Children Are Paying the Price for Vaccine Skepticism

“Some physicians are increasingly worried that Haemophilus influenzae type b (Hib), a potentially disabling and sometimes lethal bacterial infection in children, is making a comeback as vaccine hesitancy rises.”

Cheryl Clark, contributing writer, MedPage Today

“The last night I was a pediatric resident, a child came in with Hib and promptly died by the next day. I didn’t work for 50 years to have everything destroyed by one man.”

Kathryn M. Edwards, MD, Professor of Pediatrics, Vanderbilt University

Haemophilus influenzae type b (Hib) is a dangerous, potentially deadly bacterial infection. In the 1970s when Dr. Kathryn Edwards was completing her residency in pediatrics, Hib was the leading cause of bacterial meningitis in children under five worldwide. The development of Hib conjugate vaccines in the 1990s caused a dramatic decline in the disease.

Many physicians who trained in the past 40 years have never seen a case of Hib. That appears to be changing. On April 2, 2026, doctors warned that Hib may be making “comeback” likely due to falling vaccination rates. (Edwards, E., “A deadly bacterial disease is returning, doctors warn, as vaccination rates fall,” nbcnews.com, April 2, 2026). In this week’s Germ Gems post, I provide an overview of Hib meningitis and briefly describe how vaccine skepticism/hesitancy is causing a rise in preventable childhood diseases.

What is meningitis? The meninges is the protective membrane that covers the brain. Meningitis is an inflammation of this membrane. (Meningitis can be distinguished from encephalitis which is an inflammation of the brain substance itself.)

There are non-infectious diseases that can provoke “aseptic meningitis.” These include autoimmune diseases, collagen vascular diseases, and drug reactions. A vast majority of meningitis cases are precipitated, however, by infectious agents: bacteria, viruses, fungi. and parasites.

Bacterial meningitis, often referred to as purulent meningitis, is highly destructive and is commonly fatal if left untreated. The most common pathogens causing purulent meningitis are Streptococcus pneumoniae, Neisseria meningitidis, and H. influenzae.

What is Hib meningitis? In 1892, Richard Pfeiffer was the first to describe H. influenzae. (H. influenzae was initially, though incorrectly, thought to be the cause of the 1918-1920 “Spanish flu” pandemic rather than the H1N1virus, the actual cause.) In the early 20^th century, H. influenzae (“Pfeiffer’s bacillus”) was recognized as  a major cause of pediatric purulent meningitis.

The symptoms of Hib meningitis are rapid onset of high fever, stiff neck, severe headache, vomiting, and confusion. Infants may show irritability, poor feeding and bulging fontanelle (“soft spot”). Immediate medical attention is critical as Hib meningitis can cause permanent brain damage, hearing loss, or death.

In the pre-vaccine era (pre-1990s), Hib was the leading cause of bacterial meningitis in the world. According to the Centers for Disease Control and Prevention (CDC), prior to vaccines, in the U.S. alone, 20,000 children under five developed severe forms of Hib disease every year. About 1000 children died of Hib meningitis and many who survived the disease were left with permanent brain damage. (Helen Keller is thought to be one of its victims).

Hib vaccine. In 1985, the first Hib polysaccharide vaccine was licensed. In 1990-1994, the vaccine was conjugated to carrier proteins making it highly effective in infants. After vaccinations began, the number of Hib infections dropped to fewer than 50 a year with about a 5% mortality rate.

Due to vaccines, Hib essentially became eliminated in developed countries. It continues, however, to be a serious cause of morbidity and mortality in developing countries where vaccines aren’t readily available.

The CDC recommends three to four Hib shots for all kids under the age of five. Studies have shown the full vaccine is at least 93% effective in preventing the bacterial infection.

Nonetheless, as of March 21, 2026, eight cases of Hib were reported to the CDC. All eight of these cases occurred in unvaccinated or under-vaccinated children. Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia, said that the fact that there were two cases in Florida alone in the past six months is “frightening as that’s what you would expect across the entire country in a year.” (Clark, C., “Is This Deadly Childhood Illness Making a Comeback?,” MedPage Today, March 24, 2026).

Vaccine-preventable infections in children rise as vaccination rates fall.  Hib meningitis isn’t the only childhood infection that’s on the rise due to a fall in vaccination rates. The U.S. is also seeing an uptick in measles, influenza and whooping cough.

Childhood vaccination rates in the U.S. are experiencing a sustained decline. They are dropping below the 95% threshold needed to prevent outbreaks for key diseases like measles (a disease caused by rubeola virus, the most contagious pathogen of all), pertussis (whooping cough), meningococcal disease (another kind of bacterial meningitis), mumps, and influenza. As Dr. Offit said: “Physicians just have to let parents know that these viruses and bacteria are still out there. And a choice not to give their child a vaccine is not a risk-free choice. It’s a choice to take a greater risk.”

Trust in the American Academy of Pediatrics. “[V]accines are one of humanity’s great achievements in terms of having furthered the lifespan and life quality for humans in the past 50 years.” (Halle, T., “The Staggering Success of Vaccines,”Scientific American, Special Edition Winter/Spring 2026). The World Health Organization estimates that since 1974, approximately 154 million lives were saved by vaccines globally—about 95% of those were children under age five. Childhood immunization alone prevents about 4 million deaths per year. Given the extraordinary benefits of vaccines, the declining rates of childhood vaccination are even more staggering and harder to understand.

The main culprits in sowing distrust in vaccines are the science deniers. And U.S. Secretary of Health and Human Services, Robert F. Kennedy, Jr., a leading anti-vaxxer, along with his minions have played a pivotal role in this country’s declining vaccination rates. (Manto, M., “RFK Jr.’s MAHA Allies Call to Eliminate All Childhood Vaccine Recommendations,” Notus, March 9, 2026). They have led the charge to overhaul the childhood vaccination schedule—a move that was recently blocked by a federal judge. (American Academy of Pediatrics, et al., v. Robert F. Kennedy, Jr., et al., Case 1:25-cv-11916-BEM, (D. Mass. March 16, 2026)).

The American Academy of Pediatrics (AAP) is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents, and young adults. Its recommendations have long defined the standard of care in pediatrics. 

Recently, the AAP decided to stop aligning its vaccine policy with that of federal health agencies and instead, stay with its own vaccine schedule—a schedule that had not changed. (Opel, D.J., O’Leary, S. T., “Communicating about Vaccines in a Politically Contentious Climate,” New England Journal of Medicine, March 26, 2026). As Drs. Opel and O’Leary wrote:  “This unprecedented upheaval in vaccine policy in the United States is threatening the health of both children and the population at large. Pediatric clinicians are central to forging a path forward, and they can do so by remaining true to the values that have made them parents’ most trusted resource on vaccines: collaboration, clear communication, and a commitment to doing what’s best for children.”

Most Americans (by a 4-1 margin) say they are more likely to accept the advice of the AAP than that of the CDC. Let’s all hope that parents accept the AAP’s trustworthy advice when it comes to vaccinating their offspring against preventable childhood diseases. It is, after all, the children who are being put at risk and will pay the price, not the adults.