Precipitating Factors The significant precipitating risk factors for FS include the degree of fever20 and
the frequency of febrile illnesses.21 The most commonly reported febrile illnesses are upper respiratory tract infections and otitis media.10 Children with primary infec tion with human herpes virus-6 (HHV6) often develop FS.2 The pattern of the underlying febrile illness is similar in both developed and developing countries.10,26 However, certain infections like exanthematous fevers and malaria are still endemic in the developing countries. In Central Africa, malaria accounts for five per cent of pediatric emergencies.27,28 Vivax malaria is a frequent cause of typical FS in the endemic regions and FS can be the presenting feature of Falciparum malaria.14,27
FS following immunization is well known. The significance of immunization as a risk factor for FS has been the focus of debate. However meta-analysis of the data suggests diphtheria-tetanus-pertussis (DTP) vaccination is associated with a relative risk of FS.29 FS following immunization has the highest incidence at the age when children are most susceptible to seizures from febrile illnesses of any cause.30 The risk to develop FS is high in children with a family history of seizures.31 Though there is a small risk of FS following immunization, the benefits of vaccination with DTP and MMR vaccines should not be deprived to children in the regions endemic to these diseases.