Pneumococcal Bacteremia in Febrile Infants Presenting to the Emergency Department Before and After the Introduction of the Heptavalent Pneumococcal Vaccine
Presented at the Society for Academic Emergency Medicine annual meeting, May 2004, Orlando, FL.
Received 12 January 2006; received in revised form 25 March 2006 and 22 September 2006; accepted 31 October 2006. published online 10 March 2007.
Study objective
Fever is among the most common presenting complaints of infants and children younger than 3 years who present to the emergency department (ED). The evaluation and management of the febrile child is evolving rapidly. We compare the proportion of pneumococcal bacteremia between febrile infants and children younger than 3 years who had and had not received the heptavalent pneumococcal vaccine and who had received blood culture tests in our ED.
Methods
We performed a nonconcurrent prospective observational cohort study, with a standardized medical record review to collect data of patients treated in the ED of a tertiary care military hospital during 24 months. Patients were eligible if they were younger than 36 months and had a temperature greater than or equal to 100.4°F (38°C). A data collection sheet was used to abstract age, temperature, and whether CBC count and blood cultures were obtained. Heptavalent pneumococcal vaccine status and blood culture results were obtained through review of the computerized medical record. Descriptive analysis was used for comparing the 2 groups. Group size analysis was based on the prevalence of occult bacteremia caused by Pneumococcus before the introduction of heptavalent pneumococcal vaccine. Interobserver variation was assessed by independent review of 10% of abstracted records. The main outcome measure was the proportion of positive pneumococcal blood cultures in infants and children younger than 3 years who had received at least 1 vaccination of heptavalent pneumococcal vaccine versus those who had not.
Results
Three thousand five hundred seventy-one patients met entry criteria; 1,428 had blood cultures obtained, and 833 of them received at least 1 immunization of heptavalent pneumococcal vaccine. All groups were similar in age, sex, and temperature. Positive blood culture results, including probable contaminants, were obtained for 4.2% (58/1,383) of the patients. In the heptavalent pneumococcal vaccine group, there were 0 of 833 (0%) positive pneumococcal blood cultures compared with 13 of 550 (2.4%) in the unimmunized group (P<.001; 95% confidence interval 1.4% to 3.3%).
Conclusion
Pneumococcal bacteremia was found to be lower in our patients who had received the heptavalent pneumococcal vaccine than in the patients who had not.
aDepartment of Emergency Medicine, Naval Medical Center San Diego, San Diego, CA
bClinical Investigators Department, Naval Medical Center San Diego, San Diego, CA.
Address for correspondence: Keri L. Carstairs, MD, Department of Emergency Medicine, Naval Medical Center San Diego, 34-800 Bob Wilson Drive, San Diego, CA 92134-5000; 619-532-8276, fax 619-532-5307
Supervising editor: David M. Jaffe, MD
Author contributions: KLC, DAT, and ASJ conceived and designed the study and obtained research approval. KLC and DAT supervised the conduct of the trial and data collection. KLC, DAT, and SBK performed data collection. ASJ and RHR provided statistical advice on study design and analyzed the data. KLC drafted the article, and all authors contributed substantially to its revision. KLC takes responsibility for the paper as a whole.
Funding and support: This study was supported by the Clinical Investigations Department of Naval Medical Center San Diego, CA. The study received no outside funding or support.
The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States government.
Publication dates: Available online March 6, 2007.
ABSTRACT