The Prevalence of Invasive Bacterial Infection in Febrile Infants Presenting to Hospital Following Meningococcal B Immunisation: A Case Series.

Abstract

Objectives: To report the prevalence of invasive bacterial infection (IBI) in febrile infants ≤90 days presenting to hospital within 72 h of meningococcal B (MenB) immunisation.

Methods: A secondary analysis of data from two previous multicentre studies of febrile infants conducted at UK and Irish hospitals. The first study was a retrospective study, conducted at six sites between 31 August 2018 and 1 September 2019. The second study was a prospective study conducted at 35 sites between 6 July 2022 and 31 August 2023. Febrile infants ≤90 days who had received the MenB vaccine within 72 h preceding presentation were included.

Results: A total of 102 infants met the inclusion criteria, with a median age of 61 days and a male predominance of 65.7%. The most reported clinical features were an abnormal cry, decreased feeding and coryzal symptoms. In total, 68/102 (66.7%) were admitted to hospital; the median length of stay was 1 day. Median C-reactive protein (CRP) was 20.5 mg/L, mean white cell count was 13.7 × 10⁹/L, mean neutrophil count was 7.3 × 10⁹/L and mean lymphocyte count was 4.7 × 10⁹/L. In total, 38/102 (37.3%) had blood cultures performed, 26/102 (25.5%) had respiratory viral testing performed, 55/102 (53.9%) had urine culture performed and 14/102 (13.7%) had lumbar puncture performed. Additionally, 26/102 (25.5%) received parenteral antibiotics. There were no cases of IBI, and 3/102 (2.9%) cases of urinary tract infection.

Conclusions: The rate of IBI is negligible in febrile infants following MenB immunisations. Current blood tests such as CRP are unreliable in this cohort, as many exhibit a moderate CRP rise above suggested international cut-offs for this age range.