Published online October 31, 2008
PEDIATRICS Vol. 122 No. 5 November 2008, pp. e1119-e1122 (doi:10.1542/peds.2008-1884)
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EXPERIENCE & REASON

Procalcitonin Levels in Febrile Infants After Recent Immunization

Andrew Dauber, MDa,b, Scott Weiss, MDb,c, Vincenzo Maniaci, MDd, Eric Nylen, MDe,f, Kenneth L. Becker, MD, PhDe,f and Richard Bachur, MDb,c

a Divisions of Endocrinology
c Emergency Medicine
b Department of Medicine, Children's Hospital Boston, Boston, Massachusetts
d Division of Emergency Medicine, Miami Children's Hospital, Miami, Florida
e Division of Endocrinology, Department of Medicine, Veteran's Affairs Medical Center, Washington, DC
f Division of Endocrinology, Department of Medicine, George Washington University Medical Center, Washington, DC

ABSTRACT

BACKGROUND. Procalcitonin has been identified as a useful blood marker of serious bacterial infection in febrile infants. Many infants present with a febrile reaction after receiving immunizations. The effects of immunization on procalcitonin have not been investigated.

METHODS. We performed a prospective observational cohort study at a large, urban pediatric emergency department. Infants ≤90 days of age with fever of ≥38°C were enrolled. Subjects were divided into 3 groups: infants with serious bacterial infection; subjects without serious bacterial infection who received recent (<48 hours) immunizations; and subjects without serious bacterial infection who did not recently receive immunizations. Procalcitonin was measured by using a quantitative immunometric assay.

RESULTS. Over 13 months, procalcitonin was measured for 271 infants. There were 44 (16%) patients with serious bacterial infection, 35 in the recent-immunization group, and 192 in the no-recent-immunization group. The median procalcitonin level for serious bacterial infection was 0.53 ng/mL, for recent immunization was 0.29 ng/mL, and for no recent immunizations was 0.17 ng/mL. Procalcitonin values were elevated for patients with serious bacterial infection compared with patients both with and without recent immunizations. Compared with patients who had no recent immunizations, procalcitonin levels were elevated in patients with recent immunization. Using a cut point of 0.12 ng/mL, the sensitivity of procalcitonin for serious bacterial infection was 96%, specificity was 23%, and negative predictive value was 96%. Two patients with recent immunization who had serious bacterial infection were identified with this cut point.

CONCLUSIONS. Among febrile infants with recent immunization, procalcitonin levels are increased compared with patients with fever and no identified bacterial infection. Despite this increase, procalcitonin can still reliably discriminate infants with serious bacterial infection.

Key Words: fever • infant • immunization • vaccination • procalcitonin

Abbreviations: SBI, serious bacterial infection • RI, recent immunization • NRI, no recent immunization • CI, confidence interval • UTI, urinary tract infection • WBC, white blood cell • NPV, negative predictive value

Accepted Jul 21, 2008.


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