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Updated: Aug 26, 2026
Experimental Human Pneumococcal Carriage
Published on: February 15, 2013
Pneumococcal vaccines for sickle cell disease
E G Davies1, C Riddington, R Lottenberg
1Host Defence Unit, Great Ormond Street Hospital, Great Ormond Street, London, UK, WC1N 3JH.
Insights
Conjugate pneumococcal vaccines show promise for reducing infection risk in sickle cell disease patients, demonstrating good immunogenicity. Further trials are needed to confirm clinical effectiveness and optimal regimens.
Area of Science:
- Immunology
- Hematology
- Vaccinology
Background:
- Individuals with sickle cell disease face a heightened risk of fatal pneumococcal infections.
- Infants with sickle cell disease are particularly vulnerable, and conventional vaccines may be less effective.
- New conjugate pneumococcal vaccines offer potential for improved protection.
Purpose of the Study:
- To evaluate the efficacy of pneumococcal vaccines in reducing illness and death in sickle cell disease patients.
- To assess the effectiveness of both polysaccharide and conjugate pneumococcal vaccines.
Main Methods:
- Systematic review of randomized and quasi-randomized controlled trials.
- Searched multiple databases and contacted pharmaceutical companies and experts.
- Two independent reviewers selected studies, extracted data, and assessed quality.
Main Results:
- Five trials with 547 participants met inclusion criteria.
- Polysaccharide vaccine (PPV14) did not significantly reduce infection risk in children under three.
- Conjugate vaccines demonstrated increased immune response, including in infants, but clinical outcomes were not measured.
Conclusions:
- Conjugate pneumococcal vaccines are safe and immunogenic in general populations, including infants.
- Evidence suggests conjugate vaccines are suitable for individuals with sickle cell disease.
- Further randomized trials are necessary to determine optimal vaccination strategies and measure clinical effectiveness.
Background:
People with sickle cell disease are particularly susceptible to pneumococcal infection, which may be fatal. Infants (children aged up to 23 months) are at particularly high risk, but conventional polysaccharide pneumococcal vaccines may be ineffective in this age group. New conjugate pneumococcal vaccines are now available, which may help to reduce the incidence of infection in people with sickle cell disease.
Objectives:
To determine the efficacy of pneumococcal vaccines for reducing morbidity and mortality in people with sickle cell disease.
Search Strategy:
We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group trials register, comprising of references identified from comprehensive electronic database searches and hand searching relevant journals and abstract books of conference proceedings. In addition, we contacted relevant pharmaceutical companies and experts in the field.Date of most recent search of Group's trials register: November 2003.
Selection Criteria:
All randomised and quasi-randomised controlled trials comparing a polysaccharide or conjugate pneumococcal vaccine regimen with a different regimen or no vaccination in people with sickle cell disease.
Data Collection And Analysis:
Two reviewers independently selected studies for inclusion, extracted data and assessed trial quality.
Main Results:
Nine trials were identified in the searches and five trials, with a total of 547 participants, met the inclusion criteria. Only one trial reported incidence of pneumococcal infection, and this demonstrated that the polysaccharide pneumococcal vaccine used (PPV14) failed to significantly reduce the risk of infection in children under three years of age, but was associated with only minor adverse events. Three trials of conjugate pneumococcal vaccines found that immune response was increased compared to control groups, including in infants, although clinical outcomes were not measured in these trials.
Reviewer'S Conclusions:
Previous trials have shown that conjugate pneumococcal vaccines are safe and effective in normal healthy patients, even those under the age of two years. The controlled trials included in this review have demonstrated immunogenicity (the body's response, without which there is no protection) of these vaccines, and observational studies in people with sickle cell disease support these findings. We therefore recommend that conjugate pneumococcal vaccines are used in people with sickle cell disease. Randomised trials in patients with sickle cell disease will be needed to determine the optimal vaccination regimen when further, potentially more effective vaccines become available. Such trials should measure clinical outcomes of effectiveness.
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