The first American children to receive the Hib vaccine are turning 20 years old this year.

Flea wasn't practicing medicine in the pre-Hib era, so I asked an older nurse what office-based Pediatrics was like before the vaccine.

"About once a year, a kid would come in with an ear infection. They'd write him a prescription for antibiotics, then he'd go home and die."

Haemophilus influenzae type b (Hib) is a bug that lives up your nose and the back of your throat. It's passed from child to child by coughing and sneezing. In some children, Hib causes no problems at all. In other children it causes serious invasive infections such as meningitis and pneumonia. About 5% of children with Hib meningitis die despite antibiotic treatment. If the meningitis doesn't kill your child, it could leave him blind, deaf, and mentally retarded.

One of the scarier ways to die of Hib infection is epiglottitis. The epiglottis is the fleshy flap that sits over the top of your airway. Hib seems to like the epiglottis. When infected, the epiglottis swells up and covers the airway, making breathing impossible. Hib epiglottitis is a medical emergency. If you can't get a breathing tube into the child in time, you may need to perform an emergent tracheostomy (arguably making epiglottitis a surgical emergency).

The vaccine has made Hib epiglottitis almost disappear. Flea knows board-certified Pediatric ED docs in practice for 15 years who have never seen it. This news won't make the front pages, but the virtual disappearance of Hib-related disease constitutes a public health triumph that has changed dramatically the practice of Pediatrics in this country.

By the way, Orac found a great new vaccine site. Go check it out.