Invasive Pneumococcal Disease Among Children With and Without Sickle Cell Disease in the United States, 1998 to 2009

Abstract

Background Children with sickle cell disease (SCD) are at increased risk of illness and death from invasive pneumococcal disease (IPD). The introduction in 2000 of the 7-valent pneumococcal conjugate vaccine (PCV7) and penicillin prophylaxis for children with SCD has greatly reduced the incidence of IPD in this population. However, a recent report suggested an increase in cases of IPD in children with SCD. Methods Using data from Active Bacterial Core surveillance (ABCs), we analyzed trends in hospitalizations, mortality, and serotype among children with SCD compared with other children. We used neonatal screening data to estimate SCD population denominators for each ABCs site. Results From 1998–2009, 3,069 cases of IPD occurred among African-American children less than 18 years of age in the ABCs catchment area. Of these, 127 (4.1%) had SCD identified by medical chart review and 185 (6.0%) had one or more IPD risk factors, excluding SCD. Rates of IPD among children with SCD declined by 53% (1,118 versus 530 per 100,000) while the overall rates among African-American children declined by 74% (54 to 14 per 100,000). For all time periods, children with SCD and IPD were more likely to be hospitalized (84%–92% versus 31%–56%) and more likely to die (6%–17% versus 1%–2%) than children with no risk factors. Conclusions While the rate of IPD in children with SCD has dropped dramatically since PCV7 introduction, the rate of IPD in children with SCD remains higher than that of the general population of African-American children, pointing to the need for more effective prevention efforts to prevent IPD in children with SCD.

Risk of Invasive Pneumococcal Disease in Children with Sickle Cell Disease in England: A National Observational Cohort Study, 2010–2015

“…Those at increased risk of IPD (including SCD) benefited directly (through vaccination) and indirectly (through herd protection) from the programme. In the USA, where PCV7 was introduced in the early 2000s, the Active Bacterial Core surveillance reported a 53% decline in IPD rates among children with SCD during 1998–2009, which was lower than the 74% decline observed among African-American children without SCD 11. Moreover, children with SCD remained at significantly higher risk of IPD compared with their healthy peers.…”

Clinical Manifestations of Sickle Cell Anemia: Infants and Children

“…9.3 Rates of invasive pneumococcal disease (IPD) in the United States: Rates of IPD in children under age 18 years with SCD, compared to overall rate of IPD in African-American children under age 18 in the Active Bacterial Core surveillance system. Adapted from Payne et al ( 2013 ) these children have a history of fever but few have the characteristic "slapped cheek" rash (Goldstein et al 1987 ;Kellermayer et al 2003 ). Transfusion of red blood cells may be necessary while waiting for hematologic recovery.…”

“…The 13-valent pneumococcal conjugate vaccine (PCV13) may further decrease the incidence of invasive pneumococcal disease, but it will not completely prevent this problem. The majority of recent cases of invasive pneumococcal disease in children with SCD were due to serotypes not included in PCV13 (Payne et al 2013 ). Nonetheless, invasive bacterial infections are now rare with current vaccines and penicillin prophylaxis.…”

“…With the use of the 7-valent pneumococcal conjugate vaccine (PCV7) beginning in 2000, the incidence of invasive pneumococcal disease among young children with SCD has declined ( Fig. 9.3 ) (Halasa et al 2007 ;Payne et al 2013 ). The 13-valent pneumococcal conjugate vaccine (PCV13) may further decrease the incidence of invasive pneumococcal disease, but it will not completely prevent this problem.…”

Vaccination, Underlying Comorbidities, and Risk of Invasive Pneumococcal Disease

“…First, we used information from the National Cancer Institute's Surveillance, Epidemiology, and End Results Program 21 to estimate the total number of Massachusetts children with hematologic malignancies (leukemia and lymphoma for the purpose of this study). Next, we used a previously described approach 22,23 to estimate the number of incident cases of SCD in Massachusetts children by using data obtained from the New England Newborn Screening Program, and to estimate the total number of patients with SCD in each year by adjusting each birth cohort population by estimated mortality rates published in the literature. 24 characteristics of IPD cases are presented in Table 1.…”