Prep School Daily: Haemophilus influenzae Type b (Hib) in a Collapsed Society

Here’s another common childhood disease referenced in the book discussed last month on the blog, Quick Guide to Common Childhood Diseases, issued by the Provincial Heath Services Authority of the British Columbia Centre for Disease Control. (Thanks again to Exile for making us aware of this resource.) It also receives no mention whatsoever in the most popular off-grid medicine texts. And yet, as it is apparently a common childhood disease, we ought to become educated about it.

Haemophilus influenzae type b (Hib) was the most frequent cause of bacterial meningitis in children under the age of 5 years before the Hib vaccines came onto the scene. Since the advent of these vaccines, the incidence of Hi infections has diminished considerably. Most cases now arise in unimmunized children and those too young to have completed the series of vaccines administered in infancy.

Hib bacteria can also infect the following:

Bloodstream
Epiglottis
Joints
Lungs
Skin

Other types of H. influenzae (so not type b) can cause the following respiratory illnesses:

Ear infections
Sinusitis
Bronchitis
Other respiratory illnesses

Signs and symptoms of an Hib infection include the following:

Bulging fontanelle (soft spot on the skull) in infants
Fatigue
Fever
Headache
Stiff neck and back in older children
Vomiting

The bulging fontanelle in infants and stiff neck and back in older children are serious signs. If there is the slightest suspicion of meningitis, a doctor should be sought immediately. And you better hope you stored the right IV antibiotics. Of all the diseases and conditions discussed in the off-grid medicine classes with Dr. Steve, this is the one that he feared the most.

Researchers don’t actually know how long the incubation period is, but they think it is 2-4 days. A patient is contagious as long as the bacteria are present. A person infected with Hib is no longer contagious 48 hours after starting antibiotic therapy. Because this is such a serious disease, antibiotics may be recommended for contacts of the infected child. You’ll want to be sure to have a good stock of those as well.

Hib spreads by:

Breathing in air contaminated by the cough or sneeze of an infected person
Close facial contact
Kissing or sharing food, utensils, drinks, pacifiers, bottles, or toys used by other children

The Community Health Aid Practitioner Manual (I get more and more impressed by this each time I look at it) provides more specific information, firstly that someone should arrange transportation to a hospital ASAP. In the meantime, because in a collapsed society these things may take time, the following should be done. Note that I am not suggesting that you do this; you just need to know what supplies a doctor will need to care for your family members. (I love that this is all laid out in detail—after all, it’s written for someone with only 10 weeks of training!)

Start antibiotics ASAP, using one of the following regimens, which are listed in order of preference. Use only one regimen. Dosages are indicated in the chart below.

IM shot of ceftriaxone
IV or IM injection of ampicillin AND oral or IM chloramphenicol
IM shot of procaine penicillin AND oral or IM chloramphenicol
IM shot of procaine penicillin and oral amoxicillin or ampicillin

If the IM doses is more than 3 cc (or in an infant, more than 1 cc), divide the dose into two shots, one on each side of the body.

Antibiotics for Treating Meningitis

IM shot of ceftriaxone (Rocephin, 250 mg/ml), every 12 hours

Weight	Approximate age	Dose
Less than 15 lbs	Less than 4 mo.	250 mg (1 cc)
15-19 lbs	4-8 mo	375 mg (1.5 cc)
20-27 lbs	9-23 mo	500 mg (2 cc)
28-31 lbs	2 years	625 mg (2.5 cc)
32-39 lbs	3-4 years	750 mg (3 cc)
40-99 lbs	5-12 years	1000 mg (4 cc)
100 lbs or more	13 years or more	2000 mg (8 cc)

(There are IV and IM administration charts like the one above for ampicillin, penicillin, and amoxicillin, but I’m not going to reproduce them all here. I am going to very strongly recommend that you print out the Community Health Aide/Practitioner Manual. It is so full of amazing information written in the detail that someone lacking experience needs. Like all the information on starting and giving IV fluids, with all kinds of drawings to help connect tubings to bags, to help find a vein for inserting an IV needle, and so much more. Of course, this isn’t for you to do; it’s for licensed professionals who may be out of practice.)

Allergy

If the patient indicates he is allergic to penicillin, ask what happened when he had the allergic reaction.

If he had hives, do not administer ampicillin, amoxicillin, or penicillin in any form.

If he just had a rash, give the antibiotic anyway, but have epinephrine ready to inject, in case he has a severe allergic reaction.

Additional instructions

If there is a high fever, administer acetaminophen.
Keep someone with the patient at all times
If the patient is alert and can swallow without choking, give clear liquids to prevent dehydration.
If the patient cannot swallow without choking, give nothing by mouth. If the patient needs fluids to prevent dehydration, start an IV with 5% dextrose and 0.9% sodium chloride, if available. Run the IV at a slow rate, about half the “maintenance rate”, to avoid swelling the brain.
If the patient has a seizure, protect as for any seizure by moving objects out of the way. Do not try to stop movements. If possible, lay the patient on his side to help prevent choking.

Herbs that may be of use in treating Hib infections: