTHi vaccine.
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