Epiglottitis (Epiglottis) Infection or Inflammation

Written by WebMD Editorial Contributors

• What is Epiglottitis?
• Epiglottitis Causes
• Epiglottitis Symptoms
• Epiglottitis Diagnosis
• Epiglottitis Treatment
• Epiglottitis Complications
• Epiglottitis Prevention
• Epiglottitis Outlook
• More

Epiglottitis is a medical emergency. If not treated quickly, it can be fatal.  

The epiglottis is a flap of tissue at the base of the tongue that keeps food from going into the trachea, or windpipe, during swallowing. When it gets infected or inflamed, it can obstruct (block) or close off your windpipe, which makes you unable to breathe.

Respiratory infection, things in the environment, or trauma may cause inflammation and infection of other areas around the throat. The infection and inflammation may spread to the epiglottis and other areas. 

Epiglottitis usually begins as an inflammation and swelling between the base of the tongue and the epiglottis. With continued inflammation and swelling of the epiglottis, complete blockage of the airway may occur, leading to suffocation and death. Even a little narrowing of the windpipe can dramatically increase the resistance of an airway, making breathing much more difficult.

Autopsies of people with epiglottitis have shown distortion of the epiglottis and its associated structures, including the formation of abscesses (pockets of infection). For unknown reasons, adults with epiglottic involvement are more likely than children to develop epiglottic abscesses.

Epiglottitis was first described in the 18th century but was first accurately defined by Andrew Lemierre in 1936. In fact, although George Washington’s death in 1796 was attributed by some to quinsy (today we call it peritonsillar abscess), which is a pocket of pus behind the tonsils, it could have actually been due to epiglottitis.

In the past, epiglottitis was more common in children than in adults. This difference was believed to be because of the smaller diameter of children’s epiglottic opening when compared with those of adults. Epiglottitis in children under the age of 1 year is unusual.

In the past, Haemophilus influenzae type b (or Hib) was the most common organism related to epiglottitis. Since 1985, with the widespread vaccination against Hib, far fewer children have gotten the disease. 

A conservative estimate of the incidence of epiglottitis is 1 case per 100,000 people in the U.S. each year.

Most epiglottitis is caused by bacterial, fungal or viral infection, especially among adults.

• Common infectious causes are Haemophilus influenzae, Streptococcus pneumoniae and other strep species, and respiratory tract viruses. People who have immune system problems are in greater danger of infection.

• Other types of epiglottitis are caused by heat damage. Thermal epiglottitis occurs from drinking hot liquids; eating very hot solid foods; or using illicit drugs (i.e., inhaling the tips of marijuana cigarettes or metal pieces from crack cocaine pipes). In these cases, the epiglottitis from thermal injury is similar to the illness caused by infection.

Unusual causes of epiglottitis include brown recluse spider bites to the ear, which may result in swelling, or eating buffalo fish, which may cause an allergic-like reaction and swelling. Blunt trauma or something blocking the throat may also lead to epiglottitis.

When epiglottitis strikes, it usually occurs quickly, from just a few hours to a few days. The most common symptoms include sore throat, muffling or changes in the voice, difficulty speaking, swallowing or breathing, fever, and fast heart rate.

Symptoms in children often happen within hours. They include:

• Upper respiratory infections 

• Sudden, very sore throat 

• Fever  

• Stridor, a high-pitched whistling sound when your child breathes in

• Muffled voice 

• Drooling

• No coughing

• Anxiety or restlessness  

• Leaning forward while seated

• Keeping their mouth open

• Not being able to talk

• Trouble breathing

• Blue skin, a condition called cyanosis  

Adults and older children often have symptoms that come on over a few days, such as:

• Very sore throat

• Fever 

• Hoarse or muffled voice 

• Stridor 

• Pain or difficulty in swallowing 

• Drooling

• Irritability or restlessness 

When to seek medical care

Call 911 or go to the nearest emergency room if you have a sore throat accompanied by any of the following signs and symptoms:

