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Journal Article Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't Ppublish 14 citations

PubMed: 37698500 DOI: 10.1182/bloodadvances.2022009643

Pneumococcal infections in children with sickle cell disease before and after pneumococcal conjugate vaccines.

Blood Adv 7(21):6751-6761

Authors: Thomas V Adamkiewicz, Marianne E M Yee, Stepy Thomas, Amy Tunali, Kristina W Lai, Folashade S Omole, Peter A Lane, Inci Yildirim

Affiliations

  • Department of Family Medicine, Morehouse School of Medicine, Atlanta, GA.
  • Department of Pediatrics, Emory University School of Medicine, Atlanta, GA.
  • Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA.
  • Department of Medicine, Emory University School of Medicine, Atlanta, GA.
  • Georgia Emerging Infections Program, Atlanta, GA.
  • Atlanta Veterans Administration Health System, Decatur, GA.
  • University of California, Davis, CA.
  • Department of Pediatrics, Yale University School of Medicine, New Haven, CT.
  • Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT.
  • Yale Center for Infection and Immunity, Yale Institute of Global Health, New Haven, CT.

Abstract

Children with sickle cell disease (SCD) are at increased risk of invasive pneumococcal disease (IPD). Over 25 years, the Georgia Emerging Infections Program/Centers for Disease Control and Prevention Active Bacterial Core Surveillance network identified 104 IPD episodes among 3707 children with hemoglobin SS (HbSS) or HbSC aged <10 years, representing 6% of IPD in Black or African American children residing in Metropolitan Atlanta (reference population). Children with IPD and HbSS/SC were older than those with IPD in the reference population (P < .001). From 1994-1999 to 2010-2018, IPD declined by 87% in children with HbSS aged 0 to 4 years, and by 80% in those aged 5 to 9 years. However, IPD incidence rate ratios when comparing children with SCD with the reference population increased from 20.2 to 29.2 over these periods. Among children with HbSS and IPD, death declined from 14% to 3% after 2002, and meningitis declined from 16% to 8%. Penicillin resistance was more prevalent in children with SCD before 7-valent pneumococcal conjugate vaccine (PCV7) licensure. After 2010, all IPD serotypes were not included in the 13-valent PCV (PCV13). Within 3 years of vaccination, the effectiveness of the 23-valent pneumococcal polysaccharide vaccine (PPSV23) against non-PCV13 serotypes included in PPSV23 plus 15A/15C was 92% (95% confidence interval, 40.8- 99.0, P = .014; indirect-cohort effect adjusted for age and hydroxyurea). PPSV23 would cover 62% of non-PCV13 serotype IPD in children with SCD, whereas PCV15, PCV20, and PCV21/V116 (in development) could cover 16%, 51%, and 92%, respectively. Although less frequent, IPD remains a life-threatening risk in children with SCD. Effective vaccines with broader coverage could benefit these children.

MeSH

Cells, Pneumococcal Infections, Vaccines, Anemia, Sickle Cell, Incidence, Vaccines, Conjugate, Aged, Centers For Disease Control And Prevention, U.S., Hematologic Diseases, Infections, Child

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