Department of Family Medicine, Morehouse School of Medicine, Atlanta, GA.
Department of Pediatrics, Emory University School of Medicine, Atlanta, GA.
Blood Adv. 2023 Nov 14;7(21):6751-6761. doi: 10.1182/bloodadvances.2022009643.
Children with sickle cell disease (SCD) are at increased risk of invasive pneumococcal disease (IPD). Over 25 years, the Georgia Emerging Infections Program/Centers for Disease Control and Prevention Active Bacterial Core Surveillance network identified 104 IPD episodes among 3707 children with hemoglobin SS (HbSS) or HbSC aged <10 years, representing 6% of IPD in Black or African American children residing in Metropolitan Atlanta (reference population). Children with IPD and HbSS/SC were older than those with IPD in the reference population (P < .001). From 1994-1999 to 2010-2018, IPD declined by 87% in children with HbSS aged 0 to 4 years, and by 80% in those aged 5 to 9 years. However, IPD incidence rate ratios when comparing children with SCD with the reference population increased from 20.2 to 29.2 over these periods. Among children with HbSS and IPD, death declined from 14% to 3% after 2002, and meningitis declined from 16% to 8%. Penicillin resistance was more prevalent in children with SCD before 7-valent pneumococcal conjugate vaccine (PCV7) licensure. After 2010, all IPD serotypes were not included in the 13-valent PCV (PCV13). Within 3 years of vaccination, the effectiveness of the 23-valent pneumococcal polysaccharide vaccine (PPSV23) against non-PCV13 serotypes included in PPSV23 plus 15A/15C was 92% (95% confidence interval, 40.8- 99.0, P = .014; indirect-cohort effect adjusted for age and hydroxyurea). PPSV23 would cover 62% of non-PCV13 serotype IPD in children with SCD, whereas PCV15, PCV20, and PCV21/V116 (in development) could cover 16%, 51%, and 92%, respectively. Although less frequent, IPD remains a life-threatening risk in children with SCD. Effective vaccines with broader coverage could benefit these children.
患有镰状细胞病 (SCD) 的儿童罹患侵袭性肺炎球菌病 (IPD) 的风险增加。在过去 25 年中，佐治亚州新兴传染病项目/疾病控制和预防中心主动细菌核心监测网络在居住在亚特兰大都会区的 3707 名年龄小于 10 岁的血红蛋白 SS (HbSS) 或 HbSC 儿童中确定了 104 例 IPD 发作，占黑人和非裔美国儿童中 IPD 的 6%（参考人群）。患有 IPD 和 HbSS/SC 的儿童比参考人群中的 IPD 儿童年龄大（P<.001）。从 1994-1999 年到 2010-2018 年，0 至 4 岁 HbSS 儿童的 IPD 下降了 87%，5 至 9 岁儿童的 IPD 下降了 80%。然而，在此期间，比较 SCD 儿童与参考人群的 IPD 发病率比值从 20.2 增加到 29.2。在患有 HbSS 和 IPD 的儿童中，2002 年后死亡率从 14%降至 3%，脑膜炎从 16%降至 8%。在 7 价肺炎球菌结合疫苗 (PCV7) 获得许可之前，患有 SCD 的儿童中青霉素耐药性更为普遍。2010 年后，所有 IPD 血清型均未包含在 13 价肺炎球菌多糖疫苗 (PCV13) 中。接种疫苗后 3 年内，23 价肺炎球菌多糖疫苗 (PPSV23) 对 PPSV23 加 15A/15C 中包含的非 PCV13 血清型的有效性为 92%（95%置信区间，40.8-99.0，P=.014；间接队列效应调整了年龄和羟基脲）。PPSV23 将覆盖患有 SCD 的儿童中 62%的非 PCV13 血清型 IPD，而 PCV15、PCV20 和 PCV21/V116（正在开发中）可分别覆盖 16%、51%和 92%。尽管不太常见，但 IPD 仍然是患有 SCD 的儿童的致命风险。具有更广泛覆盖范围的有效疫苗可能使这些儿童受益。
