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Epiglottitis and Haemophilus influenzae immunization: the Pittsburgh experience--a five-year review
H González Valdepeña1, E R Wald, E Rose
1Department of Otolaryngology, University of Pittsburgh School of Medicine, PA, USA.
Insights
Pediatric epiglottitis cases significantly decreased after Haemophilus influenzae type b (Hib) conjugate vaccines were introduced. However, many remaining cases were due to Hib vaccine failures, particularly with older polysaccharide vaccines.
Area of Science:
- Pediatric Infectious Diseases
- Vaccinology
- Clinical Microbiology
Background:
- Epiglottitis, a serious upper airway infection in children, was historically a common pediatric emergency.
- Haemophilus influenzae type b (Hib) was the primary causative agent of epiglottitis.
- The introduction of Hib vaccines aimed to reduce the incidence of invasive Hib disease.
Purpose of the Study:
- To review current trends in the clinical presentation and management of pediatric epiglottitis.
- To assess the impact of Haemophilus influenzae type b (Hib) vaccination on epiglottitis incidence.
- To identify patterns of vaccine failure in children with epiglottitis.
Main Methods:
- Retrospective review of medical records for children diagnosed with epiglottitis at Children's Hospital of Pittsburgh (1988-1993).
- Telephone survey of primary care physicians to gather data on Hib vaccine administration.
- Analysis of causative agents and vaccine failure rates.
Main Results:
- A total of 28 children were admitted with epiglottitis during the study period.
- A remarkable decline in epiglottitis cases was observed starting in 1991.
- Haemophilus influenzae type b (Hib) caused 21 cases; 11 children experienced vaccine failure, predominantly with the polysaccharide vaccine.
Conclusions:
- The incidence of pediatric epiglottitis has dramatically decreased following the licensure and widespread use of Hib conjugate vaccines.
- A significant proportion of epiglottitis cases post-vaccine introduction represent vaccine failures, especially with the older polysaccharide vaccine formulation.
Objective:
Current trends in the clinical presentation and management of children with epiglottitis at Children's Hospital of Pittsburgh were reviewed for the years 1988 to 1993.
Methodology:
The medical records of all patients diagnosed as having epiglottitis between July 1988 and June 1993 at the Children's Hospital of Pittsburgh were reviewed. An additional telephone survey was conducted among the primary care physicians of those patients to collect information regarding administration of Haemophilus influenzae type b (HIB) vaccines.
Results:
During the study period 28 children (age range, 11 months to 11 years, 10 months) were admitted with the diagnosis of epiglottitis. Cases declined remarkably in 1991. Fever, sore throat, and stridor were the usual symptoms. HIB was the most common cause of epiglottitis accounting for 21 cases. Candida albicans was recovered from the surface culture of the epiglottis in two patients. At least 11 children experienced vaccine failure: nine with polysaccharide vaccine and two with the conjugate vaccine for HIB.
Conclusion:
Cases of epiglottitis have declined dramatically since licensure of HIB conjugate vaccines for use in early infancy. At least 52% of the reported cases represent vaccine failures with the purified polysaccharide vaccine.