Epiglottitis in children, 1979 through 1992. Effects of Haemophilus influenzae type b immunization

M. H. Gorelick and M. D. Baker
Division of General Pediatrics, Children's Hospital of Philadelphia, Pa.

OBJECTIVE: To examine secular trends in the epidemiology, bacteriology, and clinical presentation of acute epiglottitis in children in the years surrounding the introduction of vaccine against Haemophilus influenzae type b. DESIGN: Retrospective chart review of patient series. SETTING: Large, urban, tertiary care pediatric hospital. SUBJECTS: One hundred forty-two children with epiglottitis admitted during a 14-year period (1979 through 1992). MAIN RESULTS: The average annual incidence of epiglottitis declined from 10.9 per 10,000 admissions before 1990 to 1.8 per 10,000 admissions from 1990 through 1992. The median age increased from 35.5 months in the earlier period to 80.5 months (P = .007). Overall, H influenzae type b was identified as the causative organism in 76% of patients, but in only 25% of the cases since 1990 (P = .004). Of the eight cases from 1990 through 1992, three had group A beta-hemolytic streptococcus isolated from a surface culture of the epiglottis; three other cases of group A beta-hemolytic streptococcus were identified earlier. These patients were significantly older than those with H influenzae type b disease (117.5 vs 35 months, P = .004). No important differences were found in any of a number of clinical characteristics based on causative organism or year of diagnosis. CONCLUSION: Acute epiglottitis has diminished in frequency since 1990. Patients whose conditions have been diagnosed since then tend to be older and to have disease caused by organisms other than H influenzae type b (particularly group A beta-hemolytic streptococcus). However, the clinical presentation appears to be similar to that seen previously.