title: Impact of the pneumococcal conjugate vaccine in the management of highly febrile children aged 6 to 24 months in an emergency department.
abstract: 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.
authors.affiliation: Paediatric Emergency Department, Hospital Cruces, University of the Basque Country, Bizkaia, Basque Country, Spain. smintegui@hcru.osakidetza.net
authors.forename: Santiago
authors.initials: S
authors.lastname: Mintegi
authors.forename: Javier
authors.initials: J
authors.lastname: Benito
authors.forename: Maria
authors.initials: M
authors.lastname: González
authors.forename: Eider
authors.initials: E
authors.lastname: Astobiza
authors.forename: Jesus
authors.initials: J
authors.lastname: Sanchez
authors.forename: Mikel
authors.initials: M
authors.lastname: Santiago
mesh_terms: D004636:Emergency Service, Hospital; D004638:Emergency Treatment; D005260:Female; D005334:Fever / Q000188:drug therapy*; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D006801:Humans; D007223:Infant; D008297:Male; D022401:Meningococcal Vaccines / Q000627:therapeutic use*; D022242:Pneumococcal Vaccines / Q000627:therapeutic use*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018074:Vaccines, Conjugate / Q000627:therapeutic use*
chemical_list: D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D022401:Meningococcal Vaccines; D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate