Differentiating vaccine reactions from invasive bacterial infections in young infants presenting to the emergency department in the 4CMenB era: a retrospective observational comparison
Background Differentiating infants with adverse events following immunisation (AEFIs) or invasive bacterial infection (IBI) is a significant clinical challenge. Young infants post vaccination are therefore often admitted to the hospital for parenteral antibiotics to avoid missing rare cases of IBI.M...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2022-10-01
|
| Series: | BMJ Paediatrics Open |
| Online Access: | https://bmjpaedsopen.bmj.com/content/6/1/e001559.full |
| _version_ | 1797777445611372544 |
|---|---|
| author | Matthew D Snape Daniel O'Connor Emily Tough Samuel William Channon-Wells |
| author_facet | Matthew D Snape Daniel O'Connor Emily Tough Samuel William Channon-Wells |
| author_sort | Matthew D Snape |
| collection | DOAJ |
| description | Background Differentiating infants with adverse events following immunisation (AEFIs) or invasive bacterial infection (IBI) is a significant clinical challenge. Young infants post vaccination are therefore often admitted to the hospital for parenteral antibiotics to avoid missing rare cases of IBI.Methods During a service evaluation project, we conducted a single-centre retrospective observational study of infants with IBI, urinary tract infection (UTI) or AEFI from two previously published cohorts. All patients presented to hospital in Oxfordshire, UK, between 2011 and 2018, spanning the introduction of the capsular group-B meningococcal vaccine (4CMenB) into routine immunisation schedules. Data collection from paper and electronic notes were unblinded. Clinical features, including National Institute for Health and Care Excellence (NICE) ‘traffic light’ risk of severe illness and laboratory tests performed on presentation, were described, and comparisons made using regression models, adjusting for age and sex. We also compared biochemical results on presentation to those of well infants post vaccination, with and without 4CMenB regimens.Results The study included 232 infants: 40 with IBI, 97 with probable AEFI, 24 with possible AEFI, 27 with UTI and 44 post vaccination ‘well’ infants. C-reactive protein (CRP) was the only discriminatory blood marker, with CRP values above 83 mg/L only observed in infants with IBI or UTI. NICE risk stratification was significantly different between groups but still missed cases of IBI, and classification as intermediate risk was non-differential. Fever was more common in probable AEFI cases, while seizures and rashes were equally frequent. Diarrhoea and clinician-reported irritability or rigours were all more common in IBI.Conclusions Clinical features on presentation may aid risk stratification but cannot reliably differentiate IBI from AEFI in infants presenting to the emergency department. Blood results are generally unhelpful due to post vaccination inflammatory responses, particularly in children receiving 4CMenB vaccination. Improved biomarkers and clinical prediction tools are required to aid management in febrile infants post vaccination. |
| first_indexed | 2024-03-12T23:05:04Z |
| format | Article |
| id | doaj.art-c99e17827af342158cc634b295a85e4a |
| institution | Directory Open Access Journal |
| issn | 2399-9772 |
| language | English |
| last_indexed | 2024-03-12T23:05:04Z |
| publishDate | 2022-10-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Paediatrics Open |
| spelling | doaj.art-c99e17827af342158cc634b295a85e4a2023-07-19T05:00:07ZengBMJ Publishing GroupBMJ Paediatrics Open2399-97722022-10-016110.1136/bmjpo-2022-001559Differentiating vaccine reactions from invasive bacterial infections in young infants presenting to the emergency department in the 4CMenB era: a retrospective observational comparisonMatthew D Snape0Daniel O'Connor1Emily Tough2Samuel William Channon-Wells31 Department of Paediatrics, University of Oxford, Oxford, UKOxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UKOxford University Hospitals NHS Foundation Trust, Oxford, UKOxford University Hospitals NHS Foundation Trust, Oxford, UKBackground Differentiating infants with adverse events following immunisation (AEFIs) or invasive bacterial infection (IBI) is a significant clinical challenge. Young infants post vaccination are therefore often