title: Acute epiglottitis: epidemiology and Streptococcus pneumoniae serotype distribution in adults.
abstract: OBJECTIVE
  We studied the incidence and bacterial epidemiology of acute epiglottitis presenting in the first 16 years following the introduction of general childhood vaccination against Haemophilus influenzae type b. Our main objectives were to analyse (1) the incidence of Streptococcus pneumoniae epiglottitis in adults and (2) the distribution of pneumococcal serotypes involved.
  
  
  METHODS
  The medical records of patients with acute epiglottitis (International Classification of Disease code J05.1) were investigated. Streptococcus pneumoniae serotyping was performed using gel precipitation.
  
  
  RESULTS
  The overall incidence of acute epiglottitis was 0.98 cases/100,000/year, compared with 4.5 cases/100,000/year before the vaccination programme. The incidence was reduced both in children and adults, compared with pre-vaccination values. However, the incidence of Streptococcus pneumoniae epiglottitis in adults increased from 0.1 to 0.28 cases/100,000/year over the same time period. The causative agent was Streptococcus pneumoniae in 10 adults. Nine of 10 pneumococcal strains could be serotyped. All but one serotype is represented in the 23-valent pneumococcal polysaccharide vaccine (PPV23) used in adults.
  
  
  CONCLUSIONS
  In acute epiglottitis, now a disease of adults, the most important bacterial aetiology is Streptococcus pneumoniae. The serotype distribution found in this study indicates that the infection is preventable by PPV-23 vaccination with the 23-valent polysaccharide vaccine.
authors.affiliation: Department of Otolaryngology, Örebro University Hospital, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Isakson
authors.forename: S
authors.initials: S
authors.lastname: Hugosson
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D016667:Bacterial Capsules; D002648:Child; D002675:Child, Preschool; D004826:Epiglottitis / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D005260:Female; D006192:Haemophilus Infections / Q000453:epidemiology / Q000517:prevention & control; D018073:Haemophilus Vaccines; D019741:Haemophilus influenzae type b / Q000302:isolation & purification; D006801:Humans; D017589:Immunization Programs; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011008:Pneumococcal Infections / Q000453:epidemiology* / Q000382:microbiology; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000145:classification* / Q000302:isolation & purification; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult
chemical_list: D018073:Haemophilus Vaccines; C044237:Haemophilus influenzae type b polysaccharide vaccine