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Emergency department attendance following 4-component meningococcal B vaccination in infants
  1. Sarah Kapur1,
  2. Thomas Bourke2,
  3. Julie-Ann Maney3,
  4. Paul Moriarty1
  1. 1Department of Paediatric Infectious Diseases, Royal Belfast Hospital for Sick Children, Belfast, UK
  2. 2General Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, UK
  3. 3Emergency Department, Royal Belfast Hospital for Sick Children, Belfast, UK
  1. Correspondence to Dr Sarah Kapur, Department of Paediatric Infectious Diseases, Royal Belfast Hospital for Sick Children, 180-184 Falls Rd, Belfast, Co Antrim, BT12 6BE, UK; sarahkapur{at}doctors.org.uk

Abstract

Introduction In September 2015, the UK became the first country in the world to introduce the 4-component meningococcal B vaccine(4CMenB) into the routine vaccine schedule for infants. 4CMenB is known to cause fever in infants. Infants presenting with fever, particularly those under 3 months, have a significant risk of serious bacterial infection(SBI).

Method Between September 2015 and January 2016, we performed a prospective audit of management of infants between 30 and 180 days attending the regional paediatric emergency department(ED) in Northern Ireland, within 4 days of receiving 4CMenB.

Results 35 ED attendances in infants aged 30–180 days were due to symptoms occurring after primary vaccinations including 4CMenB, representing an estimated 0.8% of the vaccinated population in the catchment area. 86% of infants presented after the first vaccine and parents reported giving paracetamol to 94% of infants. 80% of infants presented with fever. Blood tests were performed in 62% of infants and leucocytosis was present in 73%. All cultures taken were negative and 51% were admitted to hospital. 100% of final diagnoses were vaccine related (diagnosis made by exclusion).

Discussion In this study, an estimated 0.8% of the vaccinated population in the catchment area attended ED with symptoms occurring after primary vaccinations including 4CMenB. Infants with fever have a higher risk of SBI, but infants with fever in the post-vaccination period may not have the same risk. Further data are essential to inform national guidelines on investigation and management of fever in infants following vaccination with 4CMenB, possibly incorporating a less-invasive approach.

  • accident & emergency
  • infectious diseases
  • immunisation

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Footnotes

  • Contributors Belfast Health and Social Care Trust Audit and Quality Improvement provided help with Excel worksheet development.

  • Competing interests None declared.

  • Patient consent No intervention was performed during the audit. Anonymous data were collected on attendance to the emergency department.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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