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. 2021 Nov 2;73(9):1617-1624.
doi: 10.1093/cid/ciab449.

Racial Disparities in Invasive Haemophilus influenzae Disease-United States, 2008-2017

Nicole E Brown  1   2 , Amy E Blain  1 , Kari Burzlaff  3 , Lee H Harrison  4 , Susan Petit  5 , William Schaffner  6 , Chad Smelser  7 , Ann Thomas  8 , Lori Triden  9 , James P Watt  10 , Tracy Pondo  1 , Melissa J Whaley  1 , Fang Hu  1 , Xin Wang  1 , Sara Oliver  1 , Heidi M Soeters  1
Affiliations

Racial Disparities in Invasive Haemophilus influenzae Disease-United States, 2008-2017

Nicole E Brown et al. Clin Infect Dis. .

Abstract

Background: Since the introduction of Haemophilus influenzae serotype b (Hib) conjugate vaccines in the United States, invasive H. influenzae disease epidemiology has changed, and racial disparities have not been recently described.

Methods: Active population- and laboratory-based surveillance for H. influenzae was conducted through Active Bacterial Core surveillance at 10 US sites. Data from 2008-2017 were used to estimate projected nationwide annual incidence, as cases per 100 000.

Results: During 2008-2017, Active Bacterial Core surveillance identified 7379 H. influenzae cases. Of 6705 patients (90.9%) with reported race, 76.2% were White, 18.6% were Black, 2.8% were Asian/Pacific Islander, and 2.4% were American Indian or Alaska Native (AI/AN). The nationwide annual incidence was 1.8 cases/100 000. By race, incidence was highest among AI/AN populations (3.1) and lowest among Asian/Pacific Islander populations (0.8). Nontypeable H. influenzae caused the largest incidence within all races (1.3), with no striking disparities identified. Among AI/AN children aged <5 years, incidence of H. influenzae serotype a (Hia) was 16.7 times higher and Hib incidence was 22.4 times higher than among White children. Although Hia incidence was lower among White and Black populations than among AI/AN populations, Hia incidence increased 13.6% annually among White children and 40.4% annually among Black children aged <5 years.

Conclusions: While nontypeable H. influenzae causes the largest H. influenzae burden overall, AI/AN populations experience disproportionately high rates of Hia and Hib, with the greatest disparity among AI/AN children aged <5 years. Prevention tools are needed to reduce disparities affecting AI/AN children and address increasing Hia incidence in other communities.

Keywords: Haemophilus influenza; Haemophilus influenzae vaccines; epidemiology; minority health; public health surveillance.

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Conflict of interest statement

Potential conflicts of interest

Lee H. Harrison has served as a consultant to GSK, Merck, Pfizer, and Sanofi Pasteur. William Schaffner has served as a consultant to Merck, Pfizer, and Roche Diagnostics. All other authors: No reported conflicts.

Figures

Figure 1.
Figure 1.. Trends in Estimated Annual Incidence of Invasive H. influenzae Disease, by Race — United States, 2008–2017
Abbreviations: PI, Pacific Islander; AI/AN, American Indian and Alaska Native
Figure 2.
Figure 2.. Trends in Estimated Annual Incidence of Invasive H. influenzae Disease, by Race and Serotype — United States, 2008–2017
Note: Incidence of invasive H. influenzae serotypes c, d, and e were omitted from Figure due to low incidence (<0.2 cases per 100,000) among all races Abbreviations: PI, Pacific Islander; AI/AN, American Indian and Alaska Native; NTHi, nontypeable H. influenzae; Hia, H. influenzae serotype a; Hib, H. influenzae serotype b; Hif, H. influenzae serotype f
Figure 3.
Figure 3.. Trends in Estimated Annual Incidence of Invasive H. influenzae serotype a Disease among Children Aged <5 years, by Race — United States, 2008–2017
Note: Supplementary Figure 1 includes a more detailed view of trends in estimated annual incidence of invasive H. influenzae serotype a disease among white and black children aged <5 years Abbreviations: PI, Pacific Islander; AI/AN, American Indian and Alaska Native
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