Vaccination status is not associated with bacteremia in the youngest children

  • Dunnick J & al.
  • J Pediatr
  • 13 Jan 2021

  • curated by Liz Scherer
  • Clinical Essentials
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Takeaway

  • Vaccination status does not appear to be significantly associated with bacteremia in very young children presenting to the pediatric emergency department (ED).
  • Haemophilus influenzae type B (Hib) and Streptococcus pneumoniae were specifically assessed in this study.

Why this matters

  • Maternal antibodies appear to protect children ages 2-6 months against S pneumoniae and Hib.
  • Authors: bacteremia, particularly with these pathogens, is uncommon in this age group, and blood culture contamination occurs often. 

Key results

  • 4742 encounters included.
  • Incidence of bacteremia was 1.5%.
  • Incidence of contaminated cultures was 5.0%.
  • 15.16% children were unvaccinated, and 6.64% were undervaccinated for age.
  • Relative risk for bacteremia vs fully vaccinated-for-age children:
    • Unvaccinated: 0.79 (95% CI, 0.39-1.59).
    • Undervaccinated: 1.20 (95% CI, 0.52-2.75).
  • 6 children had vaccine-preventable bacteremia (5 with S pneumoniae, 1 with Hib).
  • Bacteremia was associated (aORs) with:
    • Older age: 1.05 (P=.041).
    • Increased white blood count: 1.09 (P<.001>
    • Increased absolute band count: 1.05 (P=.008).
    • Ill-appearance: 6.01 (P<.001>
  • No S pneumoniae or Hib was found in undervaccinated children, ages 2-6 months, but the higher culture contamination rates (6.6%) were higher vs children ages 7-36 months (average 3.7%).

Study design

  • Retrospective cohort study evaluating association between bacteremia and vaccination status (Hib, S pneumoniae) in children ages 2-36 months presenting to a US pediatric ED.
  • Funding: None disclosed.

Limitations

  • Retrospective, single center.
  • Missing data.
  • Limited generalizability.