Invasive Pneumococcal Disease in Children With Sickle Cell Anemia

Abstract

Research Article| November 01 2017 Invasive Pneumococcal Disease in Children With Sickle Cell Anemia AAP Grand Rounds (2017) 38 (5): 57. https://doi.org/10.1542/gr.38-5-57 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Invasive Pneumococcal Disease in Children With Sickle Cell Anemia. AAP Grand Rounds November 2017; 38 (5): 57. https://doi.org/10.1542/gr.38-5-57 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: invasive pneumococcal disease, sickle cell anemia Source: Martin OO, Moquist KL, Hennessy JM, et al. Invasive pneumococcal disease in children with sickle cell disease in the pneumococcal conjugate vaccine era. Pediatr Blood Cancer. 2017 4 July [published online ahead of print]; doi: https://doi.org/10.1002/pbc.26713Google Scholar Investigators from Michigan State University, Flint, MI, and Children’s Hospitals and Clinics of Minnesota (CHCM), Minneapolis, MN, conducted a retrospective study to assess trends in invasive pneumococcal disease (IPD) among children with sickle cell disease (SCD) in the era of universal pneumococcal immunization for young children. For the study, they reviewed medical records and microbiological databases at CHCM to identify cases of IPD in children with SCD between 2000 and 2014. IPD was defined as the presence of pneumococcus in a blood or cerebrospinal fluid culture. Data collected on study patients included age, pneumococcal immunization status, pneumococcus serotype, and penicillin susceptibility. On the basis of the number of cases identified and the population of patients with SCD followed up at CHCM, the investigators estimated the incidence of IPD per 100,000 person-years among children with SCD. In addition to describing clinical characteristics of cases of IPD over the entire study period, observations were divided into 2 periods on the basis of the type of pneumococcal conjugate vaccine available. Thus, in period 1, 2000–2010, the pneumococcal conjugate vaccine (PCV) against 7 serotypes (PCV7) was available, and in period 2, 2010–2014, the 13-valent PCV (PCV13) was used. During the overall study period, 11 cases of IPD in patients with SCD were identified, including 7 in period 1 and 4 in period 2. The mean age of study patients was 5 years, with a range of 6 months to 11 years. Two children with IPD died; information on pneumococcus serotype was available for the remaining 9 patients. PCV data were available for 8 of these 9 children, and data for all 8 were classified as being up to date. During period 1, all cases of IPD were caused by serotypes of pneumococcus not included in PCV7; during period 2, 1 patient (an 8-year-old boy) had IPD caused by serotype 7F (included in PCV13 but not PCV7). All isolates tested (n = 9) were sensitive to penicillin. The overall incidence of IPD in children with SCD in this study was estimated at 417 per 100,000 patient-years, with an incidence of 390 per 100,000 patient-years in period 1 and 450 per 100,000 patient-years in period 2. The authors conclude that even in the era of universal pneumococcal immunization, children with SCD remain at risk for IPD. Dr Winer has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. When considering a prophylactic intervention, one must take into account both the burden of the potential disease and the effect of the proposed intervention. In this brief report, the authors argue for both penicillin and PCV prophylaxis in patients with SCD <5 years of age, which is the... You do not currently have access to this content.