HAEMOPHILUS-INFLUENZAE DISEASE IN CHILDREN INDIA - A HOSPITAL PERSPECTIVE

We review and summarize published information on diseases caused by Ha emophilus influenzae in India and unpublished data from our center cov ering more than three decades. Since the mid-1950s H. influenzae has b een the most common cause of pyogenic meningitis in children admitted to our hospital, accounting for one-third to one-half of cases. Inform ation from other centers in India has been scanty; the lower frequency of isolation of Haemophilus in studies in some centers may be caused by unsatisfactory media and culture methods. The annual numbers of adm issions for pyogenic meningitis in our hospital have been quite simila r to the numbers of cases of poliomyelitis. Assuming that the similar numbers of children hospitalized with these two diseases indicate simi lar incidence rates in the community and taking into account the frequ ency of Haemophilus isolations in pyogenic meningitis, we estimate tha t there may be as many as 75 to 100 cases of meningitis caused by this organism per year per 100 000 children <5 years of age. Although pneu monia caused by H, influenzae has been recognized in a few studies, in formation is too scanty to attempt the estimation of incidence. Pus-pr oducing infections caused by Haemophilus are rare. Epiglottitis caused by Haemophilus does not seem to occur in India. In recent years we ha ve found that most invasive Haemophilus infections are caused by H, in fluenzae type b (Hib); other types or untypable strains are infrequent . An increasing prevalence of resistance to chloramphenicol and ampici llin has been recognized in our center and elsewhere. Thus from a hosp ital perspective, primary prevention by using Hib vaccine seems to be a rational and beneficial intervention, Community-based studies to mea sure the disease burden of Hib are urgently needed for a more satisfac tory assessment of the need for, and cost benefit of, Hib immunization of all infants.