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Published on: February 23, 2014
Pneumococcal infections in children with sickle cell disease before and after pneumococcal conjugate vaccines
Thomas V Adamkiewicz1,2, Marianne E M Yee2,3, Stepy Thomas4,5,6
1Department of Family Medicine, Morehouse School of Medicine, Atlanta, GA.
Insights
Children with sickle cell disease (SCD) face a high risk of invasive pneumococcal disease (IPD). While IPD has declined, the relative risk for SCD patients has increased, highlighting the need for broader vaccine coverage.
Area of Science:
- Pediatric Infectious Diseases
- Hematology
- Vaccinology
Background:
- Children with sickle cell disease (SCD) have a significantly elevated risk of invasive pneumococcal disease (IPD).
- IPD remains a critical health concern for children with SCD, despite overall declines in incidence.
- The relative risk of IPD in children with SCD compared to the general pediatric population has increased over time.
Purpose of the Study:
- To analyze trends in IPD incidence, severity, and outcomes among children with SCD over a 25-year period.
- To evaluate the effectiveness of existing pneumococcal vaccines and assess the potential impact of newer vaccines.
- To identify the need for improved vaccination strategies to protect children with SCD from IPD.
Main Methods:
- Retrospective analysis of IPD cases in children with SCD (<10 years) from the Georgia Emerging Infections Program/CDC Active Bacterial Core Surveillance network (1994-2018).
- Comparison of IPD incidence rates and outcomes between children with SCD and a reference pediatric population.
- Evaluation of pneumococcal vaccine effectiveness, including the 23-valent pneumococcal polysaccharide vaccine (PPSV23) and projected coverage of newer vaccines (PCV15, PCV20, PCV21/V116).
Main Results:
- IPD incidence declined significantly in children with SCD (HbSS) from 1994-1999 to 2010-2018, but the incidence rate ratio relative to the reference population increased.
- Among children with SCD and IPD, mortality decreased from 14% to 3% after 2002, and meningitis rates declined from 16% to 8%.
- PPSV23 demonstrated 92% effectiveness against specific non-PCV13 serotypes; newer vaccines like PCV20 and PCV21/V116 show potential for broader coverage against circulating IPD serotypes in SCD patients.
Conclusions:
- Despite reductions in IPD, children with SCD continue to face a disproportionately high and increasing relative risk.
- While vaccines have improved outcomes, current vaccines do not cover all prevalent IPD serotypes in this vulnerable population.
- Development and implementation of vaccines with broader serotype coverage are crucial to further reduce the burden of IPD in children with SCD.
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.
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