Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, Michigan.
Michigan Department of Health and Human Services, Lansing, Michigan.
Pediatr Blood Cancer. 2018 Oct;65(10):e27282. doi: 10.1002/pbc.27282. Epub 2018 Jun 15.
Children with sickle cell anemia and sickle cell trait are at an increased risk of invasive pneumococcal disease compared to children with normal hemoglobin. We assessed and compared pneumococcal vaccination status among these three groups.
Children with sickle cell anemia and sickle cell trait were identified using Michigan newborn screening records (1997-2014); each child was matched to four children with normal hemoglobin based on age, Medicaid enrollment (at least 1 year from 2012-2014), race, and census tract. Vaccination records were obtained from the state's immunization system. Pneumococcal vaccine coverage (PCV7 or PCV13 depending on date of administration) was assessed at milestone ages of 3, 5, 7, and 16 months. The proportion of children with vaccine coverage at each milestone was calculated overall and compared among children with sickle cell anemia, sickle cell trait, and normal hemoglobin using chi-square tests.
The study population consisted of 355 children with sickle cell anemia, 17,319 with sickle cell trait, and 70,757 with normal hemoglobin. The proportion of children with age-appropriate pneumococcal vaccination coverage was low at each milestone and generally decreased over time. Children with sickle cell anemia were more likely to be covered compared to children with sickle cell trait or normal hemoglobin.
Despite higher pneumococcal vaccination coverage among children with sickle cell anemia, opportunities for improvement exist among all children. Targeted interventions will benefit from mechanisms to identify children with increased risks such as sickle cell anemia or trait to improve pneumococcal vaccination coverage among these groups.
与正常血红蛋白的儿童相比，镰状细胞贫血和镰状细胞特征的儿童患有侵袭性肺炎球菌病的风险增加。我们评估并比较了这三组人群的肺炎球菌疫苗接种状况。
使用密歇根州新生儿筛查记录（1997-2014 年）识别镰状细胞贫血和镰状细胞特征的儿童；每个儿童根据年龄、医疗补助计划（2012-2014 年至少有 1 年）、种族和人口普查区与四个正常血红蛋白的儿童相匹配。从该州的免疫系统中获得疫苗接种记录。根据管理日期评估 3、5、7 和 16 个月大的里程碑年龄的肺炎球菌疫苗覆盖率（PCV7 或 PCV13）。总体计算每个里程碑上有疫苗覆盖的儿童比例，并使用卡方检验比较镰状细胞贫血、镰状细胞特征和正常血红蛋白的儿童之间的比例。
研究人群包括 355 名镰状细胞贫血儿童、17319 名镰状细胞特征儿童和 70757 名正常血红蛋白儿童。每个里程碑上适龄儿童肺炎球菌疫苗接种覆盖率比例较低，且随着时间的推移普遍下降。与镰状细胞特征或正常血红蛋白的儿童相比，镰状细胞贫血的儿童更有可能得到覆盖。
尽管镰状细胞贫血儿童的肺炎球菌疫苗接种覆盖率较高，但所有儿童仍有改进的机会。针对所有儿童的目标干预措施将受益于确定具有较高风险的儿童的机制，例如镰状细胞贫血或特征，以提高这些人群的肺炎球菌疫苗接种覆盖率。
