While the Internet is often a vast wasteland of dubious information, there are credible sources out there if you look hard enough. One that I rely on heavily is MedCram, which synthesizes important medical information (primarily for clinicians and medical students) into remarkably clear online lectures.
I've been a fan (and a subscriber) for years, and use it often just to bone up on medical topics I'm interested in. While they have a paid tier, they also have an extensive YouTube Channel with more than 1.5 million subscribers and over 550 of these presentations.
Yesterday Dr. Roger Seheult, MD presented a fascinating 22 minute lecture on `Why it's not always best practice to treat a fever.' A good deal of this lecture deals with a 2022 study on elevated body temperatures and the activation of the innate immune response (link below).
Bruna Los, Marco Preußner, Kathrin Eschke, Ricardo Martin Vidal, Azza Abdelgawad, Didrik Olofsson, Sandra Keiper, Margarida Paulo-Pedro, Alica Grindel, Stefan Meinke ... Show more
Nucleic Acids Research, Volume 50, Issue 12, 8 July 2022, Pages 6769–6785, https://doi.org/10.1093/nar/gkac513
This, long-time readers will recall, is a debate we've visited numerous times in the past. Both in terms of treating fevers from viral infections, and fevers following vaccination.
- In 2010’s A Hot Topic For Further Research we saw a retrospective analysis in the Journal of the Royal Society of Medicine showing the risk of mortality increased by roughly 33% when antipyretics (aspirin, paracetamol, and diclofenac) were used in influenza infected (non-human) animals.
- A year later, in A Feverish Debate, the Wellington based Medical Research Institute of New Zealand, published a paper (Antipyretic therapy for influenza infection—benefit or harm?) in the New Zealand Medical Journal that questioned the conventional wisdom of using these drugs with influenza.
- Also from 2011 - the American Academy of Pediatrics (AAP) released a report on the use of antipyretics in children, suggesting that we ought not over-treat fevers (Clinical Report—Fever and Antipyretic Use in Children)
- And in 2013, in Adding To A Feverish Debate, we looked at a study in the Journal of Pediatrics on another possible (albeit, rare) adverse effect seen in a small number of young children with fever and dehydration at a hospital in Indiana who received treatment with NSAIDs - AKI or Acute Kidney Injury.
- In 2016, French researchers released a study in the Journal of Pediatrics (Nonsteroidal Anti-Inflammatory Drug without Antibiotics for Acute Viral Infection Increases the Empyema Risk in Children: A Matched Case-Control Study), which found an increased risk of Empyema (bacterial lung infection) in children receiving NSAIDS for viral infections.
Over the years we've seen some studies suggesting that taking analgesics following vaccination may blunt the recipient's immune response, but the evidence remains mixed.
A little over a year ago, in No Evidence That Analgesic Use after COVID-19 Vaccination Negatively Impacts Antibody Responses, the authors even suggested promoting their use might improve uptake of booster immunizations. Whether that applies across the board is unknown.
What about medications for fever?Should I give my child medication prior to a vaccine visit to prevent fever after vaccination?
No. Giving medication prior to a vaccine visit is not recommended because they may decrease the child’s immune response to the vaccine. Studies of patients who got fever-reducing medication prior to vaccination had lower antibody responses compared with patients that did not receive medicine, suggesting that their immune response to the vaccine was lower as a result of reducing the fever.
Should I give my child medication to treat a fever after vaccination or during illness?
In most cases a child does not need to be medicated for a fever unless they are extremely uncomfortable. The most important thing to do when a child has a fever is to make sure they stay hydrated by drinking plenty of fluids. If you are not sure whether the child should get medicine to address fever or other symptoms, talk to your child’s healthcare provider.