• Muffled voice

• Swallowing problems

• Difficulty speaking

• Fast heartbeat

• Irritability

• Bluish skin

• Respiratory distress with drooling, shortness of breath, rapid shallow breathing, very ill-looking appearance, sitting upright with a tendency to lean forward, and stridor (high-pitched sound when breathing in)

Epiglottitis is a medical emergency. Anyone who might have epiglottitis should be taken to the hospital immediately. Try to keep the person as calm and comfortable as possible. Make no attempt at home to inspect the throat of a person suspected of having epiglottitis. This can cause the windpipe and surrounding tissues to close and an irregular heart beat, which can lead to respiratory and/or cardiac arrest (stopping of breathing and/or heart) and death.

• The doctor may perform X-rays or simply look at the epiglottis and the windpipe by laryngoscopy.

  • The doctor may find that the pharynx is inflamed with a beefy, cherry-red, stiff and swollen epiglottis.

  • Manipulating the epiglottis may result in sudden fatal airway obstruction, and irregular slow heart rates have occurred with attempts at intubation (putting a tube down the throat and placing the person on a machine that helps with breathing). That’s why the doctor will likely use an operating room or intensive care unit to examine the throat.

• Other laboratory tests may include:

  • Blood tests to look for infection or inflammation

  • Tests to measure oxygen in the blood

  • Blood cultures (blood samples that may grow bacteria), which can indicate the cause of the epiglottitis

  • Other tests to find antibodies to specific bacteria or viruses (immunologic tests)

  • In intubated patients, epiglottal culture

These laboratory tests may not be useful in diagnosing epiglottitis until the person is stable. Also, the anxiety from having blood drawn or cultures taken from the throat may cause the unstable epiglottis to close off, completely blocking the airway and creating an emergency with only a few minutes to correct.

Even with all of our modern technology, epiglottitis is not easy to diagnose. It is often mistaken for strep throat or croup. Epiglottitis differs from croup by its worsening progress, lack of a barking cough, and a cherry-red, swollen epiglottis (unlike a red, unswollen epiglottis in croup). One way doctors can tell epiglottitis from croup is by taking X-rays of the neck, which can show the swollen epiglottis.

Other misdiagnoses of epiglottitis include diphtheria, peritonsillar abscess, and infectious mononucleosis.

Non-infectious causes have been mistaken as angioedema (swelling of the tissues in the airway), laryngeal inflammation or spasm, laryngeal trauma, cancerous growths, allergic reactions, thyroid gland infection, epiglottic hematoma (trapped blood pocket), hemangioma (abnormal collection of blood vessels), or inhalational injury.

Immediate hospitalization is required whenever the diagnosis of epiglottitis is suspected. The person is in danger of sudden and unpredictable closing of the airway. So doctors must establish a secure way for the person to breathe. Antibiotics may be given.

• Treatment of epiglottitis may start with making the person as comfortable as possible. For instance, an ill child may be placed in a dimly lit room with the parent holding the child. Then, the child may get humidified oxygen while being closely watched. If there are no signs of respiratory distress, IV fluids may be helpful. It is important to prevent anxiety, because it may lead to an acute airway obstruction, especially in children.

• People with possible signs of airway obstruction require laryngoscopy in the operating room or intensive care unit with proper staff and airway intervention equipment. In very severe cases, the doctor may need to perform a cricothyrotomy (cutting the neck to insert a breathing tube directly into the windpipe).

• IV antibiotics may effectively control inflammation and get rid of the infection from the body. Antibiotics are usually prescribed to treat the most common types of bacteria. Blood cultures are usually taken to show whether an organism is growing in the blood that could be causing the epiglottitis. In many cases, blood cultures may not show if this is the problem. If a patient is intubated, cultures taken directly from the epiglottis may work better.

Corticosteroids and epinephrine have been used in the past. However, many experts now doubt that these drugs are helpful in most cases of epiglottitis.

