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Column originally published Mar 27, 2001

Haemophilus Influenza Vaccine Could Have Prevented Sinusitis And Periorbital Cellulitis

Question: Our granddaughter visited us several weeks ago with her mother. Shortly after they arrived, this little girl got very sick with high fever. One day, her left eye suddenly became red and swollen. We took her to the hospital. We were told that she had a serious sinus infection spreading to her eye. The doctor told us that this infection could be the result of her not getting properly immunized. She had only three shots since she was born, and she is three years old. I wonder whether this doctor is just trying to scare us.


The infection that you described is called periorbital cellulitis, an infection of the tissues that surrounds the eye. It is a very serious bacterial infection. Your doctor is correct, inadequate immunization can be the underlying cause of her illness. I will explain to you in more detail here.

Your granddaughter likely started with a sinus infection that finally spread to her eye. If one had known that she had a sinus infection, it could have been treated, and would have prevented the more serious eye infection. However, sinus infection is one of the most difficult infections to detect.

Sinus infection is often a complication of colds. Instead of getting better after several days, the cold seems to drag on, and the person gets sicker instead of getting better. The swelling of the mucus membrane inside the nose blocks the sinus passage, leading to sinus infection. Children are particularly prone to sinus infections because their sinus passage is much smaller, and can become blocked very easily.

The most common symptoms of sinus infection are fever, nasal congestion, and thick yellowish or greenish pus draining from the nostrils. Unfortunately, sometimes the pus can drain backwards into the throat and get swallowed. This would not cause any harm; the bacteria from the sinuses do not infect the stomach or intestines. The acid in the stomach actually kills all the germs that get there. Because they don’t see any pus, many parents are not aware that their children are sick with sinus infections.

There are many bacteria that can cause sinus infection. One of them is called Haemophilus influenzae type b (don’t confuse this with influenza – a virus infection, the names are very similar). This kind of bacteria was better known years ago as the most common cause of meningitis in young children. Since the advent of the vaccine (called Hib vaccine) and its routine use in infants and children of North America, the incidence of meningitis due to this germ has virtually disappeared.

In addition to meningitis, Haemophilus influenzae type b (Hib) can cause other infections, including sinusitis, pneumonia, otitis media (ear infection), epiglottitis (infection and swelling of a tissue in the throat that can cause suffocation), arthritis and osteomyelitis (bone infection), just to name a few. Since the introduction of Hib vaccine, other infections caused by Hib have dropped off remarkably also.

Your granddaughter suffered from a sinus infection that your family didn’t recognize. After the sinusitis was established, the infection then spread through a thin bone into the neighbouring eye socket. At the beginning, there would be redness and swelling of the eyelids. The tissues inside the eye socket also became swollen because of infection. This type of infection is called periorbital cellulitis.

If the infection was not controlled very quickly, a few things could have happened. Pus would start to accumulate. As you can imagine, the eye socket is designed to hold the eye as well as a few muscles that move the eye in all directions. When pus collects inside the eye socket, it will push the eye forward, stretching the nerve that connects the eye to the brain. If this was not corrected rapidly, your granddaughter could lose her eyesight permanently.

Another potential danger of sinus infection is spreading inward into the head, resulting in brain abscess and meningitis, with serious and sometimes fatal outcome.

As your granddaughter had received only 3 immunizations, it is quite possible that she never received this Hib vaccine, which could have prevented this whole ordeal. Some parents are just too busy and forget to keep their children’s immunization up to date. However, we have heard that other parents have avoided immunization of their children because they were concerned about potential side effects. An even smaller number of parents are misled by false information that immunization is harmful.

One thing I can state very clearly here. I have been a paediatrician for over 25 years. I have seen many children died or suffered permanent brain damage because of meningitis due to Haemophilus influenzae type b. If it was not because of Hib vaccine, we will still be dealing with meningitis and many other serious infections everyday because of this germ.

Over the past several decades, there was major decrease in infant mortality and increase in life expectancy in developed countries. Some of it was due to other advances in medicine. However, the greatest contribution has to be immunization of children.

In some provinces, especially in the Maritimes, the provincial governments pay for all the routine immunization. If the vaccines are not essential, can you imagine any of these governments would agree to pay for them? The fact that they are paying for these vaccines tells us that vaccination is very important for the health of our children.

There is no question that side effects of vaccination do exist, but they are mostly very mild. I hope your granddaughter will catch up with her vaccination while she is recovering from her serious infection so that she won’t suffer from any other preventable infections in future.