The study by Carstairs has one of the largest N I have seen which stratifies somewhat by vaccine status.
The pneumococcal bacteremia rate - 1 or more vaccine group is 0/833,
0% 95%CI (0-0.8%)
-The pneumococcal bacteremia rate - no vaccine group is 13/550,
2.4% 95%CI (1.4-3.3%)
The high end of the 95% CI for 1 or more vaccines is still close to a 1%
No one has a large enough study to compare 0 v 1 v 2 v 3 vaccines.
So I would be cautious (agree with Jim Chamberlain) of extending the practice of not obtaining a blood culture to the 2-4 mo (1 vaccine) age group.
Pediatrics and Emergency Medicine
NYU School of Medicine
Bellevue Hospital Center
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