Serum Opsonic Activity in Infants with Sickle-Cell Disease Immunized with Pneumococcal Polysaccharide Protein Conjugate Vaccine

ABSTRACT Pneumococcal infections are an important cause of morbidity and mortality in children with sickle-cell disease (SCD). Pneumococcal conjugate vaccines (PCVs) are immunogenic in healthy infants <2 years of age but have not been evaluated in young children with SCD. Infants with SCD were immunized with a 7-valent PCV (Wyeth-Lederle Vaccines & Pediatrics) at 2, 4, and 6 months of age. A booster dose of 23-valent pneumococcal polysaccharide vaccine (PPV; Pnu-Immune) was administered at 24 months of age. Antipneumococcal type 6B and 14 serum opsonic activity was measured to assess the biologic function of the antibody. Following the administration of three doses of PCV, opsonic activity against serotype 6B increased from 4.8% at 2 months to 33.5% at 7 months, with a subsequent decline to 8.1% at 12 months and 7.5% at 24 months and with an increase to 30.7% at 25 months after administration of a booster dose of PPV. Similar trends were seen with serotype 14 (opsonic activities were 9.4% at 2 months, 24.9% at 7 months, 16.5% at 12 months, and 12.6% at 24 months, and the opsonic activity was 27.3% 1 month after the administration of PPV). Serum opsonic activity correlated with antibody levels for both serotypes. PCV induces serum opsonic activity in infants with SCD. Antipneumococcal serum opsonic activity correlates with antibody levels.

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Serum Opsonic Activity for Streptococcus pneumoniae Types 6B and 14 in Infants with Sickle Cell Disease after Immunization with Pneumococcal Protein Conjugate Vaccine

Pediatric Research ◽

10.1203/00006450-199904020-00074 ◽

1999 ◽

Vol 45 (4, Part 2 of 2) ◽

pp. 11A-11A

Author(s):

Anna H Nowak-Wegrzyn ◽

Jerry A Winkelstein ◽

Beth M Stover ◽

Andrea J Swift ◽

Howard M Lederman

Keyword(s):

Streptococcus Pneumoniae ◽

Sickle Cell Disease ◽

Conjugate Vaccine ◽

Sickle Cell ◽

Cell Disease ◽

Opsonic Activity ◽

Protein Conjugate

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Pneumococcal infections in sickle cell disease

The Journal of Pediatrics ◽

10.1016/s0022-3476(77)81357-7 ◽

1977 ◽

Vol 91 (3) ◽

pp. 521-522 ◽

Cited By ~ 5

Author(s):

Jerry A. Winkelstein

Keyword(s):

Sickle Cell Disease ◽

Sickle Cell ◽

Cell Disease ◽

Pneumococcal Infections

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Pneumococcal infections and sickle cell disease

JAMA ◽

10.1001/jama.247.20.2782b ◽

1982 ◽

Vol 247 (20) ◽

pp. 2782b-2782

Author(s):

J. M. Eustatia

Keyword(s):

Sickle Cell Disease ◽

Sickle Cell ◽

Cell Disease ◽

Pneumococcal Infections

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Invasive pneumococcal infections in children with sickle cell disease in the era of penicillin prophylaxis, antibiotic resistance, and 23-valent pneumococcal polysaccharide vaccination

The Journal of Pediatrics ◽

10.1067/s0022-3476(03)00331-7 ◽

2003 ◽

Vol 143 (4) ◽

pp. 438-444 ◽

Cited By ~ 91

Author(s):

Thomas V Adamkiewicz ◽

Sharada Sarnaik ◽

George R Buchanan ◽

Rathi V Iyer ◽

Scott T Miller ◽

...

