Hib Hib – Hooray!
Chatting with a young pediatrician recently I remarked on seeing about 350 cases of spinal meningitis in my one year as an infectious disease fellow at LA County/USC. She was amazed; she had never seen ONE!
Such is the march of progress over one’s career in medicine. Most cases of bacterial meningitis are caused by Hemophilus influenzae Type b, commonly called “H flu” or “Hib.” One of my attending physicians at Columbia-Presbyterian in New York during my residency was Dr. Hattie Alexander, who pretty much owned “H flu”, having done much of the early work on it. Since its name is a misnomer, she deserves to have it renamed after her (Hemophilus hattiae has a nice ring to it).
In the aftermath of the pandemic of influenza that swept the globe after World War I and killed many millions, a newly recognized species of bacterium was isolated from many cases and was thought to be the causative agent; ergo, H. influenzae. But it was a virus, something long imagined (“little man”) but never seen. H. flu has made its mark despite that inauspicious beginning. It was responsible for about 25,000 deaths in American children every year until the mid-80’s when a vaccine came out. Before sulfa drugs and antibiotics it was always fatal, and it remained deadly even in the modern era. Not only did it kill through nervous system infection but it caused a respiratory disease called epiglottitis, often fatal without an emergency tracheotomy. Pediatricians in my training days were taught the art of low-tech tracheotomy using a key. Did it work? I never found out.
In this era of vaccine controversies it is all too easy to forget what life was like for children growing up. I remember the terror every summer when polio lurked behind each headache. In the two years I spent at Columbia, 30,000 cases of congenital rubella occurred in New York City alone. My oldest child had measles at two during a vacation trip through redwood country, probably 300 miles from the nearest children’s hospital. In my early practice years, before my community hospital had a pediatric unit or even a proper emergency department, I treated about ten cases of H. flu meningitis myself. All recovered but one was permanently left deaf, a common result.
Now H. flu deaths are so rare that each calls for a conference when it occurs. The vaccine is safe and very effective, often combined with others and given in 3 or 4 doses by 18 months. Since 1985 over half a million of our babies have not died of this classic killer. Rubella no longer threatens pregnant women. Polio is gone from our part of the world. Measles should be but imported cases and resistance to vaccination continue to cause localized outbreaks.
The accomplishments of vaccine research are so staggering as to defy comparison to any other field of medicine. New vaccines will strike cancer (we already use one now) and other chronic diseases. A flu vaccine that doesn’t need to be reinvented every year is on the way.
Why have we so soon forgotten where we’ve been?
March 3rd, 2009 at 8:32 pm
Just two days after posting this I read of an outbreak of 5 cases of invasive H. flu disease in Minnesota, three of meningitis (one died), one of epiglottitis and another of pneumonia and blood-stream poisoning (septicemia). All but one were unimmunized by parental choice; one infant received only the first two doses and turned out to have an immune deficiency disease.