Haemophilus influenzae a invasive infections at the Montreal Children s Hospital and infection rates in Quebec

Transcription

1 Haemophilus influenzae a invasive infections at the Montreal Children s Hospital and infection rates in Quebec Andrée-Anne Boisvert MD Dorothy Moore MD PhD, Brigitte Lefebvre PhD

2 Disclosure Statement I have no affiliation (financial or otherwise) with a pharmaceutical, medical device or communications organization.

3 Invasive Hia infections: Montreal Children s Hospital

4 MCH Invasive Hia infections October 2013: Cluster of Hia infections from Nunavik including two children from one household November 2013: Quebec Public Health instituted chemoprophylaxis for close contacts of patients with Hia infection in Nunavik and James Bay Cree regions

5 Methods Tertiary care paediatric hospital, referral center for children from Northern Quebec Retrospective observational study of cases admitted Case definition: Infection with Hia isolated from normally sterile site Cases identified from laboratory records

6 Number of H. influenzae cases by type

7 Number of cases Invasive Hia by year and region Nunavik, patients not transferred James Bay Cree Nunavik

8 Number Invasive Hia by age group James Bay Cree Nunavik < 1 yr 1-2 yr 2-5 yr 5-9 yr Age group Mean age (m) (95% CI) Nunavik 25 (9-42) James Bay Cree 10 (4-16)

9 Number Invasive Hia: Clinical presentation by age group < Age Group Two patients had multifocal infections Meningitis Osteoarticular Pneumonia Septic shock

10 Invasive Hia: Age and admission data mean median range Age (months) N= Length of stay (days) PICU admission N=7 Duration (days) Mechanical ventilation N=6 Duration (days) % required PICU admission (all had meningitis) 32% required mechanical ventilation

11 Procedures * Meningitis (n=9): craniotomy for drainage of subdural empyema (1) EVD insertion (1) Osteoarticular (n=9): open exploration in OR (6) percutaneous aspiration (3) Pneumonia (n=3): insertion of pleural catheter (1) bronchoscopy with lavage (1) * Excluding insertion of central intravascular catheters

12 Outcome Meningitis: * Death shortly after admission (2) both from Nunavik 6 months and 5 years of age Stroke, R hemiparesis, profound hearing loss, developmental delay, seizure disorder (1) Seizure disorder (1) * Information available on 6 of 9 cases

13 Outcome Osteoarticular infections: (n=9) Chronic osteomyelitis, resolved after 6 months treatment (1) Readmitted with PICC malfunction (3) No sequelae noted on short term follow up Pneumonia (n=3), septic shock (n=1):* No sequelae noted on short term follow up * 2 nd case with septic shock deceased, transferred from Nunavik for autopsy, not included in this series

14 Invasive Hia infections: Quebec

15 Provincial data: Methods All invasive H. influenzae infections reportable to Quebec public health Isolates referred to laboratoire de santé publique du Québec for typing Population data from Statistics Canada 2011 census and Institut de la statistique du Québec

16 Hia by Region Annual Rates per 100,000 (all ages) Nunavik James Bay Cree Rest of Quebec

17 Rate per 100,000 Number of cases Hia Northern Quebec Rates and Numbers by age group (yrs) < >

18 In Summary Invasive Haemophilus influenzae a infections are a significant health problem for aboriginal children living in Northern Quebec, as in rest of Canada's North Infection rates are approaching rates for H. influenzae b in these populations in the pre-vaccine era While awaiting a vaccine, antibiotic prophylaxis of close contacts may be considered Information of H. influenzae a carriage is needed

19 Extra

20 Haemophilus influenzae a (Hia) invasive infections High rates in indigenous populations in Northern Canada in recent years Large proportion of infections in young children Northern Canada* < 2 yr: 88 per 100,000 Nunavut < 1 yr: 275 per 100, yr: 61 per 100,000 Clinical presentation and severity similar to Hib *North-West Territories, Yukon, Nunavut, Northern Quebec, Labrador 1. Rotondo et al Int J Circumpolar Health 2013;72: Tsang et al Int J Circumpolar Health 2016;75:29798

21 Hia by Region & age group (yr) number of cases

22 H. influenzae infections, HiA and others Nunavik , numbers of cases From FlashVigie 2013 v8, no.10

23 2006 Numbers of cases by type, Nunavik James Bay Cree Rest of Quebec A B E F Noncapsulated not typed

24 Invasive HiA infections in aboriginal children Rates per 100,000 Northern Canada (< 2 yr) Canada circumpolar (< 2 yr) Keewatin 2001 (< 5 yr) Nunavut (< 1 yr) (1-4 yr) 61.3 Northwestern Ontario (< 5 yr) HIB pre-vaccine total population (<5 yr) Bruce et al Emerg Infect Dis 2008;14:48; 2.Rotondo et al Int J Circumpolar Health 2013;72:21142; 3. McConnell et al Ped Inf Dis J 2007;26:1025; 4.Tsang et al Int J Circumpolar Health 2016;75: Brown et al Clin Inf Dis 2009:49:1240; 6. CIG

25 Methods Retrospective observational study of cases admitted Case definition: Infection with Hia isolated from normally sterile site Cases identified from laboratory records

26 Montreal Children Hospital Tertiary care teaching hospital Pavilion of McGill University Health Center, Montreal, Quebec Referral center for children from Northern Quebec