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Thanks, Daniel. Acknowledging the relative lack of evidence specific to this cohort of patients, the overwhelming practice at most children's hospitals has been to manage these children the same as a vaccinated child, with good outcomes for many years now. Occult bacteremia has become a relative non-issue, in that the rate of spontaneous resolution is very high and the rate of adverse outcome is exceptionally low. A good clinical exam with detailed anticipatory guidance, return instructions, and outpatient follow up should suffice for nearly all well-appearing febrile children (non-neonates), regardless of the individual patient's vaccination status (provided that community vaccination rates remain high enough to maintain herd immunity).
i hope this doesn't sound too sanctimonious; i apologize if it does. i was a little taken aback by the comment, " a punitive needle stick." i imagine there are many professionals just starting their careers that listen to your great segment.the comment seemed really odd. i recall 30 + years ago that NG tubes ( or worse ewald tubes ) being thought of as a a deterrent for the typically- teenage suicide gesture.anyway, thanks for the usual useful info.ewk
I definitely apologize for coming across in that fashion, and I appreciate your perspective. When Al and I are bantering, sometimes I do forget others are listening! But, to be honest, this isn't one of those times. Your point is a good one, and one I think a lot of us needed to think about. It's OK for people to be human and angry at families for not vaccinating. But we do need to think about why we are doing it. It may be a true fear of invasive bacterial disease for some, but it is a question we all need to ask ourselves. Perhaps I could have started that conversation more effectively, but I did start it. :)
What you do matters.