TOP 11 - Do the odds of having bacterial meningitis, bacteremia, or pneumonia change based on vaccination status?

Publication Number: 4713.TOP 11

Brian Davitt, Maimonides Infants and Children's Hospital of Brooklyn, Bethpage, NY, United States; Jessica Zerzan, Maimonides Infants and Children's Hospital of Brooklyn, Brooklyn, NY, United States; Hector Vazquez, Maimonides Medical Center, Brooklyn, NY, United States; Mustafa K. Saidi, Maimonides Infants and Children's Hospital of Brooklyn, Brooklyn, NY, United States

Background: Despite evidence of their safety and effectiveness, vaccine hesitancy is a growing problem. In 2019, the WHO named vaccine hesitancy as one of the ten leading threats to global health. In the US, an increasing number of parents are delaying or declining routinely recommended childhood vaccines. Thus, providers are faced with more patients presenting with fever who are under or unvaccinated. Multiple studies have shown that adequate vaccination with the pneumococcal vaccine has decreased invasive pneumococcal disease including pneumonia, bacteremia, and meningitis. There remains a lack of guidance on the evaluation of the unvaccinated child presenting with fever. Results can help guide evaluation and management of unvaccinated febrile children presenting to the emergency department (ED).

Objective: The objective of this study is to evaluate if the odds of having bacterial meningitis, bacteremia, or pneumonia change based on vaccination status in children 2 to 36 months of age presenting to the ED with fever. While vaccines have decreased the rates of these bacterial infections in children, there is concern that vaccine hesitancy is increasing. As more unvaccinated children present with fever, there remains a lack of guidance for providers on the necessary evaluation. Results of this study can help determine if a more comprehensive fever evaluation is necessary in children 2 to 36 months based on vaccination status.

Design/Methods: This is a single center, case-control study. Subjects include patients between 2 and 36 months of age who presented to the pediatric ED at Maimonides Medical Center with fever who were diagnosed with pneumonia, bacteremia, or bacterial meningitis from January 1, 2021 to December 31, 2024 and their matched counterparts. Exclusion criteria includes patients with immune compromise, patients whose vaccination records cannot be confirmed and those with complex medical history. Data was gathered on demographics, vaccination status, vital signs, lab results, ICD-10 diagnosis, antibiotics administered and disposition. Chart review and the NYS registry was used to confirm vaccination status. Within the next couple of months, we plan on comparing the odds of bacteremia, bacterial meningitis and pneumonia in those who are vaccinated to those who are under or unvaccinated. We plan on utilizing chi squared or Fisher exact testing as the predictor and the outcome variable are categorical. We plan on summarizing continuous variables using medians and interquartile ranges. We plan on using logistic regression to adjust for clinically important factors and confounders.