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Pneumococcal bacteremia reduced with vaccination, penicillin prophylaxis in sickle cell pediatric patients
Ellison AM. Pediatr Infect Dis J.2012;doi:10.1097/INF.0b013e3182480fed.
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Prophylaxis with penicillin and pneumococcal vaccination has been shown to reduce the incidence of Streptococcus pneumoniae in children with sickle cell disease, but some patients continue to progress to pneumococcal bacteremia and should continue to be monitored for infection, according to research published online.
Angela M. Ellison, MD, MSc, and colleagues retrospectively examined medical records of 815 children with sickle cell disease who were seen at the Sickle Cell Center at The Children’s Hospital of Philadelphia from 2000 to 2010.
During the 10-year period, 12 cases of pneumococcal bacteremia were identified. Ellison and colleagues said 11 of the patients had the SS type of sickle cell disease. Two patients had a splenectomy before bacteremia infection; two patients did not receive penicillin prophylaxis because of an allergy or age restrictions (patient was 14 years old). Ten of the 12 infections were susceptible to penicillin.
Ellison and colleagues said, “Among 12 cases, seven different S. pneumoniae serotypes were represented; nine of the 12 cases had serotypes not found in [7-valent pneumococcal vaccine; Prevnar, Wyeth] and six cases had serotypes not found in [13-valent pneumococcal vaccine; Prevnar13, Wyeth].”
One patient contracted bacteremia before PCV7 vaccination; another failed to receive a booster of 23-valent pneumococcal polysaccharide vaccine (Pneumovax 23, Merck) at 5 years of age. No deaths were reported in 12 cases.
Ellison and colleagues said S. pneumoniae infection occurs because of inadequate vaccination, suboptimal host immune response, alternate serotypes not found in current vaccinations and noncompliance with penicillin prophylaxis, although compliant penicillin prophylaxis is not guaranteed to prevent infection.
Therefore, the researchers said besides vaccination and penicillin prophylaxis, clinicians should remain vigilant in treating fever in pediatric patients with sickle cell.
Disclosure: The researchers report no relevant financial disclosures.
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