Infection Control & Hospital Epidemiology (2019), 40, 235–237 doi:10.1017/ice.2018.316


Concise Communication


Incidence and etiology of fever following seasonal influenza vaccination in hospitalized patients


Kap Sum Foong MD1, Ed Casabar PharmD2 and David K. Warren MD, MPH1 1Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri and 2Department of Pharmacy, Washington University School of Medicine, St Louis, Missouri


Abstract


We conducted a retrospective cohort to examine the incidence and etiology of fever postinfluenza vaccination among hospitalized patients during the 2015–2016 influenza season. Fever occurred in 63 (1.5%) of 4,185 vaccinated patients. Medical patients had fever predominantly associated with concurrent infections; surgical patients had fever explained by noninfectious etiologies.


(Received 29 August 2018; accepted 9 November 2018; electronically published 7 December 2018)


Influenza vaccination is an important strategy for preventing influenza infection and its sequelae. Traditionally, the rate of influenza vaccination in hospitalized patients has been low, ran- ging from 9.6% to 40.3%.1,2 This is partly due to provider con- cerns regarding influenza vaccine safety and immunogenicity among hospitalized patients with acute illnesses.3,4 There is also a concern of postvaccination fever resulting in additional, unwar- ranted diagnostic evaluations.2 The rate of postvaccination fever in the adult outpatient population is low, ranging from 0.4% to 1.5%.5,6 Several studies have found no evidence of increased vaccine-


associated adverse events in hospitalized surgical patients who received influenza immunization.7,8 However, these studies asses- sed only postdischarge fever. Data regarding the incidence and causes of fever postinfluenza vaccination (PIV) among hospitalized patients while still in the hospital are limited. Understanding PIV fever is important for improving clinician acceptance of in-hospital vaccination programs and compliance with government quality measures for influenza vaccination.


Methods


We performed a retrospective cohort study at Barnes-Jewish Hospital, a 1,250-bed teaching hospital, during the 2015–2016 influenza season. All patients aged≥18 years who received influenza vaccination during their hospitalization were identified by querying the medical informatics database. Postinfluenza vaccination fever was defined as a recorded body temperature of ≥38.3°C within 48 hours after vaccination. Other collected data


Author for correspondence: Kap Sum Foong MD, Department ofMedicine, Division


of Infectious Diseases, Washington University School of Medicine, 4523 Clayton Ave, St Louis, MO 63110. E-mail: KapSumFoong@wustl.edu


Cite this article: Foong KS, et al. (2019). Incidence and etiology of fever following


seasonal influenza vaccination in hospitalized patients. Infection Control & Hospital Epidemiology 2019, 40, 235–237. doi: 10.1017/ice.2018.316


© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. Statistical analysis


Demographic and baseline characteristics were described in number (percentage) for categorical variables and median (interquartile range,


included patient demographics, admission diagnosis, date and time of vaccination and fever onset, any perioperative fever <48 hours postprocedure, and any clinical laboratory evaluations for infections (including blood cultures, urinalysis, urine culture, and chest plain radiograph). A concomitant source of infection was defined by a documented diagnosis of infection (subcategorized into pulmonary, cardiovascular, gastrointestinal, genitourinary, skin and soft tissue, bone and joint, primary bacteremia, and febrile neutropenia) and whether the patient received a course of anti- microbial therapy for≥4days. The causes of fever were classified into infectious and non-


infectious. Fever was attributed to infection when a concomitant source of infection was present as defined above. Noninfectious etiology of fever included benign postoperative fever, central fever, vaccine-associated fever, and others. Benign postoperative fever was defined as a fever <48 hours after surgery, without clinical signs of infection, with negative infectious workup and/or no antibiotic prescription.9 Central fever was classified as fever occurring <72 hours of hospitalization in patients with subarachnoid hemorrhage, intraventricular hemorrhage, or tumor and without documented diagnosis of infection or sepsis syndrome. Vaccine- associated fever was defined as fever <48 hours PIV without other identifiable infectious and noninfectious (eg, acute pancreatitis, myocardial infection) causes for fever. During the study period, our institution administered Fluzone


quadrivalent (Sanofi Pasteur, Swiftwater, PA) and Fluzone high-dose (Sanofi Pasteur, Swiftwater, PA) vaccine to patients aged 18–64 and≥65 years, respectively. All inpatients were screened for influenza vaccine status by nurses and vaccinated if indicated and consent was obtained. This procedure followed the Centers for Medicare and Medicaid Ser- vices Influenza Immunization Core Measure (IMM-2).


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