The Return of Hib?
Two young children recently suffered severe Haemophilus influenzae type b (Hib) infections in Florida. Is this the tip of a bigger iceberg?
Between 1977 and 1980, I was a pediatric resident at Children’s Hospital of Pittsburgh. During my 12-hour shifts in the Emergency Department, I would perform as many as 2-3 spinal taps a night. I trained before the Haemophilus influenzae type b (Hib) vaccine, which wasn’t available until 1987. Before the vaccine, Hib was the leading cause of bacterial meningitis in children less than five years old. Hib also caused pneumonia, sepsis, cellulitis, and arthritis. When Hib infected the epiglottis, it caused suffocation. About 20,000 children every year would suffer from severe Hib infections and 1,000 would die.
The Hib vaccine caused a 99% decrease in the incidence of Hib. Today, the CDC reports fewer than 50 cases of Hib per year in the United States, which makes a recent meeting in Florida hard to understand.
On December 12, 2025, Florida health officials hosted a workshop about the State Surgeon General’s plan to end school vaccine mandates for four vaccines, including the Hib vaccine. Doctors at the meeting were angry. “I want everyone to know how serious matters are,” said Dr. Eehab Kenawy, a Panama City pediatrician. “Just in the past six months, we had two patients in the ICU with Hib. One child unfortunately succumbed at 4 months of age. No vaccines. One month ago, I was on call, and another patient came into the ICU, a 2½-year-old, never vaccinated. Hib again. Abscesses in the brain, seizures, coma, intubated.”
Think about this for a moment. Two serious cases of Hib in one state over a six-month period? Something doesn’t add up. The annual incidence of Hib is estimated by the CDC to be fewer than 50 cases per year. The CDC also estimates that about 5 percent of Hib cases are fatal. Therefore, we would expect that every year in the entire United States about two children would die from Hib. Yet in one state over 6-month period one child died from Hib, and another was facing death. Here are three ways to explain these cases:
1) The children weren’t infected with Hib. Rather, they were infected with non-typable Haemophilus influenzae, which would not have been covered by the Hib vaccine and has been increasing since the Hib vaccine was first introduced. (I spoke with one of the physicians who attended the meeting, knew about these cases, and assured me that both children suffered from Hib.)
2) The children were born in a country that didn’t give the Hib vaccine and were exposed to the bacterium at an early age. (Both children were born in the United States.)
3) This was a statistical aberration and can be ignored.
4) The CDC has underestimated the current incidence of Hib disease in the United States in large part because Robert F. Kennedy Jr., as Secretary of Health and Human Services, has cut CDC surveillance and reporting of vaccine-preventable diseases.
The last explanation is the most plausible and most frightening. Immunization rates among U.S. children are clearly declining. As a consequence, the U.S. is experiencing greater number of cases and deaths from measles, influenza and whooping cough than has been seen in decades. Isn’t it possible that Hib infections and deaths are also increasing? We need to know exactly what’s going on. Otherwise, we can’t effectively counsel our patients and respond to outbreaks of preventable diseases.
I would like to share the story of a patient I encountered in 1983 as a third year medical student. One patient I will never forget arrived while I was on call with the pediatric team at Children’s Hospital. About 11 o’clock at night, my beeper went off and the intern who was on the team told me that a young child was being medi flighted in from a small town. He was assigned to be my patient on the team. It turns out that this child had a severe case of H flu meningitis. I will never forget being in the ICU and listening to the head of the pediatric team explain to the sobbing parents that their intubated, unresponsive young child was brain dead. Just three days before, this child was normal and healthy. There was no Hib vaccine in 1983. The Hib vaccine became available in the U.S. a few years later and in the years that followed, widespread use drove H flu meningitis rates down by 80–99%, to the point of near-elimination in well-immunized communities. It also sign drove down rates of Haemophilus influenzae epiglottitis, which is a swelling in the throat, which can cause airway obstruction and brain anoxia and death.
It seems that the vaccines which we are using today are a victim of their own success. They have eliminated or nearly eliminated many of these childhood diseases, and thus have erased from public memory the horror of the morbidity and mortality of these diseases. It’s a biological certainty that these vaccine preventable diseases will mercilessly return if the immunization rates drop low enough.
RFK jr doesn’t care about kids dying, which is why he’s cutting surveillance. He doesn’t want people to hear about the resurgence of these diseases. Just like Trump with Covid..”If we don’t test for it, we won’t have any cases”.
Sheer lunacy.