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Multicenter Study
. 2003 Oct;143(4):438-44.
doi: 10.1067/S0022-3476(03)00331-7.

Invasive pneumococcal infections in children with sickle cell disease in the era of penicillin prophylaxis, antibiotic resistance, and 23-valent pneumococcal polysaccharide vaccination

Thomas V Adamkiewicz  1 , Sharada Sarnaik, George R Buchanan, Rathi V Iyer, Scott T Miller, Charles H Pegelow, Zora R Rogers, Elliott Vichinsky, John Elliott, Richard R Facklam, Katherine L O'Brien, Benjamin Schwartz, Chris A Van Beneden, Michael J Cannon, James R Eckman, Harry Keyserling, Kevin Sullivan, Wing-Yen Wong, Winfred C Wang
Affiliations
Multicenter Study

Invasive pneumococcal infections in children with sickle cell disease in the era of penicillin prophylaxis, antibiotic resistance, and 23-valent pneumococcal polysaccharide vaccination

Thomas V Adamkiewicz et al. J Pediatr. 2003 Oct.

Erratum in

  • J Pediatr. 2004 Mar;144(3):412

Abstract

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.

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