Epiglottitis in Pre and Post Haemophilus Influenza Type-b Vaccine Era: A Systematic Review and Meta-analysis

Background and purpose: Epiglottitis is an uncommon life threatening pediatric disease. Evidence suggests some changes in etiology and incidence of this disease after vaccination against H-influenza type b. This Meta-analysis and systematic review aimed at investigating the etiology and incidence of acute epiglottitis in pre and post H-influenza vaccination era. Materials and methods: A systematic literature search was conducted in PubMed, Scopus, Google Scholar, SID, and Magiran using the following keywords: acute epiglottitis, H-Influ vaccination, pre-vaccine era, and post-vaccine era. Relevant studies published in Persian and English, between 1975 and 2016 were investigated. Finally, 29 articles meeting the study inclusion criteria were selected. Three pediatric specialists independently screened the articles. Results: H-influenza was found as the main reason for acute epiglottitis. The rate of epiglottitis induced by H-influ in pre and post vaccination era was 27.54% [(95% CI=23.68-31.39), P= 0.000], and 18.41% [(95% CI= 9.29-46.10), P= 0.000], respectively. Conclusion: H-Influenza remains a common etiology of acute epiglottitis after H-Influ vaccination. But, this disease is predominantly seen in adults following the introduction of vaccination, and rarely other causative agents such as Staphylococcus aureus are identified to be associated with acute epiglottitis.