RESUMO
A comprehensive case definition was used to study all cases of epiglottitis that occurred in children under 15 years of age in Western Australia during a 5 year period. There was microbiological evidence of Haemophilus influenzae type b infection in 71% of 103 cases of epiglottitis. Seventy-five per cent of cases occurred in children under 5 years of age. In this age group, the estimated annual incidence (13.5 episodes per 100,000) was significantly lower than that reported in Victoria (22.7 per 100,000). The case definition of invasive H. influenzae type b disease used for surveillance purposes in Canada was more sensitive than the definitions used in the United States or England and Wales, yet even the Canadian definition could have detected only 65% of the cases of epiglottitis that occurred in Western Australia. A simple and sensitive surveillance system which could be used to monitor the impact of H. influenzae type b immunization in Western Australia is proposed.
Assuntos
Epiglotite/epidemiologia , Doença Aguda , Adolescente , Criança , Pré-Escolar , Coleta de Dados/métodos , Demografia , Epiglotite/microbiologia , Feminino , Infecções por Haemophilus/epidemiologia , Infecções por Haemophilus/microbiologia , Haemophilus influenzae/isolamento & purificação , Humanos , Incidência , Lactente , Masculino , Austrália Ocidental/epidemiologiaRESUMO
OBJECTIVES: To describe the epidemiology and the associated mortality and serious neurological sequelae of bacterial meningitis in children under five years of age in Western Australia, and to consider the potential impact of a Haemophilus influenzae type b vaccine on this group of children. DESIGN: A retrospective survey, using multiple sources of case ascertainment. PATIENTS: All children in Western Australia from one month to five years of age who developed bacterial meningitis, over a five-year period (from 1984 to 1988 inclusive). MAIN OUTCOME MEASURES: Episodes of bacterial meningitis, deaths associated with bacterial meningitis, and sensorineural deafness (requiring hearing aids) and cerebral palsy following bacterial meningitis. RESULTS: Two hundred and seventy episodes of bacterial meningitis were identified; 200 occurred in non-Aboriginal children and 70 in Aboriginal children. There were 16 meningitis-associated deaths (case fatality rate, 5.9%), 7 children developed profound sensorineural deafness and a further 7 children developed cerebral palsy after bacterial meningitis. H. influenzae type b caused nearly 70% of the cases of childhood bacterial meningitis. The annual incidence rate of H. influenzae meningitis was significantly greater in Aboriginal children (150 episodes per 100,000 children under five years of age per year) than in non-Aboriginal children (27 episodes per 100,000), and the mean age of onset of H. influenzae meningitis was significantly lower in Aboriginal children (6.8 months) than in non-Aboriginal children (19.8 months). CONCLUSIONS: Any conjugate H. influenzae type b vaccine should be effective when administered to non-Aboriginal children in the first six months of life, but only the most immunogenic vaccines (for example, the vaccine known as PRP-OMP) are likely to be effective in Aboriginal infants.
