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, 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

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87 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)438-444
Number of pages7
JournalJournal of Pediatrics
Volume143
Issue number4
DOIs
StatePublished - Oct 2003

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ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Adamkiewicz, T. V., Sarnaik, S., Buchanan, G. R., Iyer, R. V., Miller, S. T., Pegelow, C. H., Rogers, Z. R., Vichinsky, E., Elliott, J., Facklam, R. R., O'Brien, K. L., Schwartz, B., Van Beneden, C. A., Cannon, M. J., Eckman, J. R., Keyserling, H., Sullivan, K., Wong, W. Y., & Wang, W. C. (2003). Invasive pneumococcal infections in children with sickle cell disease in the era of penicillin prophylaxis, antibiotic resistance, and 23-valent pneumococcal polysaccharide vaccination. Journal of Pediatrics, 143(4), 438-444. https://doi.org/10.1067/S0022-3476(03)00331-7