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We report an infant case of meningococcal group W meningitis presenting within 24 hours of receiving group B meningococcal vaccine (4CMenB), illustrating the dilemma clinicians face in interpreting advice for management of post-immunisation fever and the National Institute for Health and Care Excellence (NICE) fever guidelines, and highlighting the need for sustained vigilance for bacterial infections in infants with post-4CMenB fever.
A 2-month-old girl arrived by ambulance to the local emergency department in April 2017 suffering from right-sided focal limb seizures and fever of 39°C, within 24 hours of receiving her 2-month immunisations (including 4CMenB). The seizure terminated with two doses of intravenous lorazepam and suspected sepsis was treated with immediate intravenous antibiotics.
Investigations revealed a normal cranial CT scan; elevated C-reactive protein (263.5 mg/L (0–5 mg/L)); normal full blood count; normal liver …
Contributors NS and RBP wrote the manuscript. MDS and RBP edited the manuscript. RBP was involved in the care of the patient.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests MDS conducts clinical trials of vaccines on behalf of the University of Oxford that are funded and/or sponsored by vaccine manufacturers including Glaxosmithkline, Novavax, Pfizer, Medimmune and Sanofi-Pasteur. MDS received no personal financial benefit from these activities. MDS receives salary support from the NIHR Oxford Biomedical Research Centre and is a Jenner Investigator. RBP and NS have no conflicts of interest to declare.
Patient consent Parental/guardian consent obtained.
Provenance and peer review Not commissioned; internally peer reviewed.
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