Treatment follow-up 

Take all antibiotics until the full course is completed. Keep all follow-up appointments with the doctor — and with the surgeon if a breathing tube had to be placed through the neck. The surgeon will remove the tube and make sure the site is healing well. Most people feel much better before leaving the hospital, so taking the antibiotics and returning to the hospital if there are any problems are the most important parts of follow-up.

Possible complications of epiglottitis include: 

Epiglottitis can often be prevented with proper vaccination against H influenza type b (Hib). Adults usually do not need the vaccine unless they have immune problems like sickle cell anemia, splenectomy (removal of the spleen), cancers, or other diseases affecting the immune system.

If other people live with a Hib-infected person, preventive drugs such as rifampin (Rifadin) should be given to anyone else in the house who is:

• Under the age of 4 and has not received all the Hib vaccinations

• Under 12 months and has not finished the first series of Hib vaccine

• Under age 18 with a weakened immune system

This is done to make sure that both the person with the illness and the rest of the household do not have the bacteria. This prevents a “carrier state” from forming in which a person has the bacteria in the body but is not actively sick. Carriers can still spread the infection to other family members.

A person with epiglottitis can recover very well with a good prognosis if the condition is caught early and treated in time. In fact, a good majority of people with epiglottitis do well and recover without problems. But if the person was not brought to the hospital early and was not appropriately diagnosed and treated, the prognosis may range from long-range illness to death.

• Before 1973, about 32% of adults with epiglottitis died from the disease. With current vaccination programs and earlier recognition and treatment, the death rate from epiglottitis is estimated to be less than 1%. The death rate from epiglottitis in adults is higher than that of children because the condition can be misdiagnosed.

Epiglottitis can also occur with other infections in adults, such as pneumonia. If it is caught early and treated, a person can expect to fully recover. Most of the deaths come from failure to diagnose it quickly and obstruction of the airway. As with any serious infection, bacteria may enter the blood, a condition called bacteremia, which may result in infections in other systems and sepsis (severe infection with shock, often with respiratory failure).

Top Picks

Epiglottitis (Epiglottis) Infection or Inflammation

Written by WebMD Editorial Contributors

• What is Epiglottitis?
• Epiglottitis Causes
• Epiglottitis Symptoms
• Epiglottitis Diagnosis
• Epiglottitis Treatment
• Epiglottitis Complications
• Epiglottitis Prevention
• Epiglottitis Outlook
• More

Epiglottitis is a medical emergency. If not treated quickly, it can be fatal.  

The epiglottis is a flap of tissue at the base of the tongue that keeps food from going into the trachea, or windpipe, during swallowing. When it gets infected or inflamed, it can obstruct (block) or close off your windpipe, which makes you unable to breathe.

Respiratory infection, things in the environment, or trauma may cause inflammation and infection of other areas around the throat. The infection and inflammation may spread to the epiglottis and other areas. 

Epiglottitis usually begins as an inflammation and swelling between the base of the tongue and the epiglottis. With continued inflammation and swelling of the epiglottis, complete blockage of the airway may occur, leading to suffocation and death. Even a little narrowing of the windpipe can dramatically increase the resistance of an airway, making breathing much more difficult.

Autopsies of people with epiglottitis have shown distortion of the epiglottis and its associated structures, including the formation of abscesses (pockets of infection). For unknown reasons, adults with epiglottic involvement are more likely than children to develop epiglottic abscesses.

Epiglottitis was first described in the 18th century but was first accurately defined by Andrew Lemierre in 1936. In fact, although George Washington’s death in 1796 was attributed by some to quinsy (today we call it peritonsillar abscess), which is a pocket of pus behind the tonsils, it could have actually been due to epiglottitis.

In the past, epiglottitis was more common in children than in adults. This difference was believed to be because of the smaller diameter of children’s epiglottic opening when compared with those of adults. Epiglottitis in children under the age of 1 year is unusual.

In the past, Haemophilus influenzae type b (or Hib) was the most common organism related to epiglottitis. Since 1985, with the widespread vaccination against Hib, far fewer children have gotten the disease. 

A conservative estimate of the incidence of epiglottitis is 1 case per 100,000 people in the U. S. each year.

