to develop serious bacterial infections such as septic arthritis, osteomyelitis, meningitis, or sepsis Historically, some febrile children, to 24 months of age, with temperatures greater than 39°C (102°F) and no clear source of infection were evaluated with a CBC and blood culture for risk of occult bacteremia The WBC count was used by some to determine the risk of occult bacteremia and guide empiric antibiotic use However, as the risk of occult bacteremia has decreased, the previous strategy of screening has become less valuable As mentioned previously, with the licensure of the PCV, rates of invasive pneumococcal infections including occult bacteremia have decreased Studies from the post-Hib vaccine and post-PCV era indicate the risk of occult bacteremia in immunized children to be less than 1% Currently, in an immunized population, a detailed history and physical examination and close follow-up are advocated over screening laboratory evaluations Additional laboratory testing in children to 24 months of age who are well appearing without focal source of fever is not recommended Rapid viral testing may be helpful in evaluating patients with specific symptoms or signs of a viral illness and complex medical situations, but in general is not indicated in most children without significant comorbidities Several recent investigations have shown a decreased risk of bacterial infections with positive rapid tests for specific viruses As technology for viral testing becomes more rapid, more accurate, and most cost-effective, there will likely be a growing role for rapid viral testing in decision making, including need for additional testing and antimicrobial therapy, for certain clinical scenarios Despite positive viral tests, children should be evaluated for secondary bacterial infection through careful examination, especially those patients who have an atypical course based on their duration or severity of their symptoms Caution should be taken when interpreting results of rapid antigen tests for influenza, which have been shown to have poor sensitivity and positive predictive value, particularly when clinical suspicion of disease is high Newer generation PCR-based tests for influenza have substantially higher sensitivity and specificity, close to 100%; thus, it is important to understand the test characteristics of the test used when making clinical decisions Children older than 24 months of age can usually be managed on the basis of degree of irritability, evidence of meningeal signs, and/or other foci of infection found on history and physical examination These children need not be screened routinely for occult bacteremia or other occult infections After excluding meningitis, there are several important infections that may be present in illappearing, febrile children in this age group, without obvious initial focus These