Invasive Haemophilus influenzae disease in children less than 5 years of age in Manhiça, a rural area of southern Mozambique

Abstract

Objective: To measure the disease burden and epidemiological characteristics of invasive Haemophilus influenzae in rural Mozambican children. Methods: As part of the clinical management of children admitted to Manhiça District Hospital, blood and cerebrospinal fluid samples were collected between May 2001 and April 2005 for children aged <5 years. The level of antibiotic resistance of the isolates was analysed. Results: During the surveillance period, there were 106 episodes of invasive H. influenzae disease. The estimated minimum incidence rate of invasive disease among children <5 years of age was 125/100 000 per child-year-at-risk. Fifty-six (59/106) per cent of cases were infants aged 3 to <12 months. Confirmed meningitis explained 16% of the episodes (n = 17) but was probably underestimated, as meningitis surveillance was not well implemented in the setting during the study. The case-fatality-rate was 21%, being highest among children with meningitis (odds ratio = 4.38, P = 0.011). Resistance to the antibiotics most commonly used in Mozambique was high - chloramphenicol 39%, ampicillin 35% and cotrimoxazol 74%- and had increased over the years (P < 0.001 for chloramphenicol). Conclusion: Invasive H. influenzae disease is of considerable public health importance in Mozambique; implementing H. influenzae type b vaccination in sub-Saharan Africa has the potential to increase child survival. © 2008 Blackwell Publishing Ltd.