No evidence of increasing Haemophilus influenzae non-b infection in Australian Aboriginal children

BACKGROUND High, or increasing, rates of invasive Haemophilus influenzae (Hi) type a disease have been reported from North American native children from circumpolar regions, raising the question of serotype replacement being driven by vaccination against Hi type b (Hib). Indigenous Australians from remote areas had high rates of invasive Hib disease in the past, comparable to those in North American Indigenous populations. OBJECTIVE Evaluate incidence rates of invasive Hi (overall and by serotype) in Indigenous Australian children over time. DESIGN Descriptive study of Hi incidence rates by serotype, in the Northern Territory (NT) and South Australia (SA) from 2001 to 2011. Comparison of NT data with a study that was conducted in the NT in 1985-1988, before Hib vaccine was introduced. RESULTS The average annual rate of invasive Hi type a (Hia) disease in Indigenous children aged < 5 years was 11/100,000 population. Although the incidence of Hi infection in Indigenous children in 2001-2003 was lower than during 2004-2011, this may be due to changes in surveillance. No other trend over time in individual serotypes or total invasive Hi disease, in Indigenous or non-Indigenous people, was identified. Compared to 1985-1988, rates in 2001-2011 were lower in all serotype groupings, by 98% for Hib, 75% for Hia, 79% for other serotypes and 67% for non-typeable Hi. CONCLUSIONS There is no evidence of increases in invasive disease due to Hia, other specific non-b types, or non-typeable Hi in Australian Indigenous children. These data suggest that the increase in Hia some time after the introduction of Hib vaccine, as seen in the North American Arctic Region, is not common to all populations with high pre-vaccine rates of invasive Hib disease. However, small case numbers and the lack of molecular subtyping and PCR confirmation of pre-vaccine results complicate comparisons with North American epidemiology.