Most epiglottitis is caused by bacterial, fungal or viral infection, especially among adults.

• Common infectious causes are Haemophilus influenzae, Streptococcus pneumoniae and other strep species, and respiratory tract viruses. People who have immune system problems are in greater danger of infection.

• Other types of epiglottitis are caused by heat damage. Thermal epiglottitis occurs from drinking hot liquids; eating very hot solid foods; or using illicit drugs (i.e., inhaling the tips of marijuana cigarettes or metal pieces from crack cocaine pipes). In these cases, the epiglottitis from thermal injury is similar to the illness caused by infection.

Unusual causes of epiglottitis include brown recluse spider bites to the ear, which may result in swelling, or eating buffalo fish, which may cause an allergic-like reaction and swelling. Blunt trauma or something blocking the throat may also lead to epiglottitis.

When epiglottitis strikes, it usually occurs quickly, from just a few hours to a few days. The most common symptoms include sore throat, muffling or changes in the voice, difficulty speaking, swallowing or breathing, fever, and fast heart rate.

Symptoms in children often happen within hours. They include:

• Upper respiratory infections 

• Sudden, very sore throat 

• Fever  

• Stridor, a high-pitched whistling sound when your child breathes in

• Muffled voice 

• Drooling

• No coughing

• Anxiety or restlessness  

• Leaning forward while seated

• Keeping their mouth open

• Not being able to talk

• Trouble breathing

• Blue skin, a condition called cyanosis  

Adults and older children often have symptoms that come on over a few days, such as:

• Very sore throat

• Fever 

• Hoarse or muffled voice 

• Stridor 

• Pain or difficulty in swallowing 

• Drooling

• Irritability or restlessness 

When to seek medical care

Call 911 or go to the nearest emergency room if you have a sore throat accompanied by any of the following signs and symptoms:

• Muffled voice

• Swallowing problems

• Difficulty speaking

• Fast heartbeat

• Irritability

• Bluish skin

• Respiratory distress with drooling, shortness of breath, rapid shallow breathing, very ill-looking appearance, sitting upright with a tendency to lean forward, and stridor (high-pitched sound when breathing in)

Epiglottitis is a medical emergency. Anyone who might have epiglottitis should be taken to the hospital immediately. Try to keep the person as calm and comfortable as possible. Make no attempt at home to inspect the throat of a person suspected of having epiglottitis. This can cause the windpipe and surrounding tissues to close and an irregular heart beat, which can lead to respiratory and/or cardiac arrest (stopping of breathing and/or heart) and death.

• The doctor may perform X-rays or simply look at the epiglottis and the windpipe by laryngoscopy.

  • The doctor may find that the pharynx is inflamed with a beefy, cherry-red, stiff and swollen epiglottis.

  • Manipulating the epiglottis may result in sudden fatal airway obstruction, and irregular slow heart rates have occurred with attempts at intubation (putting a tube down the throat and placing the person on a machine that helps with breathing). That’s why the doctor will likely use an operating room or intensive care unit to examine the throat.

• Other laboratory tests may include:

  • Blood tests to look for infection or inflammation

  • Tests to measure oxygen in the blood

  • Blood cultures (blood samples that may grow bacteria), which can indicate the cause of the epiglottitis

  • Other tests to find antibodies to specific bacteria or viruses (immunologic tests)

  • In intubated patients, epiglottal culture

These laboratory tests may not be useful in diagnosing epiglottitis until the person is stable. Also, the anxiety from having blood drawn or cultures taken from the throat may cause the unstable epiglottis to close off, completely blocking the airway and creating an emergency with only a few minutes to correct.

Even with all of our modern technology, epiglottitis is not easy to diagnose. It is often mistaken for strep throat or croup. Epiglottitis differs from croup by its worsening progress, lack of a barking cough, and a cherry-red, swollen epiglottis (unlike a red, unswollen epiglottis in croup). One way doctors can tell epiglottitis from croup is by taking X-rays of the neck, which can show the swollen epiglottis.

