Spectrum and Burden of Severe Haemophilus Influenzae Type B Diseases in Asia

By Peltola, H. | Bulletin of the World Health Organization, November 1999 | Go to article overview

Spectrum and Burden of Severe Haemophilus Influenzae Type B Diseases in Asia


Peltola, H., Bulletin of the World Health Organization


Voir page 884 le resume en francais. En la pagina 884 figura un resumen en espanol.

Introduction

Only a decade ago, Haemophilus influenzae type b (Hib) diseases devastated children in the USA as much as poliomyelitis had during the peak epidemic years of the early 1950s (1). Conjugate vaccines are now changing the picture entirely (2), but they are not utilized globally.

In Asia one of the obstacles to their use is the generally held view that Hib diseases are uncommon (3-8). This impression can be only partly explained by a questionable ability to culture H. influenzae (9). Reference is often made to Hong Kong Special Administrative Region of China, where no Hib strains were found among 0-4-year-old Chinese children (621 throat swabs), as opposed to 1.3% of Vietnamese children (10). Ethnic group was the only predictor suggesting Hib carriage, and this finding may explain the low incidence of Hib disease in Hong Kong, where different populations often live in rather dissimilar conditions (6-8).

Data from Asian populations living elsewhere are controversial. In Sydney, Australia, Hib disease is uncommon among Chinese and Vietnamese populations (11). In California, the risk of Hib disease among Hispanic children used to be slightly lower, and in Asian children significantly (P [is less than] 0.001) lower, than that among Caucasian and Black populations (12). However, a high incidence of Hib disease has been observed among Vietnamese refugees in Hong Kong Special Administrative Region of China (7), and among Bangladeshi, Indian, and Pakistani populations in the United Kingdom (13). One may argue that crowding and better surveillance may have contributed to the findings, but whatever the reasons, even the views of experts differ considerably.

This study attempts to look at a complex issue in its entirety, i.e not just meningitis (14), which occupies only a part of the Hib disease spectrum. It was sought to determine whether all of Asia really does enjoy a low incidence of severe Hib diseases, and what the global burden is for these life-threatening infections against which effective vaccines are already available.

Methods

A detailed literature search was undertaken to trace existing information on invasive Hib diseases in Asia. As defined by the World Bank (15), Asia was taken to be a geographical entity that extends from the Mediterranean Sea in the west to the Pacific Ocean in the east, including the Middle East and Japan but not Turkey, Russian Federation, or Papua New Guinea.

The great majority of the data used here were obtained from the published literature, but some originated from international scientific meetings. A considerable amount of information was published in languages other than English. Inclusion of all reports, irrespective of language, was deemed essential to increase precision and perhaps to reduce systematic errors (16, 17). Because bacteriological methods have improved considerably over the last 30 years or so, earlier studies were not included.

It was expected that the quality of studies would vary, and that the majority of surveys would be retrospective; prospective studies were thus a search priority. The analysis particularly focused on incidence data obtained from population studies, rather than from official reports, which tend to be unreliable. Attention was paid not only to children under 5 years of age -- who account for the majority of cases of Hib disease (1, 18) -- but to all age groups and the entire spectrum of manifestations of Hib. A total of more than 100 reports in six languages from 25 countries throughout the continent were scrutinized.

Demographic calculations were made using World Bank data (15). Actual numbers of cases were calculated from the incidences.

Results

Clinical manifestations

Meningitis. As expected, bacterial meningitis captured the most attention.

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Spectrum and Burden of Severe Haemophilus Influenzae Type B Diseases in Asia
Settings

Settings

Typeface
Text size Smaller Larger
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.