Molecular epidemiology of invasive Haemophilus influenzae disease in Portugal: an update of the post-vaccine period, 2011–2018

Abstract

Haemophilus influenzae reference laboratory from Portugal characterized the entire collection of 260 H. influenzae invasive isolates received between 2011 and 2018, with the purpose of updating the last published data (2002–2010). Capsular serotypes and antimicrobial susceptibility patterns were determined. The ftsI gene encoding the transpeptidase domain of PBP3 was sequenced for β-lactamase-negative ampicillin-resistant (BLNAR) isolates. Multilocus sequence typing (MLST) was performed to examine genetic relatedness among isolates. The majority of H. influenzae invasive isolates are nonencapsulated (NTHi-79.2%). Among encapsulated isolates (20.8%), the most characterized serotype was serotype b (13.5%), followed by serotype f (3.1%), serotype a (2.7%), and serotype e (1.5%). In contrast to NTHi that mainly affected the elderly (64.0%; ≥ 65 years old), most encapsulated isolates were characterized in preschool children (55.6%). Comparing the two periods, β-lactamase production increased from 10.4 to 13.5% (p = 0.032) and low-BLNAR (MIC ≥ 1 mg/L) isolates from 7.7 to 10.5% (p = 0.017). NTHi showed high genetic diversity (60.7%), in opposition to encapsulated isolates that were clonal within each serotype. Interestingly, ST103 and ST57 were the predominant STs among NTHi, with ST103 being associated with β-lactamase-producers and ST57 with non-β-lactamase-producers. In Portugal, susceptible and genetically diverse NTHi H. influenzae continues to be responsible for invasive disease, mainly in the elderly. Nevertheless, we are now concerned with Hib circulating in children we believe to have been vaccinated. Our data reiterates the need for continued surveillance, which will be useful in the development of public health prevention strategies.

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Acknowledgments

Members of the Portuguese Group for the Study of Haemophilus influenzae invasive infection are as follows: Ana Maria Jesus and Luísa Teixeira (Centro Hospitalar Barreiro Montijo); José Melo-Cristino, Luís Lito, Maria Dinah Carvalho, and José Gonçalo Marques (Centro Hospitalar Universitário Lisboa Norte); Margarida Pinto, Tiago Silva, and João Farela Neves (Centro Hospitalar Universitário de Lisboa Central); Filomena Martins, Maria Pessanha, and Cristina Toscano (Centro Hospitalar de Lisboa Ocidental); Henrique Oliveira and Fernanda Rodrigues (Centro Hospitalar e Universitário de Coimbra); Gina Marrão and Maria Manuel Zarcos (Centro Hospitalar de Leiria); Angélica Ramos, Manuela Ribeiro, and Artur Bonito Vitor (Centro Hospitalar de S. João, Porto); Mariana Viana and Cláudia Monteiro (Centro Hospitalar Tâmega e Sousa); Gabriela Abreu and Diana Moreira (Centro Hospitalar Vila Nova de Gaia/Espinho); Ana Paula Castro and Joana Carvalho (Centro Hospitalar de Trás-os-Montes); Hermínia Costa (Centro Hospitalar de Entre Douro e Vouga); Maria João Virtuoso (Centro Hospitalar Universitário do Algarve); Teresa Afonso, Nuno Canhoto, and Cristina Freitas (Hospital Dr. Nélio Mendonça, Funchal); Adriana Coutinho and Carla Cruz (Hospital Espírito Santo Évora); José Diogo and Filipa Nunes (Hospital Garcia de Orta, Almada); Elmano Ramalheira and Maria Manuel Flores (Hospital Infante D. Pedro, Aveiro); Luísa Sancho, Teresa Sardinha, and Paula Correia (Hospital Professor Doutor Fernando da Fonseca, Amadora); Isabel Brito and Diana Almeida (Hospital Distrital da Figueira da Foz); Alberta Faustino and Manuela Alves (Hospital de Braga); Margarida Rodrigues and Florbela Cunha (Hospital Reynaldo dos Santos, Vila Franca de Xira); Sandra Vieira and Idalina Maciel (Hospital de Santa Luzia, Viana do Castelo); Rosa Bento and Graças Seves (Hospital José Joaquim Fernandes, Beja).

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

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Correspondence to Maria Paula Bajanca-Lavado.

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Not applicable to the present study. In Portugal, invasive Haemophilus influenzae disease is of mandatory notification, where isolates depleted of personal data are sent to the Reference Laboratory for H. influenzae at the National Institute of Health for molecular characterization.

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Not applicable to the present study. This is a population-based study to define epidemiological trends, where no personal or clinical data is available.

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Heliodoro, C.I.M., Bettencourt, C.R., Bajanca-Lavado, M.P. et al. Molecular epidemiology of invasive Haemophilus influenzae disease in Portugal: an update of the post-vaccine period, 2011–2018. Eur J Clin Microbiol Infect Dis 39, 1471–1480 (2020). https://doi.org/10.1007/s10096-020-03865-0

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