Impact of the pneumococcal conjugate vaccine in the management of highly febrile children aged 6 to 24 months in an emergency department.

OBJECTIVE

To evaluate the impact of the introduction of the heptavalent pneumococcal conjugate vaccine (PCV-7) in the management of children aged 6 to 24 months with high fever without source (FWS) in a pediatric emergency department (PED).

METHODS

Retrospective study of 770 patients aged 6 to 24 months attended in a pediatric ED between October 2004 and April 2005 with FWS 39 degrees C or higher without alteration in the dipstick.

RESULTS

Out of 770 children, 215 (27.9%) were PCV-7 fully vaccinated (group A), and 555 (72.0%) were either incompletely PCV-7 vaccinated or not vaccinated at all (group B). Both groups did not show differences related to temperature registered at home or in the ED. Complete blood count (CBC) and blood culture were practiced in 163 (21.1%) patients, chest radiograph in 117 (15.1%), and lumbar puncture in 15 (1.9%). Thirty-three patients (4.3%) received a dose of intramuscular ceftriaxone, 20 (2.6%) were admitted to the observation unit, and 5 (0.6) were admitted to the hospital. One blood culture was positive, and 2 other children had a consolidation in the chest radiograph (all in group B). In patients not fully vaccinated with PCV-7, CBC and blood culture were practiced more frequently (group B, 26.6% vs. group A, 7%; P < 0.000001; odds ratio, 4.85 [limits, 2.70-8.83]) and ceftriaxone was also more frequently administered (group B, 5.3% vs. group A, 1.3%; P = 0.02; odds ratio, 4.04 [limits, 1.16-16.77]). Three children in group A (1.4%) were admitted to the observation unit or to floor versus 22 in group B (4%, P = 0.11).

CONCLUSIONS

Inclusion of PCV-7 vaccinal status in the management of highly febrile children aged 6 to 24 months significantly reduces CBC and blood cultures practiced in the ED and the administration of ceftriaxone.