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Aim: To document the clinical features and management of infants presenting with fever after their first meningococcal B vaccination and develop guidance for clinicians.Methods: A prospective case series over 12 months was conducted in a tertiary paediatric hospital. Infants ≤3 months of age with fever who had received their first set of immunisations within the preceding 72 h were included.Results: A total of 92 infants met the inclusion criteria, accounting for 0.78% of the local vaccinated population. The most commonly described associated features were poor feeding, sleepiness and irritability; 66 patients (72%) were admitted to hospital. Median C-reactive protein (CRP) was 12 mg/L, and median white cell count (WCC) was 16 × 109 /L. Fifteen patients (16%) had a lumbar puncture and were commenced on antibiotics. There was one confirmed bacterial infection in an infant who had presented with fever starting 54 h after immunisation. All other microbiology samples were negative. There were no cases of missed serious bacterial infection (SBI) in those patients who were observed or discharged.Conclusions: The routine investigation of infants presenting with post-immunisation fever is not warranted if the infant appears otherwise well on examination. Where other common associated features are present or there is clinical concern, a period of observation is a prudent course of action. Paracetamol should be given peri-immunisation as per the national guidance. We suggest selective use of investigations, especially inflammatory markers, which are unlikely to discriminate between SBI and post-immunisation response. We advocate extra caution in infants presenting with fever more than 48 h after immunisation. [ABSTRACT FROM AUTHOR]

Highlights • Awareness of MenB vaccines is lacking among parents of teenagers in the US. • Awareness of MenB vaccines was strongly associated with vaccine willingness. • Concern about meningitis was also strongly associated with vaccine willingness. • Parents want more information from their physicians about meningococcal vaccines. Abstract Background In the US, Meningococcal B (MenB) vaccines were first licensed in 2014. In 2015, the Advisory Committee on Immunization Practices recommended that parents of teens talk to their provider about receiving MenB vaccine, rather than issuing a routine recommendation. We assessed parental awareness of MenB vaccines and willingness to vaccinate their teens with MenB vaccines compared to MenACWY vaccines, which have been routinely recommended for many years. Methods We surveyed parents of teens attending high school in 2017–18 during the Minnesota State Fair. Parents reported via iPad their knowledge of and concern about meningococcal disease and their awareness of and willingness to vaccinate with MenB and MenACWY vaccines. We assessed the relationship between meningococcal disease knowledge and concern, MenB and MenACWY vaccine awareness, and willingness to vaccinate with MenB and MenACWY using adjusted logistic regression. Results Among 445 parents, the majority had not heard of the newly introduced MenB vaccines Bexsero® (80.0%; 95% CI: 76.0–83.6) or Trumenba® (82.0%; 95% CI: 78.1–85.5) or the MenACWY vaccines Menactra® or Menveo® (68.8%; 95% CI: 64.2–73.0). The majority were at least somewhat willing to vaccinate their teen with MenB vaccine (89.6%; 95% CI: 86.5, 92.3) and MenACWY vaccine (91.2%; 95% CI: 88.2, 93.7). Awareness of MenB vaccines (OR: 3.8; 95% CI: 1.2–12.2) and concern about meningococcal disease (OR: 3.1; 95% CI: 1.5–6.3) were significantly associated with willingness to vaccinate with MenB vaccine. Conclusions Awareness of MenB vaccine is lacking among parents of teens but is an important predictor of willingness to vaccinate with the newly licensed MenB vaccines. [ABSTRACT FROM AUTHOR]

Highlights: [•] Parents and community are strongly supportive of the introduction of Men B vaccines. [•] Potential local reaction or fever minimally impact Men B vaccine acceptance. [•] Family physician recommendation is strongest predictor of Men B vaccine acceptance. [Copyright &y& Elsevier]

The author conveys his thoughts on the implications for funding decisions on vaccines to prevent severe early-infant infections. Topics mentioned include maternal pertussis programs in high-income regions and countries, the change from whole-cell to acellular pertussis vaccines in 2012, and the call for a broader field of vision in vaccine funding decisions.