Characteristics of Haemophilus influenzae invasive isolates from Portugal following routine childhood vaccination against H. influenzae serotype b (2002–2010)

Abstract

We aimed to characterize Haemophilus influenzae invasive isolates recovered in Portugal over a 9-year period (2002–2010) following the inclusion of H. influenzae serotype b (Hib) conjugate vaccination in the National Immunization Program (NIP) in the year 2000 and compare the results with those obtained in a similar study from the pre-vaccination era (1989–2001) previously described by us. As part of a laboratory-based passive surveillance system, 144 invasive isolates obtained in 28 Portuguese hospitals were received at the National Reference Laboratory for Bacterial Respiratory Infections and were characterized. Capsular types and antibiotic susceptibility patterns were determined. The ftsI gene encoding PBP3 was sequenced for β-lactamase-negative ampicillin-resistant (BLNAR) isolates. Genetic relatedness among isolates was examined by multilocus sequencing typing (MLST). Most isolates (77.1 %) were non-capsulated, a significant increase compared to the pre-vaccination era (19.0 %, p < 0.001). Serotype b strains decreased significantly (from 81.0 to 13.2 %, p < 0.001) and serotype f increased significantly (from 0.8 to 6.9 %, p = 0.03). Ten percent of the isolates were β-lactamase producers, a value lower than that previously observed (26.9 %, p = 0.005). Eight percent of all isolates were BLNAR. A high genetic diversity among non-capsulated isolates was found. By contrast, capsulated isolates were clonal. The implementation of Hib vaccination has resulted in a significant decline in the proportion of serotype b H. influenzae invasive disease isolates. Most episodes of invasive disease occurring in Portugal are now due to fully susceptible, highly diverse, non-capsulated strains. Given the evolving dynamics of this pathogen and the increase in non-type b capsulated isolates, continuous surveillance is needed.

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Acknowledgments

Members of the Portuguese Group for the Study of Haemophilus influenzae invasive infection are: Ana Maria de Jesus (Centro Hospitalar do Barreiro Montijo), Henrique Oliveira, Luís Albuquerque, Sarabando Moreira (Centro Hospitalar de Coimbra), Rosa Barros, Isabel Peres, João Marques (Centro Hospitalar de Lisboa Central), José Melo-Cristino, Luís Lito, Lurdes Monteiro, Ana Fonseca, José Gonçalo Marques (Centro Hospitalar Lisboa Norte), Filomena Martins (Centro Hospitalar de Lisboa Ocidental), Fernanda Teixeira, (Centro Hospitalar do Porto), Margarida Tavares, Artur Bonito Vítor (Centro Hospitalar de S. João), Cláudia Monteiro, Mariana B. Viana (Centro Hospitalar Tâmega e Sousa), Paulo Lopes, Luísa Felício (Centro Hospitalar Vila Nova de Gaia-Espinho), Maria João Virtuoso (Hospital de Faro), Amélia Cavaco, Teresa Afonso (Hospital Dr Nélio Mendonça, Funchal), Adriana Coutinho (Hospital Espírito Santo, Évora), José Diogo (Hospital Garcia da Orta, Almada), Maria Manuel Flores, Paula Reis, Elmano Ramalheira (Hospital Infante D. Pedro, Aveiro), Luísa Sancho, Teresa Sardinha, Paula Correia (Hospital Professor Doutor Fernando da Fonseca, Amadora), Sandra Vieira (Hospital de Santa Luzia de Viana do Castelo), José Miguel Ribeiro (Hospital de São Teotónio, Viseu), Maria Augusta Santos (Instituto Nacional de Saúde, Porto), Florbela Cunha, Margarida Rodrigues (Hospital Reynaldo dos Santos, Vila Franca de Xira), Luísa Cabral (Hospital dos SAMS, Lisboa), Ana Paula Castro (Hospital de Vila Real).

We thank Manuela Caniça, Head of the National Reference Laboratory for Antimicrobial Resistance, from the National Institute of Health, Lisbon, Portugal, for providing us with some Haemophilus influenzae strains.

Funding

This work was supported by the National Institute of Health, Lisbon, Portugal.

Conflict of interest

The authors declare that they have no conflict of interest.

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Correspondence to M. P. Bajanca-Lavado.

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Bajanca-Lavado, M.P., Simões, A.S., Betencourt, C.R. et al. Characteristics of Haemophilus influenzae invasive isolates from Portugal following routine childhood vaccination against H. influenzae serotype b (2002–2010). Eur J Clin Microbiol Infect Dis 33, 603–610 (2014). https://doi.org/10.1007/s10096-013-1994-6

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Keywords

  • Pleural Fluid
  • Invasive Disease
  • Cefaclor
  • National Immunization Program
  • Capsular Type