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Supraglottitis is a rapidly progressive, life-threatening airway emergency in pediatric patients typically caused by Haemophilus influenzae type B (HIB). With distribution of the first efficacious vaccine for HIB in April 1985, changing disease patterns have begun to emerge; however, certain characteristics have remarkably persisted. The authors reviewed 252 pediatric patients with acute supraglottitis spanning the prevaccination and postvaccination years 1980 to 1992 at three major regional pediatric hospitals in Massachusetts, Ohio, and California, as well as at two community hospitals in Massachusetts. Findings include a decline in disease prevalence in all geographic areas with demographic, etiologic, and management evolution all seen. Children who had been immunized yet developed supraglottitis have been examined as predictive of future trends.

Fifty-two children hospitalized in the Pediatric service of a general hospital between January 1978 and December 1979 were found to be infected with Haemophilus influenzae or para-influenzae (43 with H. influenzae and 9 with para-influenzae). Most of these children (34/52) were less than 4 years of age. The localizations of infections were as follow: 5 meningitis with satisfactory resolution except for 1 who developed slight deafness, 1 epiglotitis, 11 pneumonias or bronchopneumonias, 1 arthritis, 10 otitis medias, 6 conjunctivitis, 3 sinusitis, 10 upper airway infections and 1 neonatal infection. On 8 of these cases the patients were felt to be carriers of H. influenzae or para-influenzae, the signs and symptoms beeing not related to these bacteria. These results are compared with those found in the literature.

48,997 children of 3 months to 5 years were vaccinated with Haemophilus influenzae type b (Hib) capsular polysaccharide vaccine in a double blind study carried out in Finland in 1974. A clear-cut effect was obtained in the incidence of epiglottitis. The number of patients decreased 58% for three years when compared with the three-year-period before vaccination (p less than 0.002). On the other hand, the number of cases during the three years following vaccination was 65% less than during the next three year period (p less than 0.001). The efficacy implies an exceptionally strong herd immunity, because only 37.7% of the children in the area were vaccinated. Regarding meningitis, no herd immunity was observed but vaccination induced a highly significant (p less than 0.001) individual protection (2 cases in the specifically vaccinated versus 20 in the control group in four years' time), provided the vaccine was given at the age of 18 months or later. No efficacy was obtained before this age limit. It was calculated that approximately 90 per cent of cases of epiglottitis and 50 per cent of meningitis would be prevented with the vaccine currently available. Taking also into account the strong herd immunity tendency, vaccination is likely to offer even larger benefits.

2379 cases of infections due to Haemophilus are reported in a one year long French multicenter study. There were 1368 low respiratory and 540 high respiratory infections, 22 epiglottitis, 86 meningitis, and 68 septicemia (bacteremia). Four hundred and one times, we considered that the bacteria was not the cause of the infection. For each type of infection, we studied the distribution according to the age, the sex and the period of the year, the eventual associations and the involved serotypes. The lethality was low (22), mainly due to a particular deficiency. At last, we compared the different methods to obtain the pathologic products from the upper bronchial tract.

A survey of serious infections due to Haemophilus influenzae, in the years 1973-1984, was made at the Birmingham Children's Hospital. Eight-three cases were recorded, comprising 42 of meningitis, 18 of septicaemia, 16 of epiglottitis and seven of septic arthritis or osteomyelitis. The mortality rate for meningitis and septicaemia was 5%, but no child with epiglottitis or septic arthritis died. The data are compared with those of American studies. The incidence of severe haemophilus infection in the inner city area of Birmingham was estimated to be at least 1 in 950 children during the period of the study.

Forty-nine children who had systemic Haemophilus infection and were treated at the Westmead Centre, Sydney, over a two-year period are described. The majority (29 of 49 children) were aged two years or less. Epiglottis and meningitis accounted for 77% of these infections. All H. influenzae isolates associated with clinical disease were of the capsular type b. Eight per cent (four of 50) of H. influenzae infections were caused by beta-lactamase producing strains. There was no geographic clustering or seasonal variation. There was no mortality. Major morbidity included two patients who had epiglottis and required tracheostomy, and two patients who had meningitis developed bilateral profound sensorineural deafness. No secondary cases were detected in household contacts of 21 patients with H. influenzae meningitis during the study period. Epiglottis frequently occurs in very young children. The rapid response to antibiotic treatment suggests that early cases of epiglottis may be undiagnosed, but treated with antibiotic agents in the community.