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A Systematic Review and Critical Evaluation of Invasive Haemophilus influenzae Type B Disease Burden Studies in Asia From the Last Decade: Lessons Learned for Invasive Bacterial Disease Surveillance

Shetty, Sharmila MD*; Cohen, Adam L. MD, MPH; Edmond, Karen MB BS, PhD; Ojo, Linda MPH; Loo, Jennifer MPH; O'Loughlin, Rosalyn PhD; Hajjeh, Rana MD

The Pediatric Infectious Disease Journal: July 2010 - Volume 29 - Issue 7 - p 653-661
doi: 10.1097/INF.0b013e3181d3ce19
CDC Series

In Asia, questions regarding the burden of Haemophilus influenzae type b (Hib) disease have delayed decision-making on introduction of Hib vaccine. However, over the past decade many studies have been published regarding Hib disease burden in Asia. We conducted a systematic literature review of all reports of Hib disease burden in Asia between 1998 and 2009, and critically reviewed their methods and data quality. We identified 94 studies from 28 countries in Asia presenting data on Hib disease burden. Of the 94 studies reviewed, 49 (52%) used a case definition consistent with World Health Organization standards, and 47 (50%) described laboratory methodology used. Twenty-seven surveillance studies presented data on incidence of Hib disease, with 8 (30%) accounting for missed cases, 6 (15%) accounting for cases with missed diagnostic tests, and 2 (7%) that considered prior antibiotic use. Of the 21 studies that provided incidence data for Hib meningitis, 10 (48%) used active, prospective, population-based surveillance, and found unadjusted incidence rates of Hib meningitis ranging from a low of 0.98 per 100,000 child-years in children aged less than 5 years in China to a high of 28 per 100,000 child-years in children less than 5 years in Mongolia. Of 49 studies that reported the etiology of bacterial meningitis, 30 (60%) identified Hib as the most common cause. This review highlights the importance of using rigorous methodologies, including standardized surveillance methods and appropriate laboratory diagnostic tests, when conducting studies measuring the burden of invasive bacterial diseases including those caused by Hib. When poorly conducted, studies can underestimate disease burden and lead to inappropriate decisions about vaccine introduction.

From the *Division of Global Migration and Quarantine, National Center for Preparedness, Detection, and Control of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA; †Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA; and ‡Department of Epidemiology and Population Health, The London School of Hygiene and Tropical Medicine, London, United Kingdom.

Accepted for publication January 4, 2010.

Address for correspondence: Sharmila Shetty, MD, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS E-03, Atlanta, GA 30333. E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.