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African children with sickle-cell disease could benefit from same vaccines as children in U.S.
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Recent data have confirmed that bacteremia-causing organisms in African children with sickle-cell anemia are the same as those in children with the disease in developed countries, leading researchers to conclude that the survival of African children with sickle-cell anemia could improve with the introduction of certain vaccines.
“Similarly to infections in children with sickle-cell disease from the United States and Europe, the most common pathogens isolated from the patients were Streptococcus pneumoniae, Haemophilus influenzae, and non-typhi Salmonella species,” wrote Jane Hankins, MD, and Russell E. Ware, MD, both from the department of hematology, St Jude Children’s Research Hospital, Memphis, Tenn., in an editorial responding to the results. “Of note, 45% and 75% of the pneumococcal isolates identified in [the] paper were serotypes present in the seven-valent and 10-valent pneumococcal conjugate vaccines, respectively.”
In a case-control study, researchers obtained blood cultures from all children (n=38,441) aged younger than 14 who were admitted to Kilifi District Hospital in Kenya from Aug. 1, 1998, to March 31, 2008. Children with bacteremia were defined as cases; there were two sets of controls: children recruited by random sampling into other studies from Sept. 1, 1998, to Nov. 30, 2005, and children born consecutively in the area from May 1, 2006, to April 30, 2008.
The researchers found 2,157 cases of bacteremia (6%) among the entire study population. Of these, 81% of cases were typed for sickle-cell anemia and 6% were positive. One percent of the control group patients tested (n=13,492) were positive for sickle-cell anemia.
The most commonly found organisms in cases with sickle-cell anemia included S. pneumoniae (41%), non-typhi Salmonella species (18%), H. influenzae type b (12%), Acinetobacter species (7%), and Escherichia coli (7%).
The age-adjusted OR for bacteremia in children with sickle-cell disease was 26.3 (95% CI, 14.5-47.6). The strongest associations were observed for S. pneumoniae (OR=33; 95% CI, 17.4-62.8), non-typhi Salmonella species (OR=35.5; 95% CI, 16.4-76.8), and H. influenzae type b (OR=28.1; 95% CI, 12.0-65.9).
“Because this study only included cases of in-hospital bacteremia, cases were missed if children died before reaching hospital or were treated at home; therefore, these results probably underestimate the true odds ratio for having sickle-cell disease and bacteremia, and its effect on infant mortality,” Hankins and Ware wrote.
Agreeing with the study authors, they said, “The key to reducing morbidity and mortality involves early identification through hemoglobinopathy screening, early antibiotic prophylaxis, education about disease complications, and appropriate immunizations against bacterial pathogens, especially S pneumoniae. When these ounces of prevention are put into place, we make important strides toward a pound of improvement and eventual cure.”
Hankins J. Lancet. 2009;doi:10.1016/S0140-6736(09)61602-0.
Williams TN et al. Lancet. 2009;doi:10.1016/S0140-6736(09)61374-X.
