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A 2-month-old infant is brought into the emergency department with a 24 h history of fever. He was born at term and had an uneventful neonatal period with no risk factors for sepsis. Clinical examination was unremarkable apart from a temperature of 38.5°C. Upon further questioning, his mother revealed that the infant had received his routine vaccinations the previous day. She had been advised to give prophylactic paracetamol at the time of vaccination but had refrained from doing so because, 2 years previously, the same practice nurse had told her to give paracetamol to her older child only if he developed fever after vaccination. You are not aware of current national recommendations or the evidence for prophylactic paracetamol with vaccination.
Structured clinical question
In infants receiving their routine primary immunisations (population), does prophylactic paracetamol given around the time of vaccination (intervention) compared with no prophylactic paracetamol (comparison) reduce the risk of fever post vaccination (outcome)?
Search strategy and outcome
MEDLINE, EMBASE and PubMed (1 January 2000 to 30 June 2015). Used terms (prophyla*) AND (vaccine* OR immuni*) AND (antipyretics OR paracetamol OR ibuprofen OR acetaminophen). The search was then limited to randomised controlled trials (RCTs) and systematic reviews with no language limitations. The search retrieved 22 articles including one systematic review,1 which included all the relevant articles identified by the search as well as hand-searching through reference lists and clinical trials databases, apart from an as-yet unpublished RCT reported on http://www.clinicaltrials.gov 2 and a more recent RCT assessing the effect of prophylactic paracetamol on adverse reactions (including fever) and vaccine responses in infants receiving a MenB vaccine with their routine vaccinations (table 1).3
From 1 September 2015, infants in the UK are offered a novel multicomponent protein-based MenB vaccine (Bexsero; GSK biologicals) alongside their routine vaccinations at 2, 4 and 12 months (https://www.gov.uk/government/collections/immunisation). Neisseria meningitidis …
Contributors SB and SNL conducted the literature review and wrote the first draft. All authors contributed to the commentary and the clinical bottom line.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.