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The yin and yang of fever after meningococcal B vaccination
  1. Shamez N Ladhani1,2,
  2. Andrew Riordan3
  1. 1 Immunisation Department, Public Health England, London, UK
  2. 2 Paediatric Infectious Diseases Research Group, St. George’s University of London, London, UK
  3. 3 Paediatric Infectious Diseases and Immunology, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
  1. Correspondence to Dr Shamez N Ladhani, Immunisation Department, PublicHealth England, 61 Colindale Avenue, London NW9 5EQ, UK; shamez.ladhani{at}

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Meningococcal disease remains a major global cause of meningitis and septicaemia. In Europe and other industrialised countries, serogroup B (MenB) is responsible for most cases of invasive meningococcal disease (IMD) in young children and adolescents. An effective vaccine against MenB has been challenging to develop because its polysaccharide capsule is similar to human foetal nerve cells and is, therefore, poorly immunogenic. 4CMenB (Bexsero) is a novel, multicomponent, recombinant protein-based vaccine that includes major antigens on the surface of most meningococci. 4CMenB also includes the outer membrane vesicle (OMV) of the New Zealand MenB outbreak strain, containing additional major and minor surface antigens. It is this OMV component that makes the vaccine very reactogenic.1

Around 50%–60% of infants will develop fever ≥38.5°C when 4CMenB is given with other routine immunisations.1 The fever usually peaks after 6 hours and subsides within 24–48 hours. Prophylactic paracetamol significantly decreases the rate of fever after vaccination, as well as other local and systemic reactions. However unlike some previous studies, prophylactic paracetamol does not reduce the immune response to 4CMenB or any of the other routine infant immunisations. Consequently, the UK has recommended three doses of paracetamol to be given to infants receiving 4CMenB with their routine vaccinations at 2 months and 4 months of age. Prelicensure and postlicensure studies have reported that around 1%–2% of parents will still remain sufficiently concerned to seek additional medical attention following 4CMenB vaccination. Cost-effectiveness analysis in the UK included the costs of treating medically attended adverse reactions.

In the UK, 4CMenB was introduced into the national infant immunisation programme in September 2015 and …

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  • Contributors Both authors contributed equally to the drafting, editing and revision of the manuscript.

  • Funding None.

  • Competing interests AR is a member of the Joint Committee of Vaccination and Immunisation and chaired the Meningococcal Sub-Committee. He was also a topic expert for Surveillance report 2016 – Fever in under 5s (2013) NICE guideline CG160. SNL is the clinical lead for the meningococcal immunisation programme at Public Health England.

  • Provenance and peer review Commissioned; internally peer reviewed.

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