Keyword(s):

Antibiotic Resistance ◽

Sickle Cell Disease ◽

Sickle Cell ◽

Cell Disease ◽

Pneumococcal Infections ◽

Penicillin Prophylaxis

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Sickle cell disease: a comprehensive program of care from birth

Hematology ◽

10.1182/hematology.2019000053 ◽

2019 ◽

Vol 2019 (1) ◽

pp. 490-495

Author(s):

Mariane de Montalembert ◽

Léon Tshilolo ◽

Slimane Allali

Keyword(s):

Sickle Cell Disease ◽

Sickle Cell ◽

Health Care Professionals ◽

Improve Patient Care ◽

The United States ◽

Cell Disease ◽

Pneumococcal Infections ◽

African Countries ◽

Early Management ◽

High Resource

Abstract As more children are appropriately being diagnosed, the burden of sickle cell disease is increasing greatly in Africa and in high-resource countries such as the United States and Europe. Early management is mandatory, but newborn screening is not implemented everywhere. Point-of-care testing devices are increasingly being used in low-resource countries, showing good sensitivity and specificity. Because the diagnosis is often traumatic for the families, the announcement should be made by an experienced person. The development of care networks is urgently required to facilitate daily life by defining the respective functions of nearby and highly specialized health care professionals, who should work in close collaboration. Comprehensive programs targeting the prevention of pneumococcal infections, malaria in infested zones, and stroke may substantially improve patient care. Hydroxyurea is increasingly being used, but whether it should be systematically prescribed in all children is debated, and its access is still limited in many African countries. Yearly checkups should be organized early in life in order to screen and then treat any organ impairment. Enhancing parents’ and patients’ knowledge and skills is mandatory.

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Prevalence of Severe Bacterial Infection in Febrile Children with Sickle CELL Disease in the Era of Pneumococcal Conjugate Vaccine 13

Blood ◽

10.1182/blood-2018-99-111362 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 3665-3665

Author(s):

Gloria Contreras-Yametti ◽

Custodio Haidee ◽

Hamayun Imran

Keyword(s):

Sickle Cell Disease ◽

Conjugate Vaccine ◽

Sickle Cell ◽

Pneumococcal Conjugate Vaccine ◽

Univariate Analysis ◽

Cell Disease ◽

Pneumococcal Infections ◽

Patient Disposition ◽

Penicillin Prophylaxis ◽

Febrile Events

Abstract Introduction The incidence of invasive pneumococcal infections in patients with sickle cell disease (SCD) decreased after introduction of penicillin prophylaxis and pneumococcal conjugate vaccine (PCV). However, the decrease in pneumococcal infections alone may not necessarily mean an overall decrease in severe bacterial infections (SBI). In a previous publication, we reported a 0.4 % prevalence of pneumococcal bacteremia following introduction of PCV 13. In the current study, we aimed to define the prevalence of SBI and hospitalization in febrile patients in the same cohort in the later years. Methods We performed a retrospective study of patients with SCD <18 years old presenting with fever to University of South Alabama Children's and Women's Hospital from January 2014 to June 2017. SBI was defined as: bacteremia, pneumonia, pyelonephritis, meningitis, osteomyelitis and abscess (superficial and deep). Univariate analysis and multivariate logistic regression were used to determine factors associated with patient disposition as well as presence of SBI. Results There were 258 febrile events in 120 patients resulting in 187 (72%) admissions (figure 1). SBI was seen in 12% of admissions with uncomplicated community acquired pneumonia being the most common. The prevalence of bacteremia was 1.6% with single cases of pneumococcus, E. coli, and H. influenzae bacteremia. Younger age, high fever, and splenectomy were associated with hospitalization (p<0.05). However, only C reactive protein was associated with SBI (p<0.02). Viral infection was diagnosed in 80% of outpatients but 87% were given antibiotics. Among inpatients, all received parenteral antibiotics, and 67% were assessed to have viral illness, although only 23% had a virus identified. Pneumococcal vaccination status was satisfactory in 77% of our sample while compliance rate with penicillin prophylaxis was >85% in both inpatient and outpatient groups. Conclusion Although majority of febrile events were due to viral infections, 3 of four febrile episodes in our cohort resulted in hospitalization. A small proportion of patients had SBI and a much smaller proportion had bacteremia. These findings support early virus identification which can have implications on patient discharge disposition and antibiotic use. Further studies looking at risk stratification of febrile patients with SCD are needed to encourage outpatient management without compromising safety. Figure 1. Figure 1. Disclosures Imran: Novo Nordask: Speakers Bureau.

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