Post-immunisation pyrexia
Consultation guide for UK community pharmacy: clinical features, referral criteria, time frame to resolution and management strategy.
Clinical features
- Body temperature above normal
- Infant's face feels hot to the touch and they look red or flushed
Referral criteria
- Fever of 39C or above at any time
- Fever lasting longer than 48 hours after vaccination. For appointments that do not include MenB (in the routine infant schedule, the 16-week appointment), BNFC states one 2.5mL dose of paracetamol followed by a further 2.5mL dose 4 to 6 hours later, with referral to the GP if fever persists after the second dose. This does not apply after MenB vaccination (given at 8 and 12 weeks), where UKHSA advises 3 doses of 2.5mL and states that paracetamol may be continued for up to 48 hours after vaccination without seeking medical advice
Time frame to resolution
- Post-immunisation pyrexia normally lasts 1-2 days after vaccination
Management strategy
Non-pharmacological advice
- Be vigilant regarding signs of dehydration (poor urine output, dry mouth, no tears, sunken eyes, general appearance poor, cold extremities and low skin turgor) and if present, seek medical advice
- NICE does not advocate the use of tepid sponging or bathing to reduce temperature
- Dress child appropriately to avoid overheating or shivering
- Give regular fluids
- Seek further medical advice if referral criteria develop (see referral criteria)
Pharmacological advice
- Meningitis B (the 8-week and 12-week vaccinations): MenB (Bexsero) is given at the first and second immunisation appointments, at 8 and 12 weeks of age. When these first two MenB vaccines are administered, 3 doses of infant paracetamol suspension 120 mg/5 ml are advised — 2.5 ml (60 mg) as soon as possible after vaccination, a second 2.5 ml dose 4 to 6 hours later, and a third 2.5 ml dose 4 to 6 hours after that. If fever persists in the 48 hours after vaccination and the baby is otherwise well, the same 2.5 ml dose can be continued, leaving at least 4 hours between doses and never exceeding 4 doses in any 24-hour period. Prophylactic paracetamol is not routinely needed after the MenB booster at 12 months, when the risk of fever is the same as after other vaccines (UKHSA: Using paracetamol to prevent and treat fever after MenB vaccination). Please note: this dosing and/or immediate use prior to the presentation of any fever (or distress) may be outside of some manufacturers' marketing authorisations and the advice in BNFC
- Other childhood vaccinations: paracetamol or ibuprofen can be administered at doses and dosing frequencies within the product licence and in keeping with NICE guidance on the treatment of fever. For appointments that do not include MenB — in the routine infant schedule this is the 16-week appointment (6-in-1 and PCV) — BNFC states one 2.5mL dose of paracetamol, followed by a further 2.5mL dose 4 to 6 hours later, and referral to the GP if fever persists after the second dose. This '2-dose then refer' advice does not apply after a MenB vaccination: UKHSA advises 3 doses at 8 and 12 weeks, continued if needed for up to 48 hours without seeking medical advice (see the MenB bullet above)