admitted to the hospital for parenteral antibiotics to avoid missing rare cases of IBI.Methods During a service evaluation project, we conducted a single-centre retrospective observational study of infants with IBI, urinary tract infection (UTI) or AEFI from two previously published cohorts. All patients presented to hospital in Oxfordshire, UK, between 2011 and 2018, spanning the introduction of the capsular group-B meningococcal vaccine (4CMenB) into routine immunisation schedules. Data collection from paper and electronic notes were unblinded. Clinical features, including National Institute for Health and Care Excellence (NICE) ‘traffic light’ risk of severe illness and laboratory tests performed on presentation, were described, and comparisons made using regression models, adjusting for age and sex. We also compared biochemical results on presentation to those of well infants post vaccination, with and without 4CMenB regimens.Results The study included 232 infants: 40 with IBI, 97 with probable AEFI, 24 with possible AEFI, 27 with UTI and 44 post vaccination ‘well’ infants. C-reactive protein (CRP) was the only discriminatory blood marker, with CRP values above 83 mg/L only observed in infants with IBI or UTI. NICE risk stratification was significantly different between groups but still missed cases of IBI, and classification as intermediate risk was non-differential. Fever was more common in probable AEFI cases, while seizures and rashes were equally frequent. Diarrhoea and clinician-reported irritability or rigours were all more common in IBI.Conclusions Clinical features on presentation may aid risk stratification but cannot reliably differentiate IBI from AEFI in infants presenting to the emergency department. Blood results are generally unhelpful due to post vaccination inflammatory responses, particularly in children receiving 4CMenB vaccination. Improved biomarkers and clinical prediction tools are required to aid management in febrile infants post vaccination.https://bmjpaedsopen.bmj.com/content/6/1/e001559.full |
| spellingShingle | Matthew D Snape Daniel O'Connor Emily Tough Samuel William Channon-Wells Differentiating vaccine reactions from invasive bacterial infections in young infants presenting to the emergency department in the 4CMenB era: a retrospective observational comparison BMJ Paediatrics Open |
| title | Differentiating vaccine reactions from invasive bacterial infections in young infants presenting to the emergency department in the 4CMenB era: a retrospective observational comparison |
| title_full | Differentiating vaccine reactions from invasive bacterial infections in young infants presenting to the emergency department in the 4CMenB era: a retrospective observational comparison |
| title_fullStr | Differentiating vaccine reactions from invasive bacterial infections in young infants presenting to the emergency department in the 4CMenB era: a retrospective observational comparison |
| title_full_unstemmed | Differentiating vaccine reactions from invasive bacterial infections in young infants presenting to the emergency department in the 4CMenB era: a retrospective observational comparison |
| title_short | Differentiating vaccine reactions from invasive bacterial infections in young infants presenting to the emergency department in the 4CMenB era: a retrospective observational comparison |
| title_sort | differentiating vaccine reactions from invasive bacterial infections in young infants presenting to the emergency department in the 4cmenb era a retrospective observational comparison |
| url | https://bmjpaedsopen.bmj.com/content/6/1/e001559.full |
| work_keys_str_mv | AT matthewdsnape differentiatingvaccinereactionsfrominvasivebacterialinfectionsinyounginfantspresentingtotheemergencydepartmentinthe4cmenberaaretrospectiveobservationalcomparison AT danieloconnor differentiatingvaccinereactionsfrominvasivebacterialinfectionsinyounginfantspresentingtotheemergencydepartmentinthe4cmenberaaretrospectiveobservationalcomparison AT emilytough differentiatingvaccinereactionsfrominvasivebacterialinfectionsinyounginfantspresentingtotheemergencydepartmentinthe4cmenberaaretrospectiveobservationalcomparison AT samuelwilliamchannonwells differentiatingvaccinereactionsfrominvasivebacterialinfectionsinyounginfantspresentingtotheemergencydepartmentinthe4cmenberaaretrospectiveobservationalcomparison |