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[Epiglottitis--a pediatric disease?]
J Schüpbach1, D Bachmann, M A Hotz
1Universitätsklinik für Hals-, Nasen- und Ohrenkrankheiten, Hals-, Kiefer- und Gesichtschirurgie, Inselspital Bern.
Insights
Childhood epiglottitis incidence dramatically decreased following Haemophilus influenzae b vaccination. Adult epiglottitis remains heterogeneous, with no change observed post-vaccination, precluding adult vaccination recommendations.
Area of Science:
- Pediatrics
- Infectious Diseases
- Epidemiology
Background:
- Epiglottitis, an inflammation of the epiglottis, can cause rapid upper airway obstruction.
- While often considered a pediatric illness, epiglottitis also affects adults.
- Prompt diagnosis and treatment are critical due to the potentially life-threatening nature of airway compromise.
Purpose of the Study:
- To investigate clinical and epidemiological shifts in epiglottitis.
- To assess the impact of Haemophilus influenzae type b (Hib) vaccination on epiglottitis incidence in children.
- To compare epiglottitis characteristics in adults and children before and after Hib vaccination implementation in Switzerland.
Main Methods:
- Retrospective review of patient histories.
- Inclusion criteria: hospitalisation with epiglottitis at the University Hospital of Berne.
- Study period: 1989-1999, encompassing the introduction of Hib vaccination in 1992.
- Patient cohort: 31 adults and 88 children.
Main Results:
- A significant decrease in childhood epiglottitis incidence was observed post-Hib vaccination.
- Childhood epiglottitis presented as a clinically, epidemiologically, and bacteriologically homogeneous condition.
- Adult epiglottitis demonstrated heterogeneity, with no discernible changes linked to the vaccination program.
- Common causative agents included Streptococci and Haemophilus influenzae b, particularly in children.
Conclusions:
- Hib vaccination has dramatically reduced epiglottitis incidence in children.
- Epiglottitis in adults is a more varied disease, unaffected by the pediatric vaccination strategy.
- The diverse etiology of adult epiglottitis makes a recommendation for Hib vaccination in this population inappropriate.
Abstract:
Epiglottitis, commonly described as a paediatric disease, also occurs in adults. Early diagnosis and immediate treatment are crucial because of the rapid and possibly lethal course of upper airway obstruction due to swelling. Initial treatment consists in securing the upper airway and in antibiotic treatment. Streptococci and, especially in children, Haemophilus influenzae b are the most common bacteria. Our study focused on clinical and epidemiological changes since children started to be vaccinated against Haemophilus influenzae b in Switzerland (1992). We reviewed patient histories of 31 adults and 88 children who were hospitalised with epiglottitis at the University Hospital of Berne between 1989 and 1999. Our findings show that the incidence of epiglottitis in children, a clinically, epidemiologically and bacteriologically homogeneous disease, has dramatically decreased. Epiglottitis in adults presents as a more heterogeneous disease without change since the beginning of the vaccination programme. Due to the variety of germs it is impossible to recommend vaccination for adults against Haemophilus influenzae b.