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Is the use of prophylactic paracetamol to prevent febrile reactions justified in hospitalised ex preterm infants receiving the new Meningitis B (Bexero) vaccination?

Presented as a poster at the Neonatal Society 2016 Summer Meeting.

Dubus M, Vasu V

East Kent Hospitals University NHS Foundation Trust, Department of Neonatal Medicine, William Harvey Hospital, Ashford, Kent, TN24 0LZ

Background: The new Meningitis B vaccine (Bexsero) is a welcome addition to the routine vaccine schedule in the UK. Given the increase in frequency of febrile reactions following administration of this vaccine in term infants, Public Health England recommend that 3 doses of oral paracetamol should be administered prophylactically in infants aged 8 weeks to under 12 months of age (1). However, there is little data to guide clinician’s on whether prophylactic use of paracetamol in ex preterm infants, many of whom will be resident on neonatal units, is of benefit.

Methods: We conducted a retrospective note review of all babies under 37 weeks gestation, who had received vaccinations at the William Harvey Hospital, Ashford, Kent for the period between September 2014 – March 2016 (covering the year prior to the introduction of Bexsero and 6 months post-introduction). Data regarding type of vaccination and adverse events in the 48 hours post vaccination were collected.

Results: 45 vaccination episodes were identified (1 was excluded due to incomplete data). Our data indicated that Bexero containing vaccine schedules were associated with a higher proportion of adverse events as shown in Table 1.

Is the use of prophylactic paracetamol to prevent febrile reactions justified in hospitalised ex preterm infants receiving the new Meningitis B (Bexero) vaccination?

Conclusion: Our data suggest that the post-Bexero febrile response evident in term infants may also be a problem in ex-preterm infants on neonatal units, particularly in respect to the need for partial septic screens and antibiotics. Our data needs replicating and future research should explore whether prophylactic paracetamol ameliorates the incidence of post Bexero adverse events.

Corresponding author: vimal.vasu@nhs.net

References
1. Public Health England (2015) Clinical Guidance on Immunisation of Infants against Meningococcal B Disease [Online], London. Available athttps://www.gov.uk/government/uploads/system/uploads/attachment_data/file/437906/150622_MenB_bipartite_letter.pdf(Accessed 16 May 2016).

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