A review of Hib epidemiology in Asia.

Meningitis due to an invasive Haemophilus influenzae type b (Hib) infection, has been previously perceived to be relatively uncommon in Asia. However, the incidence of disease and its impact may have been underestimated. In addition to a lack of microbiological facilities in some hospitals, difficulties in culturing the organism and the widespread use of antibiotics may have hidden the true incidence of the disease in some countries. Furthermore, the reported disease burden probably underestimates the incidence of Hib pneumonia. The epidemiology of invasive Hib disease for various Asian nations is reviewed in this paper. Hospital-based studies show that Hib is a major cause of bacterial meningitis and/or pneumonia in the Philippines, India, Thailand, Malaysia, Indonesia and Vietnam. Singapore and Hong Kong have a low incidence of infection compared with Western and other Asian nations. This low incidence is not due to a higher level of natural protective antibodies, but may be related to an interaction between environmental and genetic factors. Therefore the widespread belief that Hib infection is unimportant in Asia does not refer to Asia as a whole and possibly to Chinese patients only, and failure to recognize this has serious implications. The inclusion of Hib vaccine in the routine infant immunization schedule in many industrialized nations has significantly reduced the incidence of invasive disease. Recent studies have shown Hib vaccination is also effective in preventing invasive disease in children in developing countries. While population-based data may be required to confirm the need for public-funded infant Hib immunization in Asia, its introduction in countries with a high incidence of Hib meningitis and/or pneumonia has the potential to significantly improve pediatric health and survival.

Outbreak of febrile gastroenteritis in a five-star hotel in Metro Manila

In September 1989, a national tabloid reported that over 70 persons became ill with gastroenteritis shortly after attending a banquet in a five star hotel in Metro Manila. An epidemiologic investigation was immediately conducted. Illness was defined as diarrhea (passage of watery stool three or more times in a day) or vomiting. A total of 54 (35% of the 150 guests) were interviewed; 38 (70%) became ill and 16 (30%) did not. Salmonella sp. was isolated from the stool of one of the hospitalized cases. Analysis of food specific attack rates implicated steamed lapu-lapu with mayonnaise as the most likely vehicle of transmission (p 0.01). An infected egg may have been used in the preparation of mayonnaise. We presented our findings to Hotel X and we advised them against the use of cracked eggs.