Other misdiagnoses of epiglottitis include diphtheria, peritonsillar abscess, and infectious mononucleosis.

Non-infectious causes have been mistaken as angioedema (swelling of the tissues in the airway), laryngeal inflammation or spasm, laryngeal trauma, cancerous growths, allergic reactions, thyroid gland infection, epiglottic hematoma (trapped blood pocket), hemangioma (abnormal collection of blood vessels), or inhalational injury.

Immediate hospitalization is required whenever the diagnosis of epiglottitis is suspected. The person is in danger of sudden and unpredictable closing of the airway. So doctors must establish a secure way for the person to breathe. Antibiotics may be given.

• Treatment of epiglottitis may start with making the person as comfortable as possible. For instance, an ill child may be placed in a dimly lit room with the parent holding the child. Then, the child may get humidified oxygen while being closely watched. If there are no signs of respiratory distress, IV fluids may be helpful. It is important to prevent anxiety, because it may lead to an acute airway obstruction, especially in children.

• People with possible signs of airway obstruction require laryngoscopy in the operating room or intensive care unit with proper staff and airway intervention equipment. In very severe cases, the doctor may need to perform a cricothyrotomy (cutting the neck to insert a breathing tube directly into the windpipe).

• IV antibiotics may effectively control inflammation and get rid of the infection from the body. Antibiotics are usually prescribed to treat the most common types of bacteria. Blood cultures are usually taken to show whether an organism is growing in the blood that could be causing the epiglottitis. In many cases, blood cultures may not show if this is the problem. If a patient is intubated, cultures taken directly from the epiglottis may work better.

Corticosteroids and epinephrine have been used in the past. However, many experts now doubt that these drugs are helpful in most cases of epiglottitis.

Treatment follow-up 

Take all antibiotics until the full course is completed. Keep all follow-up appointments with the doctor — and with the surgeon if a breathing tube had to be placed through the neck. The surgeon will remove the tube and make sure the site is healing well. Most people feel much better before leaving the hospital, so taking the antibiotics and returning to the hospital if there are any problems are the most important parts of follow-up.

Possible complications of epiglottitis include: 

Epiglottitis can often be prevented with proper vaccination against H influenza type b (Hib). Adults usually do not need the vaccine unless they have immune problems like sickle cell anemia, splenectomy (removal of the spleen), cancers, or other diseases affecting the immune system.

If other people live with a Hib-infected person, preventive drugs such as rifampin (Rifadin) should be given to anyone else in the house who is:

• Under the age of 4 and has not received all the Hib vaccinations

• Under 12 months and has not finished the first series of Hib vaccine

• Under age 18 with a weakened immune system

This is done to make sure that both the person with the illness and the rest of the household do not have the bacteria. This prevents a “carrier state” from forming in which a person has the bacteria in the body but is not actively sick. Carriers can still spread the infection to other family members.

A person with epiglottitis can recover very well with a good prognosis if the condition is caught early and treated in time. In fact, a good majority of people with epiglottitis do well and recover without problems. But if the person was not brought to the hospital early and was not appropriately diagnosed and treated, the prognosis may range from long-range illness to death.

• Before 1973, about 32% of adults with epiglottitis died from the disease. With current vaccination programs and earlier recognition and treatment, the death rate from epiglottitis is estimated to be less than 1%. The death rate from epiglottitis in adults is higher than that of children because the condition can be misdiagnosed.

Epiglottitis can also occur with other infections in adults, such as pneumonia. If it is caught early and treated, a person can expect to fully recover. Most of the deaths come from failure to diagnose it quickly and obstruction of the airway. As with any serious infection, bacteria may enter the blood, a condition called bacteremia, which may result in infections in other systems and sepsis (severe infection with shock, often with respiratory failure).

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Immunization Week in the Republic of Belarus from April 23 to 29, 2018

Information for the public that can be used in the preparation of information and educational materials (brochures, leaflets, leaflets) for the European Immunization Week

Measles 9000 6

Measles is a highly contagious disease caused by a virus that is spread by coughing and sneezing through close or direct contact with infected nasal secretions. A sick person can spread the virus from the fourth day before the rash appears and up to four days after the rash appears.

