The Hib vaccine has significantly reduced cases of the once feared infectious disease. New cases among unvaccinated children have raised concerns about a resurgence in Hib infections.
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Several children have been hospitalized with deadly bacterial infections, alarming some doctors about the possibility of a resurgence of a once-feared epidemic that was suppressed by vaccines.
Severe cases of Haemophilus influenzae type B (Hib) once affected 20,000 children each year in the United States. The disease is spread by coughing or sneezing, which releases droplets containing bacteria.
Invasive infections included infants and young children developing pneumonia, meningitis, septic arthritis, blood infections, and throat swelling, causing permanent disability or death in about 5% of cases, or about 1,000 children a year.
Elderly doctors have haunting memories of serious illnesses that left brains swollen and children suffocated.
The Hib vaccine, introduced more than 30 years ago and now recommended for all children under the age of 5, has significantly reduced the number of infections and prevented nearly all vaccinated children from developing the disease. Infants receive three or four vaccinations starting at 2 months of age. The U.S. Centers for Disease Control and Prevention now reports fewer than 50 cases per year, a decrease of more than 99%.
But with more parents skipping their children’s routine immunizations, doctors fear a resurgence in Hib cases. Two seriously ill patients at a hospital in a Florida beach town in 2025 and another two reported at a research facility in Tennessee are raising concerns.
“If this was something that adults were exposed to, a lot of people would panic,” said Dr. Ehab Kennawi, a pediatrician in Panama City, Florida, a tourist destination. In 2025, two critically ill patients were admitted to intensive care at the city’s hospitals within six months.
One child died at the age of 4 months because he had not been vaccinated. The other, a 2-year-old (also unvaccinated), developed a brain abscess and seizures with long-term effects. Kennawi, who did not personally treat the patient but was on call at the time, first alerted the state Department of Health’s rulemaking board about the case in December.
Both children were visiting from out of state, so it was difficult to know how prevalent Hib was in the area. Health experts are concerned about undetected spread, especially as CDC surveillance and reporting to detect diseases such as Hib are cut back.
“What’s really going on?” Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia, wrote a blog post in March titled “Hib Resurrection?” “This is not a disease I want to go back to.”
Andrew Nixon, a spokesperson for the U.S. Department of Health and Human Services, said in an email that the CDC has not seen an increase in preventable invasive Hib infections among children. As of March 28, there have been eight cases this year, according to the latest CDC surveillance data.
Dozens of states have broad exemptions from vaccination based on religion or personal beliefs. The state of Florida is considering eliminating vaccinations for school entry, including the Hib vaccine. The decline in vaccinations is already contributing to the rapid resurgence of measles outbreaks across the country.
“There are a number of serious diseases that our children could contract if we choose not to vaccinate them,” said Dr. Kathryn Edwards, a vaccine safety expert and professor emeritus of pediatrics at Vanderbilt University Medical Center in Tennessee. Doctors at the center recently saw two cases of Hib. “Parents need to know that, and doctors need to remember that.”
Because the Hib vaccine has nearly eradicated the disease, doctors today may not look for signs of infection in children.
“We’ve reduced the number of cases in the country to almost zero,” said Dr. Mathuram Santoshyam, a professor of pediatrics and global health at the Johns Hopkins Bloomberg School of Public Health. Mr. Santosham, like Mr. Edwards, worked on the development of the first Hib vaccine in the 1980s. “It’s scary not just for Hib disease, but for other diseases,” Santosham said.
Edwards, Santosham and Offit, now three leading experts on pediatric infectious diseases and vaccines, vividly recall treating children with complications from Hib when they were young doctors, before a vaccine was available.
In Chicago, Edwards witnessed a young girl die from epiglottitis, a condition in which the small cartilage lining the windpipe swelled and closed the airway. In Baltimore, Santosham recalled seeing milky spinal fluid hitting his chest during a spinal tap as he tried to examine a 9-month-old baby who had suffered a seizure and had a soft bulge on his head. The child suffered from severe meningitis and ended up in a vegetative state before dying. Offit, of Pittsburgh, recalled seeing an aquarium in a small, dark room at a children’s hospital. The tank was used to calm infected children, especially to prevent them from convulsing and blocking their airways before being intubated.
“It’s just crazy to put vaccine-preventable diseases on the back burner,” said Dr. Philip Huang, director of the Dallas County Health and Human Services Department in Texas.
Huang, who saw cases at the medical school just before the vaccine became available, said his county continues to see a significant decline in Hib vaccinations. Huang, a former head of the Metropolitan Health Coalition, said federal surveillance has been slow to report and support laboratories to monitor Hib, making it difficult to detect infected people until it’s too late.
Kennawi, who has been a doctor in Florida for 27 years, has never seen a bacterial infection. But he now has to consider that fever, which is common in children, could be a symptom of a much more serious illness.
“I have to think about these differences now,” he said.
Eduardo Cuevas is based in New York City. Contact us via email (emcuevas1@usatoday.com) or Signal (emcuevas.01).
