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Published on: February 23, 2014
Management of febrile children in the conjugate pneumococcal vaccine era
Michael E Gabriel1, Leslie Aiuto, Nina Kohn
1Department of Pediatrics, Schneider Children's Hospital at North Shore University Hospital, USA.
Insights
Physician management of febrile children changed after the conjugate heptavalent pneumococcal vaccine (PCV 7) introduction. Vaccinated children led to fewer blood tests and less ceftriaxone use by pediatricians and emergency department physicians.
Area of Science:
- Pediatrics
- Vaccinology
- Infectious Disease Management
Background:
- The introduction of the conjugate heptavalent pneumococcal vaccine (PCV 7) aimed to reduce pneumococcal disease burden.
- Physician diagnostic and treatment strategies for febrile children may be influenced by vaccination status.
Purpose of the Study:
- To evaluate how pediatricians and emergency department (ED) physicians manage young febrile children post-PCV 7 introduction.
- To assess changes in diagnostic test ordering and antibiotic use based on PCV 7 vaccination status.
Main Methods:
- A survey was distributed to 7,500 pediatricians and 7,500 ED physicians.
- Physicians were queried on their management of febrile 7-month-old and 20-month-old children, with and without PCV 7 vaccination.
- Specific management aspects included ordering complete blood cell (CBC) counts, blood cultures, chest radiographs, and administering ceftriaxone.
Main Results:
- Vaccinated febrile children led to significantly fewer CBC counts, blood cultures, and chest radiographs ordered by both pediatricians and ED physicians (p<0.0001).
- Fewer pediatricians and ED physicians would administer ceftriaxone for vaccinated children compared to unvaccinated children (p<0.0001).
- The reduction in diagnostic tests and antibiotic use was observed for both 7-month-old and 20-month-old vaccinated children.
Conclusions:
- Physician management of febrile children has adapted following PCV 7 implementation.
- Vaccination with PCV 7 is associated with decreased utilization of laboratory tests and empiric antibiotic therapy in young febrile children.
- These findings suggest a potential impact of PCV 7 on clinical practice patterns and resource utilization.
Abstract:
The objective of this study was to evaluate physician attitudes toward the management of young febrile children since the introduction of the conjugate heptavalent pneumococcal vaccine (PCV 7). Seven thousand five hundred pediatricians and 7,500 emergency department (ED) physicians were surveyed with regard to their management of a febrile 7-month-old child and 20-month-old child without an apparent fever focus. Specifically, physicians were asked how they would manage a febrile child who had and who had not been vaccinated with PCV 7. When evaluating a febrile 7-month-old child, pediatricians would order 5% fewer complete blood cell (CBC) counts and 6% fewer blood cultures (p<0.0001) if a child was vaccinated. ED physicians would order 13% fewer CBC's and 15% fewer blood cultures (p<0.0001). ED physicians and pediatricians ordered fewer chest radiographs, an 8% and 3% decrease, respectively (p<0.0001). For the PCV 7 immunized 20-month-old child, pediatricians ordered 6% fewer CBC counts and 8% fewer blood cultures (p<0.0001). ED physicians would perform 12% fewer CBC counts and cultures (p<0.0001). Four percent fewer pediatricians and 10% fewer ED physicians would order chest radiographs (p<0.0001). When treating the vaccinated 7-month-old child, pediatricians would use 11% less ceftriaxone and ED physicians 20% less (p<0.0001). Twelve percent fewer pediatricians and 19% fewer ED physicians would administer ceftriaxone (p<0.0001) for the 20-month-old vaccinated child. Our survey suggests that pediatricians and ED physicians would order fewer CBC counts and blood cultures and administer less empiric ceftriaxone if a child was vaccinated with PCV 7.
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