‘Hib’: When every minute counts
Watching her 5-month-old daughter Romee play, Sophie Williams knows things could have easily gone another way.
In November, Romee, then just a few weeks old, became unwell.
Williams, of Auckland, was in Ashburton visiting her mum, as her husband, Josiah, was working in Christchurch. Over the course of the day, Romee’s breathing appeared more laboured, she was hard to wake, and “wasn’t interested” in feeding.
Williams checked in with her midwife throughout the day, and as soon as she noticed Romee had a temperature, took her to a local A&E clinic. They were sent to Christchurch Hospital in an ambulance “straight away”, Williams said. “She was deteriorating before our eyes.” She was started on antibiotics, and tests revealed she had Hib meningitis.
“I [was] relieved they’d found out what it was. It hadn’t really triggered for me what that meant,” Williams said.
It wasn’t until the next day, when a team of doctors came in, that it sunk in just how serious Romee’s condition was. She said they were told it was “lucky you came in when you did … as every minute, every hour counts with meningitis”.
Haemophilus influenzae type b (Hib) is a bacteria that can cause serious illness in young children.
Meningitis is an infection and inflammation of the fluid and membranes surrounding the brain and spinal cord. It can occur due to viral, bacterial or fungal infection, and can be potentially fatal within hours.
Many people have Hib bacteria in their nose and throat without getting sick. Illness happens when the bacteria spreads and creates an infection.
Hib was once the most common cause of life-threatening bacterial infection in children under 5, but has “almost disappeared” since vaccination was introduced in the 1990s.
Since then, the number of children hospitalised for Hib meningitis or epiglottitis (a potentially life-threatening inflammation and swelling of the epiglottis) has decreased by about 90%, the Immunisation Advisory Centre (IMAC) says. In New Zealand, Hib vaccination is given at 6 weeks, 3 months and 5 months (with a booster at 15 months). Romee was too young to have received her first dose.
In the early stages of Hib meningitis, a person typically feels unwell, with fever, headache and vomiting, according to Health NZ.
In babies, meningitis may cause poor eating and drinking, low alertness, vomiting and a high-pitched cry. They may have a bulging fontanelle (the soft spot on top of their head).
Survivors can have long-term complications, including deafness and brain damage. One person in every 20 infected with Hib meningitis will die, even with early identification and treatment.
When Romee looked to be “perking up” after a few days in hospital, Williams thought the worst might be behind them. But then she started having seizures. Holding her daughter as she seized, Williams felt “powerless”. “It was the worst thing in the world, I couldn’t do anything … if I could take that pain and give it to myself, I would [have], but I can’t.”
Scans found pockets of fluid and inflammation on her brain. They were being warned to be prepared, that Romee’s future might look different to how they’d pictured.
In those early days, Williams was too scared to ask what the outcome might be, but wondered whether her daughter was going to die.
In early December, the family were taken to Starship Children’s Hospital where Romee had surgery to drain the brain fluid. After surgery, Romee’s seizures stopped.
The family marked their first Christmas with Romee in hospital, and had a “really great view” of the Sky Tower New Year’s Eve fireworks from their room.
Romee was improving, and when another scan showed she wouldn’t need further surgery, her parents were “jumping for joy”.
On January 4, they got to go home – six weeks after going into hospital.
Two weeks later, after another scan, Williams said they were told Romee had recovered, and her PICC line (used to give fluids and medication) was removed. “It was the best thing in the entire world.”
Romee’s development is being monitored, and so far she’s hitting all the milestones you’d expect, Williams said.
But there are a number of potential longterm consequences, some of which won’t become apparent until later, she said.
Between 1997 and 2023, 172 cases of Hib were notified in the country. Of these, 48 were cases with meningitis, the Institute of Environmental Science and Research (ESR) said.
There have been five deaths from Hib since 1997, of which two were in cases with meningitis, both aged 1, ESR said.
GP and Immunisation Advisory Centre medical director Dr Nikki Turner remembered clearly how “scary” Hib was early in her medical career.
While it hasn’t been eradicated, incidence is now “really rare, due to vaccination”, with cases dropping “enormously”, she said.
Turner said the Hib vaccine is among “the best we have”, as it helps provide both individual protection, and herd immunity. However, Hib was an example of a disease that “could come back”, due to decreasing vaccination coverage, alongside things like pertussis, measles and pneumococcal disease, Turner said.