[Impact of pneumococcal vaccination on the management of infants with fever according to vaccination rates].
OBJECTIVE
To calculate the impact of the heptavalent pneumococcal conjugate vaccine (PCV-7) in the management of fever without source (FWS) in infants according to vaccination rates.


METHODS
The rate of pneumococcal vaccination in infants visiting 14 pediatric emergency departments (PEDs) was calculated. For the statistical analysis, two groups were established; group A: hospitals with vaccination rates of > or = 40%, and group B: hospitals with vaccination rates of < 40 %. A survey was carried out among pediatricians from 14 PEDs on the specific management of two hypothetical clinical cases of FWS (case 1: 7-month-old girl; case 2: 20-month-old girl) depending on their pneumococcal vaccination status (no vaccination, 1 o 2 doses, or 3 doses).


RESULTS
In February 2005, data were collected in 1357 patients, aged 3 to 36 months; 568 (41.86 %) had received at least one dose of PCV-7. A total of 235 questionnaires were collected, 104 in group A and 131 in group B. Pneumococcal vaccination would lead (with statistically significant differences) to fewer diagnostic tests (complete blood cell counts and blood culture). This decrease would be more pronounced in group A than in group B (56.7 % vs 26.7 % and 55.8 vs 26.7 % in case 1 and 54.8 % vs 26 % and 57.7 vs 13.7 %, case 2, respectively), p < 0.05. Infants who had received complete pneumococcal vaccination would receive fewer antibiotics and would be more likely to be discharged directly from hospital (p < 0.001).


CONCLUSIONS
In the previously vaccinated infant with FWS, there would be a significant reduction in the number of diagnostic tests, need for observation in the PED, rates of hospitalization and antibiotic therapy. The reduction in diagnostic tests would increase in areas with higher rates of pneumococcal vaccination.
Capapé Zache
S
S
Urgencias de Pediatría, Hospital de Cruces, Baracaldo, España. sacapape@hcru.osakidetza.net
Luaces Cubells
C
C
Garrido Romero
R
R
Claret Teruel
G
G
Fernández Landaluce
A
A
Benito Fernández
J
J
D002675:Child, Preschool; D005260:Female; D005335:Fever of Unknown Origin / 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*; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D014611:Vaccination / Q000706:statistics & numerical data*; D018074:Vaccines, Conjugate / Q000627:therapeutic use*
D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D022401:Meningococcal Vaccines; D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate