Periorbital and orbital cellulitis before and after the advent of Haemophilus influenzae type B vaccination

Objective: To evaluate the effect of the introduction of the Haemophilus in fluenzae B (Hib) vaccine (introduced first in 1985, then extended in 1990 t o children at least 2 months of age) on the epidemiologic features of perio rbital and orbital cellulitis. Design: Retrospective, comparative case series. Participants: Three hundred fifteen pediatric inpatients. Methods: Children at Massachusetts General Hospital and Massachusetts Eye a nd Ear Infirmary with discharge diagnosis of periorbital or orbital celluli tis 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 orb ital cellulitis were reviewed. Before 1990, there were 27 cases of Hib-rela ted cellulitis (11.7% of total in that period), whereas after 1990, there w ere 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 1 990 (76 [33.0%] vs. 9 [10.6%]; P < 0.001). The medical conditions most comm only 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 dec line not only in the number of periorbital and orbital cellulitis cases rel ated to H. influenzae, but also in the annual case rate. These data are con sistent with a facilitative role for H. influenzae in the development of ce llulitis secondary to other pathogens. They also may support restriction of the spectrum of antibiotics used to manage these conditions. Ophthalmology 2000;107:1450-1453 (C) 2000 by the American Academy of Ophthalmology.