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Acute epiglottitis and infant conjugate Haemophilus influenzae type b vaccination in northern Finland
Insights
Conjugate Haemophilus influenzae type b vaccination nearly eliminated childhood epiglottitis. However, adult cases of acute epiglottitis significantly increased following the vaccination program.
Area of Science:
- Pediatric Infectious Diseases
- Vaccinology
- Epidemiology
Background:
- Acute epiglottitis was a significant cause of severe upper airway obstruction in children.
- The introduction of conjugate vaccines against Haemophilus influenzae type b (Hib) aimed to reduce the incidence of Hib-related diseases.
Purpose of the Study:
- To assess the impact of widespread infant conjugate Hib vaccination on the incidence and characteristics of acute epiglottitis in children and adults.
- To compare epiglottitis rates before and after the implementation of the Hib vaccination program.
Main Methods:
- A retrospective population-based survey was conducted over 27 years (1967-1993) in 35 Finnish communities.
- Data on acute epiglottitis cases were collected from hospital discharge and autopsy registers.
- Incidence rates were calculated for children and adults before and after the 1986 introduction of conjugate Hib vaccination.
Main Results:
- The incidence of acute epiglottitis in children aged 0-4 years decreased from 7.6 to 0 cases per 100,000 after vaccination.
- A fourfold increase in adult acute epiglottitis was observed post-vaccination (incidence rate ratio of 4.6).
- No significant changes in the adult patient profile were noted despite the increased incidence.
Conclusions:
- Conjugate Hib vaccination was highly effective in eradicating acute epiglottitis among young children.
- The study identified a concerning rise in adult acute epiglottitis cases following childhood vaccination, with no alteration in patient characteristics.
Objective:
To determine the incidence and characteristics of acute epiglottitis among children (< or = 19 years of age) and adults (> or = 20 years of age) before and after widespread conjugate Haemophilus influenzae type b vaccination for infants.
Design:
A retrospective population-based survey over a 27-year period from 1967 through 1993 in 35 communities in a northern province of Finland with a population of approximately 300,000.
Setting:
An academic tertiary referral center.
Main Outcome Measures:
All acute epiglottitis cases in the area identified from the hospital discharge register and the regional autopsy register.
Results:
The average incidence rate for children was 1.8 cases per 100,000 individuals per year (95% confidence interval [CI], 1.3 to 2.5). As no vaccine failures emerged, the incidence rate for children aged 0 to 4 years declined sharply once the vaccination started in 1986 from 7.6 (95% CI, 5.3 to 10.4) to 0 (95% CI, 0 to 3.3) cases per 100,000 individuals per year. By contrast, a fourfold increase in adult acute epiglottitis (incidence rate ratio, 4.6; 95% CI, 2.7 to 7.9) was detected after vaccination of the children, the average incidence rate for the whole period being 1.0 cases per 100,000 individuals per year (95% CI, 0.8 to 1.3). No marked change in the adult patient profile was found during this increase, however.
Conclusion:
Acute epiglottitis practically vanished among young children in this population after conjugate H influenzae vaccination, but adult cases increased, the patient profile remaining the same.