Long-Term Consequences of Vaccine-Preventable Diseases

A visible scar on Dr. Lara Johnson’s neck continually reminds her of the severe impact of a vaccine-preventable illness.

At just 4 years old, Johnson experienced a dangerous bacterial infection known as Haemophilus influenzae type b, or Hib. This bacteria threatened her epiglottis—the cartilage that protects the windpipe during eating—leading to a near closure of her airway and difficulty swallowing.

“I had a fever and felt like I was choking,” Johnson recalls. “I thought I needed to throw up.” She was hurried to Covenant Children’s Hospital in Lubbock, Texas, where she now works as the chief medical officer, for an emergency tracheostomy. To facilitate her breathing, doctors had to cut into her neck and windpipe. Thankfully, antibiotics addressed her infection, the plastic airway was later removed, and she made a full recovery.

This was in 1980, which was unfortunate because the Hib vaccine didn’t become available for another seven years.

Before the vaccine’s introduction, around 20,000 children in the U.S.—primarily infants and toddlers—contracted severe Hib cases annually, with many suffering lifelong consequences. Tragically, about 1,000 children lost their lives each year due to this infection.

Once vaccinations began, the annual Hib infections plummeted to fewer than 50 cases. Nowadays, many doctors who trained in the last four decades have never encountered a single case.

However, a growing number of parents who have not personally seen the distress caused by this highly contagious infection are choosing not to vaccinate their children against Hib. Last week, the CDC announced a slight decline from 2019 to 2021 in the percentage of infants receiving the complete series of Hib vaccinations, dropping from 78.8% to 77.6%.

Doctors like Johnson, who treated children during a recent measles outbreak in West Texas, are expressing concern that Hib could be the next disease to resurface.

“Measles is just the start,” warned Dr. Leisha Nolen, Utah’s state epidemiologist, as the state grapples with an escalating measles outbreak that has seen 559 cases as of Tuesday.

The drop in vaccinations means that Hib “is something we might see soon,” Nolen noted. “It’s tragic to think about having emergency rooms filled with infants suffering from this highly dangerous disease.”

A Transitioning Medical Landscape

The CDC does monitor Hib cases, but reporting can lag by a year or more since states typically don’t expedite reporting outside of acute outbreaks like flu. As of March 21, the CDC had recorded eight Hib cases this year: two each in Ohio and New York, and one each in Kansas, North Carolina, and Tennessee.

Conversations with pediatricians suggest that more Hib cases are emerging and causing serious illness.

Dr. Kathryn Edwards, a vaccine safety specialist at Vanderbilt University Medical Center, shared that her colleagues recently treated two cases of Hib-related meningitis—something that hadn’t occurred at Vanderbilt for quite some time.

Dr. Eehab Kenawy, a pediatrician in Panama City, Florida, noted that in December, two young, unvaccinated children were treated in the ICU. One was a 2-year-old, and the other, a 4-month-old, sadly did not survive. “I hadn’t seen a case of Hib for years. Now, it’s back in the conversation,” he said.

This potential resurgence of Hib means that doctors need to adopt a more vigilant approach when assessing young, unvaccinated patients presenting with seemingly routine bacterial infections.

“I can’t just think ‘strep throat or ear infection’ anymore,” Kenawy said. “Now we have to consider these conditions in our evaluations. It may lead to more hospital admissions and additional monitoring.”

Understanding Hib

Despite its name, the Haemophilus influenzae bacteria do not cause the flu. These bacteria can exist harmlessly in the noses and throats of healthy individuals but can also be transmitted through respiratory droplets. While they can lead to minor ailments like ear infections, they can also result in serious conditions like pneumonia or meningitis.

What doctors fear most about Hib is its ability to cause meningitis, an inflammation of the brain and spinal cord. Prior to the availability of vaccines, diagnosing this condition often involved performing lumbar punctures on multiple patients each night.

“Back when I trained, I’d do two to three spinal taps a night,” reflected Dr. Paul Offit, a pediatrician and director at the Vaccine Education Center in Philadelphia. At that time, Hib was a leading cause of bacterial meningitis in children under five. “Now, pediatric residents hardly ever need to do them, a testament to the effectiveness of vaccines.”

The CDC recommends a series of three to four Hib vaccinations for all children under five years, with studies showing a success rate of over 93% in preventing the illness.

Sadly, not only are Hib vaccinations declining; an investigation found that childhood vaccination rates have dropped across the board in 77% of U.S. counties since 2019.

Increased hesitance surrounding vaccines has been noticeable. “There will always be some who refuse anything, but the trend is rising,” stated Dr. Rana Alissa from the American Academy of Pediatrics in Florida. “It feels like we’re nearing a free fall.”

Anti-vaccine sentiments have been further fueled by figures like Robert F. Kennedy Jr., who has downplayed serious outbreaks and attempted to alter the established vaccination schedule—an action recently blocked by a federal judge.

Many physicians strive to reverse the damage to keep vaccine-preventable diseases at bay.

“During my last night as a pediatric resident, a child with Hib came in and passed away the next day,” recalled Edwards. “I didn’t spend decades in my field to see all that hard work undone by one individual.”

About a year has passed since Ashlee Dahlberg tragically lost her 8-year-old son, Liam, to Hib. On April 24 last year, he returned home from school complaining of a headache. She gave him some ibuprofen, which seemed to make him feel better for a bit.

However, the next morning, Liam woke up with a 103-degree fever and seemed “off,” according to Dahlberg. He was dizzy and unable to stand but still managed to answer questions.

At a local hospital, tests indicated he might have meningitis, leading to his transfer to a larger facility in Chicago. Liam needed sedation for a lumbar puncture, which ultimately confirmed the presence of Hib and a diagnosis of bacterial meningitis.

By April 26, MRI scans showed that Liam’s brain had swelled to the point of irreversible damage. He was taken off life support two days later.

While Liam and his siblings had been vaccinated, Dahlberg explained that his immune system was weak due to asthma treatment. She advocates for vaccinations now, hoping to protect other vulnerable children—including her youngest daughter, who also has asthma.

“I want others to realize there are kids like Liam with weakened immune systems,” Dahlberg remarked. “What’s just a cold to some can spell hospitalization or worse for others.”

“I can’t endure losing another child,” she added. “I would be shattered.”