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Pneumococcal Vaccination Reduces Incidence of Occult Bacteremia in Young Children

Before 1990, 3% to 10% of infants who had high fevers but otherwise appeared to be well had occult bacteremia (OB): Its dread consequences were sepsis and meningitis. The Haemophilus influenzae type b (Hib) vaccine was introduced in that year, and it largely eliminated Hib as a cause of OB and reduced the total number of OB episodes by 3% to 25%. Streptococcus pneumoniae causes most OB episodes, but has the recently introduced pneumococcal conjugate vaccine (PCV7) had an effect similar to that of the Hib vaccine?

Data were obtained retrospectively from records of 631 children in New York for whom blood cultures were ordered because they were at high risk for OB (i.e., 2-36 months of age with temperatures of 39°C) and did not have focal bacterial infections other than acute otitis media. Four cultures yielded contaminants. Two children had three positive cultures; all yielded S. pneumoniae as the infecting organism: One child was infected with a strain of S. pneumoniae that was not included in the PCV7 vaccine, and the other child (who had two OB episodes) had not received the vaccine. Complete blood count results did not predict OB.

Comment: This study began 1 year after routine administration of PCV7 began, and its results confirm the vaccine's effectiveness. The findings suggest that workups for occult bacteremia, and empirical initiation of antibiotic therapy against OB, might not be indicated in children who traditionally have been considered to be at high risk for OB but who have been vaccinated against both Hib and S. pneumoniae.

— Robert A. Dershewitz, MD, MSc

Published in Journal Watch General Medicine July 23, 2004

Citation(s):

Stoll ML and Rubin LG. Incidence of occult bacteremia among highly febrile young children in the era of the pneumococcal conjugate vaccine: A study from a children's hospital emergency department and urgent care center. Arch Pediatr Adolesc Med 2004 Jul; 158:671-5.

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