<br /> This episode of PEM Currents: The Pediatric Emergency Medicine Podcast focuses on the approach to unvaccinated or undervaccinated children aged 3–36 months presenting to the ED with fever. Host Brad Sobolewski reviews differences in immune response, risk for serious and invasive bacterial infections, and outlines evaluation strategies including labs, imaging, and empiric antibiotics. He highlights data showing increased interventions in this population and calls for local guideline development. The episode emphasizes thoughtful, individualized care in the context of rising vaccine hesitancy and declining immunization rates.<br /> <br /> <br /> <br /> Learning Objectives<br /> <br /> <br /> <br /> <br /> * Compare the clinical presentation of bacterial infections in unvaccinated and undervaccinated children versus fully immunized children in the Emergency Department<br /> <br /> <br /> <br /> * Assess the need for empiric antibiotics and diagnostic testing in an unvaccinated or undervaccinated child presenting with fever without source<br /> <br /> <br /> <br /> * <br /> <br /> <br /> <br /> <br /> Connect with Brad Sobolewski<br /> <br /> <br /> <br /> PEMBlog: <a href="https://pemblog.com/">PEMBlog.com</a><br /> <br /> <br /> <br /> Blue Sky: <a href="https://bsky.app/profile/bradsobo.bsky.social">@bradsobo</a><br /> <br /> <br /> <br /> X (Twitter): <a href="https://x.com/PEMTweets">@PEMTweets</a><br /> <br /> <br /> <br /> Instagram: <a href="https://www.instagram.com/bradsobolewski">Brad Sobolewski</a><br /> <br /> <br /> <br /> Mastodon: <a href="https://mastodon.social/@bradsobo">@bradsobo</a><br /> <br /> <br /> <br /> References<br /> <br /> <br /> <br /> Curtis M, Kanis J, Wagers B, et al. Immunization status and the management of febrile children in the pediatric emergency department: what are we doing? Pediatr Emerg Care. 2023;39(1):1-5. doi:10.1097/PEC.0000000000002864<br /> <br /> <br /> <br /> Finkel L, Ospina-Jimenez C, Byers M, Eilbert W. Fever without source in unvaccinated children aged 3 to 24 months: what workup is recommended? Pediatr Emerg Care. 2021;37(12):e882-e885. doi:10.1097/PEC.0000000000002249<br /> <br /> <br /> <br /> Herz AM, Greenhow TL, Alcantara J, et al. Changing epidemiology of outpatient bacteremia in 3- to 36-month-old children after the introduction of the heptavalent-conjugated pneumococcal vaccine. Pediatr Infect Dis J. 2006;25(4):293-300. doi:10.1097/01.inf.0000207485.39112.bf<br /> <br /> <br /> <br /> Kaufman J, Fitzpatrick P, Tosif S, et al. Faster clean catch urine collection (Quick-Wee method) from infants: randomised controlled trial. BMJ. 2017;357:j1341. doi:10.1136/bmj.j1341<br /> <br /> <br /> <br /> Kuppermann N, Fleisher GR, Jaffe DM. Predictors of occult pneumococcal bacteremia in young febrile children. Ann Emerg Med. 1998;31(6):679-687. doi:10.1016/S0196-0644(98)70225-2<br /> <br /> <br /> <br /> Rutman MS, Bachur R, Harper MB. Radiographic pneumonia in young, highly febrile children with leukocytosis before and after universal conjugate pneumococcal vaccination. Pediatr Emerg Care. 2009;25(1):1-7. doi:10.1097/PEC.0b013e318191dab2<br /> <br /> <br /> <br /> Trippella G, Galli L, De Martino M, Lisi C, Chiappini E. Procalcitonin performance in detecting serious and invasive bacterial infections in children with fever without apparent source: a systematic review and meta-analysis. Expert Rev Anti Infect Ther. 2017;15(