We will see sick kids. And some will die.

We will need to go back to the decision-making protocols of the last century for the evaluation of suspected illness. Croup, pink eye and fever management changed when the Hib vaccine came out. Without that vaccine we will see more spinal taps, x-rays, and hospitalizations with ICU admissions.

Hib also causes infections of the eye that have to be distinguished from pink eye and other infections around the eye. Hib infection can get into the orbit of the eye with devastating consequences.

You have to be very careful about examining a child with a suspected infected epiglottis because you can make the obstruction worse if they start crying. You have to be able to tell the difference between croup and Hib, especially early. Many who take care of children have never seen this illness.

Hib also causes upper airway obstruction that can show up as symptoms very similar to croup. The treatment of croup is straightforward now but we all learned to think about Hib in any kid with upper airway symptoms because Hib caused an upper airway obstruction from infection of epiglottis.

If children came into the emergency room with a high fever, we did spinal taps. We did a lot of them. We were all very good at them. Because we never, ever, ever wanted to miss Hib disease and that means looking for the bacteria all the time.