Signs and symptoms:

Early signs include:

high fever, runny nose, cough, sore eyes, watery eyes, small white spots that develop in the primary stage on the inside of the cheeks.

After a few days, rash appears, usually on the face and upper neck. The rash spreads, eventually reaching the arms and legs, lasts five or six days, then dries up.

The most serious complications are:

•blindness,

•encephalitis (an infection that causes swelling of the brain),

•acute diarrhea and subsequent dehydration,

•ear infections,

•serious respiratory infections such as pneumonia.

In most severe cases of measles, complications can be fatal. For example, in the WHO European Region in 2017, more than 21,000 cases of measles were reported with 35 deaths.

Rubella

Rubella is a viral disease that is spread through contact with an infected person through coughing and sneezing. The disease is especially contagious during the rash, but can be transmitted up to 7 days before the rash appears. Individuals without symptoms can still spread rubella.

Signs and symptoms:

Rubella may start with a mild fever for 1-2 days, tenderness, and swollen lymph nodes, usually in the back of the neck and behind the ears. Then a rash appears on the face, which spreads below. However, some people with rubella do not have any symptoms.

Rubella is usually mild in children, although serious problems can occur in rare cases. This includes meningitis and bleeding. Rubella is especially dangerous for the fetus if a woman becomes ill during pregnancy. Congenital rubella syndrome can cause miscarriage or birth defects such as deafness, mental retardation, and organ failure such as the heart.

Mumps

Mumps (mumps) is transmitted by inhalation of a virus released into the air when an infected person coughs or sneezes. The virus can also be transmitted through saliva. Mumps can spread before the onset of clinical symptoms and up to five days after.

Signs and symptoms:

Common symptoms of mumps include: fever, loss of appetite, fatigue, muscle pain, headache, followed by enlargement of the parotid or submandibular glands. For some, the disease is asymptomatic.

Most children have mild mumps, but the disease can cause serious problems such as meningitis and deafness. In rare cases, parotitis can be fatal.

Polio

Polio is caused by a virus that attacks the nervous system. The virus enters the body through the mouth and multiplies in the intestines. Transmitted by the fecal-oral route. The source of infection is most often food or drinking water. Contributing factors: poor personal hygiene, poor sanitation or inadequate control of wastewater. The polio virus is also spread by coughing and sneezing.

Signs and symptoms:

Initial symptoms include:

• fever,

• fatigue,

• headache,

• vomiting,

• neck stiffness and pain in limbs.

Poliomyelitis mainly affects children, but can also lead to paralysis in non-immune adolescents and adults.

Polio can cause complete paralysis within hours as the disease affects the spinal cord and/or the brain. Such paralysis may be irreversible. In case of paralysis, immobility of the respiratory muscles can occur, leading to death. There is no specific treatment for poliomyelitis.

Rotavirus infection

Rotavirus is found in the stool of infected individuals and is spread through hands, diapers, or objects such as toys, baby changing tables, and doorknobs.

The disease is usually spread among family members, in hospitals and childcare facilities.

Signs and symptoms:

• temperature,

• watery stools,

• vomiting,

• abdominal pain.

Diarrhea and vomiting may last three to eight days. This can lead to severe dehydration. If dehydration is not treated, it can be fatal. Children under the age of five, and especially between six months and two years of age, are most vulnerable to this disease.

Haemophilus influenzae type b ( Hib ) 9000 3

Haemophilus influenzae type b is caused by a bacterium. Usually, the bacteria are found in the human nasopharynx and do not cause disease. But, under certain conditions, if the bacteria get into the lungs or into the bloodstream, a person can get sick. The disease is spread by coughing and sneezing from an infected person.

