Epiglottitis in the Hemophilus influenzae Type B Vaccine Era: Changing Trends

Abstract

The demographics, causative organisms, and natural history of epiglottitis have changed substantially in the Hib vaccination era. The clinician evaluating and treating patients with epiglottitis should be aware of current trends.

Supraglottitis in the era following widespread immunization against Haemophilus influenzae type B: Evolving principles in diagnosis and management

“…The incidence of pediatric supraglottitis in the postvaccine era has been quoted to be from 0.3 to 0.7 per 100,000 patients per year, compared to 3.47 to 6.0 per 100,000 in the prevaccine era. 2,7,13 The incidence of adult supraglottitis has stayed relatively constant at 1 to 4 per 100,000 people per year. 4,7,13 These numbers have been quoted to be even higher in some countries outside of the United States.…”

“…Data from several children's hospitals around the country have demonstrated a marked decrease in the incidence of the disease as well as an increase in the mean age of affected children. [1][2][3] Case reports from other hospitals have also identified new challenges in recognizing adult supraglottitis during the postvaccine era. 4,5 The frequency of supraglottitis in adults is now greater than that in children, 6,7 and clinicians recognize that the presenting symptoms of supraglottitis are no longer the classic presenting symptoms taught in medical school.…”

“…1,2,4,6,9 Management decisions are also complicated by current trends in the bacteriology of supraglottitis. Hib is still a cause of supraglottitis in the postvaccine era owing to vaccine failure and incomplete herd protection.…”

“…Streptococcus pneumoniae and Streptococcus pyogenes are commonly implicated in both pediatric and adult cases, and other reported pathogens include Staphylococcus aureus, Moraxella catarrhalis, Streptococcus viridans, Streptococcus agalactiae, Neisseria meningitidis, Kingella kingae, Bacteroides species, and herpes simplex. 2,6,[10][11][12] Surface cultures of the epiglottis are often negative, and blood cultures are not completely sensitive in accurately diagnosing the responsible pathogen, especially when patients begin treatment before a culture is obtained. 12 Although the mortality rate and the risk of requiring emergent airway intervention secondary to supraglottitis have significantly decreased in the pediatric population, 1 we continue to see a wide spectrum of disease in the adult population, and the presentation that necessitates intensive care may now be less predictable.…”

Simulation to Implement a Novel System of Care for Pediatric Critical Airway Obstruction

“…To our knowledge, no study has used simulation to implement a system of care for critical airway obstruction, and very few reports even describe such a system. 15,16 The objective of this study was to describe the implementation of a novel system of care for children with critical airway obstruction presenting to a pediatric ED, accomplished through (1) the use of in situ simulations to assess the existing system of care, (2) the design of a novel system of care based on findings from these simulations, and (3) the assessment of the novel system's impact on the timeliness and quality of care for simulated patients.…”