A small number of children have been hospitalized with a potentially deadly bacterial infection, raising concerns among some doctors about the possible resurgence of a once-dreaded disease that was largely controlled through vaccination.
Serious cases of Haemophilus influenzae type B (Hib) once affected approximately 20,000 children in the United States each year. The bacteria spread through respiratory droplets when an infected person coughs or sneezes.
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Invasive Hib infections often struck infants and toddlers, leading to severe conditions such as pneumonia, meningitis, septic arthritis, bloodstream infections, and swelling of the throat. These complications could result in permanent disabilities, and historically, about 5% of cases—roughly 1,000 children annually—proved fatal.
Older doctors recall the severe cases they once witnessed—children suffering from brain swelling or even dying from airway obstruction.
The Hib vaccine, introduced over thirty years ago and now recommended for all children under five, has dramatically reduced the incidence of the disease, protecting nearly all vaccinated children. Infants typically receive three to four doses starting at two months of age. According to the U.S. Centers for Disease Control and Prevention, there are now fewer than 50 cases annually in the United States, representing a decline of more than 99% since the vaccine’s introduction.
However, with an increasing number of parents skipping routine childhood vaccinations, doctors are concerned that Hib could make a strong comeback. In 2025, two severe cases were reported at a hospital in a Florida beach town, while another two cases appeared at a research institution in Tennessee, raising alarms among healthcare professionals.
“If this was something adults would get, you would see a lot of people panicking,” said Dr. Eehab Kenawy, a pediatrician in Panama City, Florida, a tourist destination where the local hospital saw two severe cases in intensive care within a six-month period in 2025.
One of the cases involved an unvaccinated 4-month-old who tragically died, he said. Another involved a 2-year-old, also unvaccinated, who developed brain abscesses and seizures, leaving them with long-term complications. Kenawy, who did not personally treat the children but was on call at the time, first reported the cases to a state Department of Health rule-making conference in December.
Both children were visiting from out of state, making it difficult to determine how widespread Hib might be in the local community. Health experts are concerned about the potential for undetected transmission, particularly in light of reductions in CDC surveillance and reporting systems designed to track diseases such as Hib.
“What’s really going on?” said Dr. Paul Offit, director of the Children’s Hospital of Philadelphia’s Vaccine Education Center, who wrote a blog post titled, “The Return of Hib?” in March. “This is not a disease you want to come back.”
According to Andrew Nixon, a spokesperson for the U.S. Department of Health and Human Services, the CDC has not observed a rise in preventable invasive Hib infections among children. As of March 28, the agency’s most recent surveillance data reported a total of eight cases so far this year.
Dozens of states allow broad vaccine exemptions for religious or personal beliefs. In Florida, lawmakers are considering eliminating school-entry vaccination requirements, including for Hib. Declines in vaccination rates have already fueled the rapid resurgence of measles outbreaks across the United States.
“If we choose not to vaccinate, there are a number of serious diseases that children can acquire,” said Dr. Kathryn Edwards, a vaccine safety expert and pediatrics professor emerita at Vanderbilt University Medical Center in Tennessee, where doctors recently saw two cases of Hib. “Parents need to know that, and doctors need to remember.”
Since the Hib vaccine nearly eliminated the disease, physicians today may not look for signs of infection in a child.
“We brought it down to pretty much zero in the country,” said Dr. Mathuram Santosham, professor of pediatrics and international health at Johns Hopkins University Bloomberg School of Public Health. Santosham, like Edwards, worked to pioneer the first Hib vaccines in the 1980s. “It’s frightening, not only for Hib, but for other diseases,” Santosham said.
Edwards, Santosham, and Offit, now recognized as leading authorities in pediatric infectious diseases and vaccines, vividly recalled the harrowing cases of Hib complications they encountered early in their careers, before vaccines were available.
In Chicago, Edwards witnessed the tragic death of a young girl from epiglottitis, a dangerous swelling of the tiny cartilage that covers the windpipe, which completely blocked her airway. In Baltimore, Santosham recalled the chilling moment during a spinal tap when milky spinal fluid spilled onto his chest as he attempted to test a 9-month-old infant suffering from seizures and a bulging soft spot on the head; the child, afflicted with severe meningitis, ultimately lapsed into a vegetative state before passing away. Meanwhile, in Pittsburgh, Offit remembered the small, dimly lit room in the children’s hospital with its aquarium, designed specifically to keep infected children calm and prevent them from spasming, which could close their airways before intubation could be performed. These vivid experiences left an indelible mark on the doctors, shaping their lifelong dedication to preventing such tragedies through vaccination.
“It’s just crazy that we’re going backwards on these vaccine-preventable diseases,” said Dr. Phillip Huang, director of the Dallas County Health and Human Services.
Huang, who encountered Hib cases during medical school just before vaccines were introduced, noted that his county has continued to experience significant drops in Hib immunization rates. A former chair of the Big Cities Health Coalition, Huang emphasized that federal monitoring has lagged, with delays in reporting and limited laboratory support making it harder to identify Hib cases before serious complications occur.
In Florida, Dr. Kenawy, a physician with 27 years of experience, admitted that he had never previously seen this bacterial infection. However, he now must consider that a seemingly routine fever in a child could signal something far more serious, highlighting the renewed vigilance required as vaccination rates decline.
