Invasive pneumococcal infections in children with sickle cell disease in the era of penicillin prophylaxis, antibiotic resistance, and 23-valent pneumococcal polysaccharide vaccination.
Rates and severity of pneumococcal infections in children with sickle cell disease were examined before licensure of pneumococcal-conjugated vaccine (PVC). Rates of peak invasive infection rates in 1-year-old children with hemoglobin SS and mortality in those 0 to 10 years of age were 36.5 to 63.4 and 1.4 to 2.8 per 1000 person-years, respectively (>10 and 100 times as frequent as in the general population). Overall, 71% of serotyped isolates (n=80) were PVC serotypes and 71% of nonvaccine serotype strains were penicillin-sensitive. Clinical presentation in children with hemoglobin SS (n=71; more with hypotension) and hemoglobin SC (n=18; more with acute chest syndrome, otitis media) differed. Penicillin nonsusceptibility (38% of isolates) varied between geographic study sites. Penicillin prophylaxis appeared less effective against intermediate and resistant strains. Of all infected children, meningitis developed in 20% and 15% died (hemoglobin SS, n=15 and 11; hemoglobin SC, n=1 each). Factors associated with death included age >4 years (58%), serotype 19F, and not being followed by a hematologist (42% each). The pneumococcal-polysaccharide vaccine was 80.4% effective within 3 years after vaccination (95% CI, 39.7, 93.6). Children with sickle cell disease of all ages may benefit from PVC boosted with polysaccharide vaccination.
Centers for Disease Control and Prevention, and Department of Pediatrics, Emory University School of Medicine, 2040 Ridgewood Drive NE, Atlanta, GA 30333, USA.
Thomas V
TV
Adamkiewicz
Sharada
S
Sarnaik
George R
GR
Buchanan
Rathi V
RV
Iyer
Scott T
ST
Miller
Charles H
CH
Pegelow
Zora R
ZR
Rogers
Elliott
E
Vichinsky
John
J
Elliott
Richard R
RR
Facklam
Katherine L
KL
O'Brien
Benjamin
B
Schwartz
Chris A
CA
Van Beneden
Michael J
MJ
Cannon
James R
JR
Eckman
Harry
H
Keyserling
Kevin
K
Sullivan
Wing-Yen
WY
Wong
Winfred C
WC
Wang
D000755:Anemia, Sickle Cell / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010406:Penicillins / Q000627:therapeutic use*; D011008:Pneumococcal Infections / Q000453:epidemiology* / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000627:therapeutic use; D012307:Risk Factors; D012703:Serotyping
D010406:Penicillins; D022242:Pneumococcal Vaccines