Signs and symptoms:

Symptoms depend on which part of the body is affected. Temperature is characteristic of all forms of the disease:

• meningitis (inflammation of the membranes of the brain and spinal cord),

• epiglottitis (swelling of the epiglottis on the back of the throat),

• pneumonia (inflammation of the lungs),

• osteomyelitis (inflammation of bones and joints),

• cellulitis (inflammation of the subcutaneous tissue, usually on the face).

The disease can develop rapidly, and meningitis and epiglottitis can be fatal. Most children with this condition require hospitalization. Even with treatment, the risk of death or disability remains.

Pneumococcal disease

The bacterium Streptococcus pneumoniae causes pneumococcal disease. The disease is spread by airborne droplets when coughing or sneezing from a sick person or a person who is a carrier of the bacterium.

Signs and symptoms:

There are many types of pneumococcal infections, and the symptoms depend on which body system is affected. Pneumonia is the most common and severe form of the disease. It is characterized by the following symptoms: fever, chills, cough, rapid or labored breathing, chest pain.

Another serious form of the disease is pneumococcal meningitis, which is an infection of the lining of the brain and spinal cord. Symptoms of meningitis are: neck stiffness, fever, headache, and stinging eyes from bright lights. Meningitis caused by pneumococcus leads to long-term disability or death. Pneumococcal infections are sometimes difficult to treat, especially because some bacteria are resistant to antibiotics.

Hib infection (HIB): symptoms, causes, vaccination 016 type

b (haemophilus type b) ^1-3 . Hib infection mainly affects the respiratory organs, causing pneumonia, and the central nervous system, leading to purulent meningitis, and can also cause purulent inflammation in other organs.

Most dangerous for children under 5 years old ^1.2 .

Which microorganism causes Hib infection?

How does infection occur?

How does the disease progress?

How long is the patient contagious?

How long does immunity last after an illness?

Vaccination

Which microorganism causes Hib infection?

Hib infection is caused by Haemophilus influenzae ( Haemophilus influenzae ). There are 2 forms of this bacterium – with an envelope (encapsulated) or without an envelope (non-encapsulated) ^1.2 .

Both forms of the bacterium can be found in the nasopharynx and cause disease. Unencapsulated strains cause otitis media and sinusitis. Encapsulated strains cause more severe infections (pneumonia, meningitis), including invasion into the bloodstream ^1-3 .

Encapsulated forms (strains) of Haemophilus influenzae differ in the chemical composition of the outer capsule. According to the structure of this capsule, six serotypes of Haemophilus influenzae are currently known to exist: types a, b, c, d, e, f ^1.2 .

Of which serotype b ( Haemophilus influenzae type b, Hib, or HIB ) is responsible for approximately 95% of all severe cases of diseases caused by Haemophilus influenzae ² .

According to the World Health Organization, prior to the introduction of routine Hib vaccination of young children, Haemophilus influenzae was responsible for millions of cases of severe infections in children worldwide. With the introduction of mass vaccination, the morbidity and mortality from HiB infections has dropped sharply ² .

Hib vaccination introduced in Russian National Immunization Schedule since 2011 for children from certain risk groups ⁴ .

Since 2022, the national vaccination schedule has regulated vaccination against Haemophilus influenzae type b for all children according to a schedule of 3 – 4.5 – 6 – 18 months, including as part of multicomponent vaccines ⁵ .

The World Health Organization recommends the inclusion of Hib vaccines in all national immunization programs children under one year of age as a strategy to combat pneumonia and purulent meningitis in children ^2.6 .

How does infection occur?

Hib-bacterium is localized in the nasopharynx , from where it can be transmitted to other people by airborne droplets (communication, coughing, sneezing) ^1-3 .

Hib carriers in the nasopharynx are an important source of pathogen spread. The main carriers of are small children , they are an important source of infection ² . The likelihood of infection in children from 3 months. up to 5 years is many times higher than at other ages, due to physiological characteristics ¹ .

Once on the mucous membrane of the upper respiratory tract, Hib-bacterium can be asymptomatic for a long time or cause a disease in the form of a common respiratory infection, as well as sinusitis or otitis media ^1-3 . In some cases, the bacterium crosses the mucosal barrier and enters the bloodstream, causing a severe infection ^1.2 .

