In September 2015, the UK introduced the 4Conjugate Meningococcal B vaccine to the routine immunisation schedule, to be given at 2 and 4 months of age. Those of us who’ve witnessed the devastating effects of meningococcal sepsis welcomed this warmly. There was however a small catch. It was recognised that one of the effects of the vaccination was to produce a fever in the recipient shortly after administration, and parents were advised to give paracetamol.
This of course posed a dilemma to the ED physician met with a febrile infant post immunisation. Was the fever solely vaccine related or was it the presentation of a serious bacterial infection? Somewhat unhelpfully there was no, and still is no, national guidance on what to do. Do we assume all fevers are vaccine related and risk missing a septic infant, or do we assume all are possibly septic and risk over-treating?
Several teams in the UK are currently auditing their practices and publishing their findings. The first group to do so was in Northern Ireland – publishing their findings in the Archives of Disease in Childhood. This is an important start to collecting data to allow us to come up with some guidance and to this end I have summarised the paper in the following infographic.