Infection Control & Hospital Epidemiology Discussion
Fever PIV is a recognized adverse event, but the rate remains low in both outpatient and inpatient settings.5–8 In our cohort, the incidence of fever PIV during hospitalization was 1.5%, which is consistent with a previously published range of 1.5%–2.0%.7,8 A prospective study found similar self-reported fever PIV among hospitalized (2%) and clinic patients (2%).7 Tartof et al8 reported that 1.5% of hospitalized surgical patients had a postdischarge fever following vaccination, versus 1.1% of unvaccinated patients. It is often assumed that a fever PIV is generally due to vaccination
itself.However, no studies have investigated the etiologies of fever PIV. Kohl et al10 suggested evaluating patients with fever PIVfor alternative explanations. Most febrile episodes in our cohort were attributable to concomitant infections, benign postoperative fever, or central fever. Only 1 medical patient had a postvaccination fever without an alternativeexplanation. Fever duetoinfection was morecommon among medical patients; 75% of these patients in our cohort were admitted because of an infection. Although elective surgical patients were more likely to develop
perioperative fever within 48 hours PIV compared with nonelective surgical subgroup, there was no increase in the proportion undergoing additional evaluation for infection. Our finding is consistent with a previous study.8 The length of hospital stay was longer in the nonelective surgical subgroup, which was more likely due to the complexity of their underlying medical conditions. The limitations of our study include retrospective analysis in a
single institution, with a single vaccine manufacturer during a single influenza season. Therefore, our findings may not be generalizable to other populations. Because our data only inclu- ded fever within the first 48 hours postvaccination, we may have missed patients who developed fever after 48 hours. This is the first study examining the incidence and etiologies of
fever within 48 hours PIV among an inpatient population. Our data suggest that incidence of fever PIV in hospitalized patients was low and was primarily caused by concurrent infectious pro- cesses and other noninfectious causes rather than influenza vac- cination itself.
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Acknowledgments. None. Financial support. No financial support was provided relevant to this article.
Conflicts of interest. All authors report no conflicts of interest relevant to this article.
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6. Dunkle LM, Izikson R, Patriarca PA, Goldenthal KL, Muse D, Cox MMJ. Randomized comparison of immunogenicity and safety of quadrivalent recombinant versus inactivated influenza vaccine in healthy adults 18–49 years of age. J Infect Dis 2017;216:1219–1226.
7. Berry BB, Ehlert DA, Battiola RJ, Sedmak G. Influenza vaccination is safe and immunogenic when administered to hospitalized patients. Vaccine 2001;19:3493–3498.
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