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Burden of Invasive Disease Caused by Haemophilus influenzae Type b in Bamako, Mali: Impetus for Routine Infant Immunization With Conjugate Vaccine

Sow, Samba O. MD, MS*; Diallo, Souleymane PharmD; Campbell, James D. MD; Tapia, Milagritos D. MD; Keita, Tatiana MD; Keita, Mamadou Marouf MD; Murray, Patrick PhD§; Kotloff, Karen L. MD; Levine, Myron M. MD, DTPH

The Pediatric Infectious Disease Journal: June 2005 - Volume 24 - Issue 6 - p 533-537
doi: 10.1097/01.inf.0000164768.28135.0d
Original Studies

Background: Population-based, bacteriologically confirmed disease burden data aid decision makers in African countries pondering whether to introduce Haemophilus influenzae type b (Hib) immunization for infants.

Methods: A bacteriology laboratory was established in Hôpital Gabriel Touré, serving Bamako, Mali. Children age 0–15 years with fever ≥39°C or syndromes compatible with invasive bacterial disease (meningitis, etc.) were eligible. From 2 to 5 mL of blood or relevant body fluid were inoculated into Bactec Ped Plus/F medium for automated culture; body fluids were also inoculated directly onto solid media. Hib was confirmed by standard microbiologic techniques and antibiograms generated by disk diffusion.

Results: From June 1, 2002 to May 31, 2004, 3592 (87.8%) of 4092 children admitted to Hôpital Gabriel Touré with high fever or suspected invasive bacterial disease were cultured, including 1745 who were 0–11 months old, 1132 who were 1–4 years old and 715 who were 5–15 years old. Hib was isolated from 207 Bamako children, 81 from blood alone and 124 from cerebrospinal fluid (with or without positive blood culture). Of 207 cases 204 (98.5%) occurred in children younger than age 5 years (annual incidence, 45.2/105) and 159 (77%) in infants age 0–11 months (annual incidence, 158.4/105). Peak incidence (370.0 cases/105) and 12 of 21 Hib deaths occurred in 6- to 7-month-olds. Of the Hib isolates, 11.1% were resistant to ampicillin, 32% to chloramphenicol and 0.5% to ceftriaxone.

Conclusions: The substantial burden of invasive Hib disease documented in Bamako has prompted the Malian government to introduce routine infant immunization with Hib conjugate.

From the *Centre pour le Développement des Vaccins, Mali (CVD-Mali), and the †Clinical Bacteriology Laboratory and the Pediatric Service, Gabriel Touré Hospital, Bamako, Mali; the ‡Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD; and §Clinical Microbiology Laboratories, National Institutes of Health, Bethesda, MD.

Accepted for publication January 12, 2005.

Supported by grants from the Bill and Melinda Gates Foundation (M. M. Levine, Principal Investigator) and the Rockefeller Foundation (M. M. Levine, Principal Investigator).

Reprints not available.

© 2005 Lippincott Williams & Wilkins, Inc.