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Published on: February 23, 2014

Fever without localizing signs in children: a review in the post-Hib and postpneumococcal era

R J Chancey1, R Jhaveri

  • 1Department of Pediatrics, Duke University Medical Center, Durham, NC 27710, USA.

Minerva Pediatrica
|October 2, 2009
PubMed

Insights

Fever management in children has evolved due to vaccines like Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae, significantly reducing serious bacterial infections. Current evaluation strategies need updating to reflect these lower risks in febrile children.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Public Health

Background:

  • Historically, febrile infants and children required extensive workups for serious bacterial infections, with occult bacteremia rates around 5.7%.
  • Clinical practice guidelines in 1993 recommended risk-based evaluation for febrile children.
  • Introduction of Haemophilus influenzae type b (Hib) and Pneumococcal Conjugate Vaccine (PCV7) vaccines dramatically reduced serious infection rates.

Purpose of the Study:

  • To review the historical management of febrile children.
  • To discuss advancements impacting the evaluation of serious bacterial infections.
  • To provide updated recommendations for managing febrile children in the current era.

Main Methods:

  • Literature review of historical and current practices in pediatric fever management.
  • Analysis of the impact of vaccination and antibiotic prophylaxis on serious bacterial infection rates.
  • Synthesis of evidence to inform revised clinical guidelines.

Main Results:

  • Occult bacteremia rates have fallen from 5.7% to 0-0.74% post-vaccination.
  • Intrapartum antibiotic administration has reduced early-onset Group B Streptococcus disease.
  • Despite reduced risks, evaluation and management protocols for febrile children have largely remained unchanged.

Conclusions:

  • The significant decline in serious bacterial infections necessitates a re-evaluation of current management strategies for febrile children.
  • Updated guidelines are crucial to align clinical practice with the current low-risk landscape.
  • Recommendations focus on adapting evaluation and management to reflect contemporary pediatric infectious disease epidemiology.

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