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Meningococcal meningitis presenting postinfant group B meningococcal immunisation
  1. Neda So1,2,
  2. Rani Pal3,
  3. Matthew D Snape1,3,4
  1. 1 Department of Paediatrics, Oxford Vaccine Group, University of Oxford, Oxford, UK
  2. 2 Department of Paediatrics, Monash University, Infection and Immunity, Monash Children’s Hospital, Clayton, Victoria, Australia
  3. 3 Children’s Services, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  4. 4 NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS trust, Oxford, UK
  1. Correspondence to Prof Matthew D Snape, Department of Paediatrics, University of Oxford, Oxford OX3 7LJ, UK; matthew.snape{at}paediatrics.ox.ac.uk

https://doi.org/10.1136/archdischild-2018-316341

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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 …

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    Footnotes

    • 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.