Periorbital and orbital cellulitis before and after the advent of haemophilus influenzae type B vaccination1
Presented in part at the annual meeting of the Association for Research in Vision and Ophthalmology, Fort Lauderdale, Florida, May 1999.
Abstract
Objective
To evaluate the effect of the introduction of the Haemophilus influenzae B (Hib) vaccine (introduced first in 1985, then extended in 1990 to children at least 2 months of age) on the epidemiologic features of periorbital and orbital cellulitis.
Design
Retrospective, comparative case series.
Participants
Three hundred fifteen pediatric inpatients.
Methods
Children at Massachusetts General Hospital and Massachusetts Eye and Ear Infirmary with discharge diagnosis of periorbital or orbital cellulitis from 1980 through 1998 were reviewed.
Main outcome measures
Case rate, culture-positive isolates, and associated conditions.
Results
A total of 297 cases of periorbital cellulitis and 18 cases of orbital cellulitis were reviewed. Before 1990, there were 27 cases of Hib-related cellulitis (11.7% of total in that period), whereas after 1990, there were only three (3.5% of total; P = 0.028). The number of cases per year was significantly lower after 1990 (21.2 ± 10.4 vs. 8.7 ± 3.9; P = 0.008), as were the number of positive culture isolates (for any organism) after 1990 (76 [33.0%] vs. 9 [10.6%]; P < 0.001). The medical conditions most commonly associated with periorbital cellulitis were sinusitis (44 [14.5%]) and upper respiratory infections (73 [26.6%]). All cases of orbital cellulitis were associated with sinusitis.
Conclusions
The introduction of the Hib vaccine coincided with a sharp decline not only in the number of periorbital and orbital cellulitis cases related to H. influenzae, but also in the annual case rate. These data are consistent with a facilitative role for H. influenzae in the development of cellulitis secondary to other pathogens. They also may support restriction of the spectrum of antibiotics used to manage these conditions.
Manuscript no. 99752.
aDepartment of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
bDepartment of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
Correspondence to Balamurali K. Ambati, MD, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114
1 Received November 12, 1999. Accepted March 28, 2000.
ABSTRACT