Influenza vaccination essential for young patients with sickle cell disease

Pandemic and seasonal influenza vaccination is essential for children and young adults with sickle cell disease as well as their household contacts, according to researchers at Johns Hopkins University.

“After caring for several children with severe complications from H1N1 and sickle cell disease, we decided to compare the severity of seasonal influenza A and influenza B with the H1N1 cases in patients with sickle cell disease,” John J. Strouse, MD, PhD, of the department of pediatrics in the division of pediatric hematology at the Johns Hopkins University School of Medicine, said during a press conference at the 51st ASH Annual Meeting.

Data were pooled from September 1993 to July 2006 from the discharge and billing databases of the hospital. Researchers identified patients aged 21 or younger with sickle cell disease and laboratory testing for respiratory infections. Ninety-nine patients with both sickle cell disease and influenza, of which 64 had influenza A, 25 had influenza B and 10 had H1N1.

Although reports of fever (90%), cough (93%) and rhinorrhea (79%), were similar across all groups, patients with H1N1 were more likely to have acute chest syndrome, require intensive care and ventilator support.

Older-age (OR=1.2 per year; P=.004) and H1N1 diagnosis were associated with an increased risk for intensive care when compared with those with seasonal influenza (OR=11; P=.025).

“These results in addition to previously published data support the need for programs to increase immunization rates and treatment of patients with sickle cell disease,” Strouse said. “We hope that these programs will potentially decrease costs due to complications in this high-risk group.” – by Jennifer Southall

For more information:

Strouse JJ. #264. Presented at: 51st ASH Annual Meeting and Exposition; December 4-8, 2009; New Orleans.

This study demonstrates the increased morbidity of H1N1 influenza, compared to seasonal flu, in young sickle cell patients. Thus, the results come as no surprise, but do justify the premise of the aggressive immunization efforts by pediatric hematologists and infectious disease specialists this year. Hopefully, the pandemic is now on the down slope. Everyone made a major effort to immunize children with sickle cell when the vaccine became available; the major barrier was not a lack of knowledge, but a lack of vaccine.

– Peter Newburger, MD
Professor of Pediatrics and Cancer Biology
Vice Chair of Pediatrics
University of Massachusetts Medical Center, Worcester, Massachusettes