How does the disease progress?

Severe forms of Hib infection include purulent meningitis, pneumonia, septicemia (infection of the blood by a bacterium), epiglottitis (inflammation of the epiglottis that can lead to difficulty breathing), septic arthritis (infection of the joints), osteomyelitis (bone damage), pericarditis ( inflammation of the heart bag), endocarditis (inflammation in the cavity of the heart), cellulitis (infection of the subcutaneous tissue). The vast majority of these diseases develop in children under the age of 5 years ^1-3 .

Hib can cause different symptoms depending on which part of the body is affected. The most common severe form of infection is purulent Hib meningitis, which is clinically indistinguishable from other types of purulent meningitis ² . There is evidence that in Russia in children under 6 years old, up to a third of all cases of purulent meningitis are caused by Hib ³ .

Even in high-income countries, long-term effects after HiB meningitis were observed in a quarter (26%) of survivors, manifesting as hearing loss (10%), intellectual disability (6%) and epilepsy (6%) ^2,7,8 .

In Russia, the mortality rate (mortality rate) from Hib-meningitis in children under 5 years old in 2019 was 10% ⁴ .

For what period is the patient contagious?

A child or adult can carry Hib bacteria up to 6 months without developing any clinical symptoms ⁸ .

How long does immunity last after an illness?

Children who have had invasive Hib infection before 24 months of age may stay at risk of developing a second episode of the disease . This is due to the nature of the immune system of young children who fail to develop sufficient immune defenses after exposure to natural Hib infection ^8.9 .

Vaccination

Hib infection which causes serious illness (meningitis and pneumonia) and death in infants and young children can be controlled by vaccination ² .

The World Health Organization recommends the inclusion of Hib vaccines in all national infant immunization programs.

Because severe Hib infection usually occurs in children aged 4 to 18 months, immunization should start early ^2.9 .

Hib vaccines aim to provide immune protection in the youngest children from 6 weeks of age ^{2. 8} .

Currently, in accordance with the national calendar of preventive vaccinations in Russia ⁵ vaccination against Hib infection should be carried out for all children aged 3-4.5-6 months and revaccination at 18 months of life ⁵ .

The Union of Pediatricians of Russia also recommends that all children be vaccinated within the framework of the national vaccination schedule, starting from the age of 3 months of life as part of combined vaccines ^10.11 .

1. Infectious diseases: national guidelines / ed. N. D. Yushchuk, Yu. V. Vengerov. – 2nd ed., revised. and additional – M. : GEOTAR-Media, 2019. – 1104 p. (Series “National guides”).
2. World Health Organization. WHO position paper on Haemophilus influenzae type b (Hib) vaccination. Weekly epidemiological bulletin. 2013; 39:413-428.
3. Vaccination specialists. Haemophilus infection. https://yaprivit.ru/diseases/gemofilnaya-infekciya/ (date of access: 04/28/2022).
4. Koroleva MA, Gritsai MI Epidemiological features of meningitis caused by Haemophilus influenzae. Russian pediatric journal. 2020; 1:100.
5. Order of the Ministry of Health of the Russian Federation No. 1122n of December 6, 2021 “On approval of the national calendar of preventive vaccinations, the calendar of preventive vaccinations for epidemic indications and the procedure for conducting preventive vaccinations.”
6. World Health Organization. Achieving the 2030 Meningitis Goals: A Global Roadmap. https://www.who.int/immunization/research/development/DefeatingMeningitisRoadmap-EN.pdf .
7. Slack M. P. E., Cripps A. W., Grimwood K. et al. Invasive Haemophilus influenzae infections after 3 decades of Hib protein conjugate vaccine use. Clin Microbiol Rev. 2021; 34: e00028-21.
8. Plotkin’s vaccines. Stanley A. Plotkin; Walter A. Orenstein; Paul A. Offit; Kathryn M. Edwards / Haemophilus influenzae Type b Vaccines. 301-318/ Philadelphia, PA: Elsevier, ©2018.