{
  "abstract": "When Archivist was a resident doctor (junior doctor, as we used to call them) he would see invasive Haemophilus influenzae (Hi) infection regularly; epiglottis, pneumonia, meningitis and preseptal (or periorbital, as we called it) cellulitis. Immunisation against Hi type b (Hib) made a huge impact and the epidemiology of invasive Hi changed dramatically. It was only the children who were unimmunised, non-a, non-b (non-typable) or failed vaccine response that seemed to occasionally present. It was with great interest to read this paper from Alaska. Balta VA et al (The Journal of Pediatrics 2026;288; 114 799. https://doi.org/10.1016/j.jpeds.2025.114799) have compared the clinical course of invasive H. influenzae disease by type among children at two hospitals in a retrospective review of 65 children aged <10 years who received care at the Alaska Native Medical Center in Anchorage or the Yukon-Kuskokwim Delta Regional Hospital in Bethel, Alaska, during 2013–2019. They were all Alaska native children. There were 45 (73%) type a (Hia), 8 (13%) type b (Hib), 7 (11%) non-typeable (NTHi) and 2 (3%) type f (Hif). Overall, 43 (69%) cases occurred in previously healthy children with no underlying medical conditions. Twenty-two (35%) had meningitis, 19 (31%) children required intensive care and 13 (21%) died or still had clinical sequelae at 1 year postinfection. All deaths (n=6) and long-term sequelae (n=7) occurred in children with Hia or Hib meningitis. Overall, 59 (95%) children were hospitalised for a median of 9 days (range: 2–70 days). Children with NTHi were more likely to require respiratory support compared with children with Hia, Hib or Hif (6/7, 86% vs 15/55, 27%) (p<0.01). H. influenzae continues to cause severe disease, with Hia and Hib causing more meningitis-associated deaths, and NTHi causing more respiratory complications. Data not in the abstract were the immunisation status of these children; as society appears to be more suspicious of immunisation and vaccination schedules with subsequent reductions in individual and herd immunity, we need to be aware of these trends to develop public health strategies, including the development and use of novel vaccines. Of the eight children aged 2 months–9 years with invasive Hib disease, five had received Hib vaccine, including three who received three doses (ages 3 years, 5 years and 9 years), one who received two doses (age 1 year) and one who received one dose (age 6 months). All vaccinated children received PedvaxHIB (Merck). It is clear that there are effective vaccines to protect against Hib but children can still suffer from severe disease. We need to be aware of the increasing incidence and risk of severe disease due to invasive Hia and NTHi disease. Characterising trends in invasive Hia disease and identifying populations at highest risk will be important for developing public health strategies and, more importantly, including the development of future vaccines. Archivist thought H. influenzae infection had become rare and this paper is just a reminder that it is still out there and we need to remain vigilant.",
  "authors": [
    {
      "affiliations": [],
      "name": "BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health"
    }
  ],
  "title": "Invasive Haemophilus influenzae infections",
  "uid": "c1c24996-b545-5523-8791-9873f7d14782"
}