{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T02:11:50Z","timestamp":1792635110350,"version":"4.5.0"},"reference-count":43,"publisher":"American Academy of Pediatrics (AAP)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,4,1]]},"abstract":"\n BACKGROUND AND OBJECTIVES:<\/jats:title>\n In June 2010, Kaiser Permanente Northern California replaced all 7-valent pneumococcal conjugate vaccine (PCV7) vaccines with the 13-valent pneumococcal conjugate vaccine (PCV13). Our objectives were to compare the incidence of bacteremia in children 3 to 36 months old by 3 time periods: pre-PCV7, post-PCV7\/pre-PCV13, and post-PCV13.<\/jats:p>\n <\/jats:sec>\n \n METHODS:<\/jats:title>\n We designed a retrospective review of the electronic medical records of all blood cultures collected on children 3 to 36 months old at Kaiser Permanente Northern California from September 1, 1998 to August 31, 2014 in outpatient clinics, in emergency departments, and in the first 24 hours of hospitalization.<\/jats:p>\n <\/jats:sec>\n \n RESULTS:<\/jats:title>\n During the study period, 57\u2009733 blood cultures were collected in the population of children 3 to 36 months old. Implementation of routine immunization with the pneumococcal conjugate vaccine resulted in a 95.3% reduction of Streptococcus pneumoniae bacteremia, decreasing from 74.5 to 10 to 3.5 per 100\u2009000 children per year by the post-PCV13 period. As pneumococcal rates decreased, Escherichia coli, Salmonella spp, and Staphylococcus aureus caused 77% of bacteremia. Seventy-six percent of all bacteremia in the post-PCV13 period occurred with a source.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS:<\/jats:title>\n In the United States, routine immunizations have made bacteremia in the previously healthy toddler a rare event. As the incidence of pneumococcal bacteremia has decreased, E coli, Salmonella spp, and S aureus have increased in relative importance. New guidelines are needed to approach the previously healthy febrile toddler in the outpatient setting.<\/jats:p>\n <\/jats:sec>","DOI":"10.1542\/peds.2016-2098","type":"journal-article","created":{"date-parts":[[2017,3,10]],"date-time":"2017-03-10T10:10:20Z","timestamp":1489140620000},"source":"Crossref","is-referenced-by-count":53,"title":["Bacteremia in Children 3 to 36 Months Old After Introduction of Conjugated Pneumococcal Vaccines"],"prefix":"10.1542","volume":"139","author":[{"given":"Tara L.","family":"Greenhow","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Department of Pediatrics, Kaiser Permanente Northern California, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun-Yi","family":"Hung","sequence":"additional","affiliation":[{"name":"Division of Research, Kaiser Permanente Northern California, Oakland, California; 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