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.
Adamkiewicz
Thomas V
TV
Centers for Disease Control and Prevention, and Department of Pediatrics, Emory University School of Medicine, 2040 Ridgewood Drive NE, Atlanta, GA 30333, USA.
Sarnaik
Sharada
S
Buchanan
George R
GR
Iyer
Rathi V
RV
Miller
Scott T
ST
Pegelow
Charles H
CH
Rogers
Zora R
ZR
Vichinsky
Elliott
E
Elliott
John
J
Facklam
Richard R
RR
O'Brien
Katherine L
KL
Schwartz
Benjamin
B
Van Beneden
Chris A
CA
Cannon
Michael J
MJ
Eckman
James R
JR
Keyserling
Harry
H
Sullivan
Kevin
K
Wong
Wing-Yen
WY
Wang
Winfred C
WC
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