Peer-reviewed article
Fever after meningococcal B immunisation: A case series
Gillian Campbell, Ruth M Bland, Scott J Hendry ·
Summary
Written by AI, not yet AICS's view · claude-sonnet-5-5This prospective case series followed 92 infants aged 3 months or younger who came to a tertiary children's hospital with fever within 72 hours of their first set of immunisations, including meningococcal B vaccine. Most had poor feeding, sleepiness or irritability, and 72% were admitted to hospital. Only one infant had a confirmed bacterial infection, and that infant's fever began 54 hours after the vaccination. The authors suggest that infants who look otherwise well do not need routine investigations, and that observation is sensible when other features or clinical concern are present.
Key points
- 92 infants met the inclusion criteria, 0.78% of the local vaccinated population.
- Common associated features were poor feeding, sleepiness and irritability; 66 infants (72%) were admitted.
- Median CRP was 12 mg/L and median white cell count was 16 × 10^9/L.
- Fifteen infants (16%) had a lumbar puncture and were started on antibiotics; only one confirmed bacterial infection was found, in an infant whose fever began 54 h after immunisation.
- No serious bacterial infection was missed in infants who were observed or discharged.
Limitations
This is a single-centre case series with no comparison group, so it cannot show how often serious infection occurs in other settings or prove that selective testing is safe. The country is not stated in the abstract, and only one bacterial infection was found, so the findings are imprecise.
Abstract
AimTo document the clinical features and management of infants presenting with fever after their first meningococcal B vaccination and develop guidance for clinicians.MethodsA prospective case series over 12 months was conducted in a tertiary paediatric hospital. Infants ≤3 months of age with fever who had received their first set of immunisations within the preceding 72 h were included.ResultsA total of 92 infants met the inclusion criteria, accounting for 0.78% of the local vaccinated population. The most commonly described associated features were poor feeding, sleepiness and irritability; 66 patients (72%) were admitted to hospital. Median C‐reactive protein (CRP) was 12 mg/L, and median white cell count (WCC) was 16 × 109/L. Fifteen patients (16%) had a lumbar puncture and were commenced on antibiotics. There was one confirmed bacterial infection in an infant who had presented with fever starting 54 h after immunisation. All other microbiology samples were negative. There were no cases of missed serious bacterial infection (SBI) in those patients who were observed or discharged.ConclusionsThe routine investigation of infants presenting with post‐immunisation fever is not warranted if the infant appears otherwise well on examination. Where other common associated features are present or there is clinical concern, a period of observation is a prudent course of action. Paracetamol should be given peri‐immunisation as per the national guidance. We suggest selective use of investigations, especially inflammatory markers, which are unlikely to discriminate between SBI and post‐immunisation response. We advocate extra caution in infants presenting with fever more than 48 h after immunisation.