The increasing burden of disease in Bangladeshi children due to Haemophilus influenzaetype b meningitis

SummaryA laboratory-based study of diagnosed bacterial meningitis in the national paediatric hospital identified 852 cases of meningitis in the 8-year period 1987–1994. There were 587 culture-positive cases, of which Haemophilus influenzae(47%) and Streptococcus pneumoniae(32%) accounted for 80%. H. influenzaeshowed a remarkable increase of 700% during the study period. Most of the H. influenzaecases (90%) occurred in the 1st 2 years of life. Analysis of culture-negative specimens by antigen detection in the last 2 years also revealed the predominance of H. influenzae(71.4%) and S. pneumoniae(22.4%). Typing of H. influenzaeisolates during this time showed that 98% of the strains were type b. This retrospective hospital-based study indicated a pronounced increase in the incidence of H. influenzaemeningitis and strongly supports the need for large-scale Hib vaccination for young children. However, such nationwide intervention will probably need to be based on a prospective and population-based surveillance of H. influenzaeinfections.