Fever in the Toddler-Aged Child: Old Concerns Replaced With New Ones

The widespread use of highly effective and safe vaccines against Haemophilus influenzae type b and Streptococcus pneumoniae has impacted the epidemiology of serious bacterial illness in the febrile child. Because of the resultant decline in the incidence of invasive pneumococcal disease, one needs to reconsider the evaluation and management of the febrile child. In particular, for well-appearing febrile children who are vaccinated, routine screening for occult bacterial infections with or without empiric treatment can no longer recommended. At the same time, early evidence suggests that infections due to nonvaccine serotypes are increasing along with selected invasive diseases such as complicated pneumonia. Therefore, although likely to evolve, the optimal management strategy for the well-appearing, immunized, febrile child may be screening for urinary tract infections and observation with adequate follow-up. Continued surveillance of disease due to nonvaccine serotypes is essential.