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

Journal Article (Journal Article;Multicenter Study)

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.

Full Text

Duke Authors

Cited Authors

  • Adamkiewicz, TV; Sarnaik, S; Buchanan, GR; Iyer, RV; Miller, ST; Pegelow, CH; Rogers, ZR; Vichinsky, E; Elliott, J; Facklam, RR; O'Brien, KL; Schwartz, B; Van Beneden, CA; Cannon, MJ; Eckman, JR; Keyserling, H; Sullivan, K; Wong, W-Y; Wang, WC

Published Date

  • October 1, 2003

Published In

Volume / Issue

  • 143 / 4

Start / End Page

  • 438 - 444

PubMed ID

  • 14571216

International Standard Serial Number (ISSN)

  • 0022-3476

Digital Object Identifier (DOI)

  • 10.1067/S0022-3476(03)00331-7


  • eng

Conference Location

  • United States