No abstract

In a retrospective study of the incidence of acute epiglottitis in Sweden, 485 children and 356 adults fulfilled the following criteria: (a) red and swollen epiglottis visualised at laryngoscopy; (b) stridor or difficulties in swallowing own saliva or water; and (c) temperature -380C. The age specific incidence in children (0-14 years) was 10 and in adults (,15 years) 1-8/100 000/year. These incidence rates were higher than the incidence of Haemophilus influenzae meningitis in the same population. Blood cultures were obtained from 290 children (60%) and 185 adults (52%). H influenzae was isolated from 267 blood cultures (92%) from children and 98 blood cultures from adults (53%). Other organisms were isolated from six adults (3%). An artificial airway was established in 352 children (73%) and in 68 adults (19%); the remainder were treated conservatively. Six children and two adults died.Sweden has a high incidence of acute epiglottitis in children and the disease also occurs in adults. The importance of H influenzae in the aetiology of epiglottitis in all age groups is confirmed, but in adults many cases occur without septicaemia. The mortality is currently very low.

The occurrence of otitis media was studied in 108 Sweden children attending 14 day-care centers and compared with that in 57 children cared for in their own homes (usually with one or no sibling) and with that in 42 children in family day-care homes (where a woman cared for both her own and 1 to 4 other children in her home during the day). The children were 6 months to 2 years old. In the day-care centers 37% of the children had otitis media at least once during 8 months with an average of 2.2 episodes each. Otitis media was more common in 6- to 17-months-old children in the day-care centers than in children of the same age cared for in their own homes. The occurrences of otitis media in the day-care centers and in the family day-care homes were approximately equal. Children attending centers where those with signs of infection were excluded had otitis in about the same frequency as those attending centers where children with infections were accepted.

SUMMARY Four hundred and seventy cases of meningitis caused by Haemophilus influenzae in children and 30 cases in adults were identified in Sweden between 1981 and 1983. The age specific incidence in the most susceptible age group (0-4 years) was 31/100 000/year (440 cases), which is higher than previously reported from Europe. A further 30 cases were seen in children aged 5-14. The risk of developing H influenzae meningitis before the age of 15 was 1 in 669. There were 11 deaths (2%) and five cases of serious neurological sequelae among the children. Only 18 children (4%) had predisposing diseases. All but one of the 294 strains of H influenzae from children that had been serotyped were type b. Infections in adults differed from infections in children. Five of the adults died (17%), 12 had important predisposing diseases, and at least six of the infections were caused by non-typable strains. It is concluded that research into the prevention of invasive H influenzae infections in children should have high priority.

This report concerns a boy with congenital rubella virus infection. The diagnosis was confirmed by virus isolation, demonstration of rubella-specific serum IgM and by persistence of serum antibody at the age of 9 months. In 2 sera from the mother sampled 2 weeks apart 20 months before the birth of the boy, low titers of rubella antibody were demonstrated by hemagglutination-inhibition, hemolysis-in-gel and complement fixation tests, but not by neutralization. Significant rises in titer were demonstrable by all serologic reactions--including neutralization--at the time of birth of the infected child. The mother was not aware of any rubella-like illness or exposure to such disease during pregnancy. The case is discussed against findings of neutralizing activity in sera from natural immunes and rubella vaccinees.