Management of Febrile Children in the Conjugate Pneumococcal Vaccine Era

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.