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Occult Pneumococcal Bacteremia: A Review

Joffe, Mark D. MD*†; Alpern, Elizabeth R. MD, MSCE†‡

doi: 10.1097/PEC.0b013e3181e15e36
CME Review Article

Occult bacteremia is primarily caused by Streptococcus pneumoniae and has been an intense clinical controversy in pediatric emergency medicine, with passionate opinions rendered from inside and outside the field. Vaccine development and widespread immunization have rapidly affected the changing epidemiology of this disease. There is a growing consensus that the reduction in incidence of occult bacteremia and the significant problem of antibiotic resistance are tipping the balance in favor of no testing and no treatment for well-appearing febrile children between 6 and 36 months of age who are immunized with Haemophilus influenzae B vaccination and PCV-7 (pneumococcal conjugate vaccine). This review of occult pneumococcal bacteremia will not only elaborate on current knowledge and clinical practice, but will also provide historical context to this fascinating phenomenon.

*Director (Joffe), Community Pediatric Medicine, Children's Hospital of Philadelphia; †Associate Professors (Joffe, Alpern), Division of Emergency Medicine, Department of Pediatrics, University of Pennsylvania School of Medicine; and ‡Children's Hospital of Philadelphia, Philadelphia, PA.

Reprints: Mark D. Joffe, MD, Division of Emergency Medicine, Children's Hospital of Philadelphia, 34th Street and Civic Center Blvd., Philadelphia, PA 19104 (e-mail:

Unless otherwise noted, the staff's and faculty's spouse/life partner (if any) has nothing to disclose.

The authors and all staff in a position to control the content of this CME activity have disclosed that they have no financial relationships with, or financial interests in, any commercial companies pertaining to this educational activity.

© 2010 Lippincott Williams & Wilkins, Inc.