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Invasive Pneumococcal Disease Among Children With and Without Sickle Cell Disease in the United States, 1998 to 2009

Payne, Amanda B. MPH*; Link-Gelles, Ruth MPH; Azonobi, Ijeoma MD*; Hooper, W. Craig PhD*; Beall, Bernard W. PhD; Jorgensen, James H. PhD; Juni, Billie MS§; Moore, Matthew MD, MPH; for the Active Bacterial Core Surveillance Team

Pediatric Infectious Disease Journal: December 2013 - Volume 32 - Issue 12 - p 1308–1312
doi: 10.1097/INF.0b013e3182a11808
Original Studies

Background: Children with sickle cell disease (SCD) are at increased risk of illness and death from invasive pneumococcal disease (IPD). The introduction in 2000 of the 7-valent pneumococcal conjugate vaccine and penicillin prophylaxis for children with SCD has greatly reduced the incidence of IPD in this population. However, a recent report suggested an increase in cases of IPD in children with SCD.

Methods: Using data from Active Bacterial Core surveillance, we analyzed trends in hospitalizations, mortality and serotype among children with SCD compared with other children. We used neonatal screening data to estimate SCD population denominators for each Active Bacterial Core surveillance site.

Results: From 1998 to 2009, 3069 cases of IPD occurred among African-American children less than 18 years of age in the Active Bacterial Core surveillance catchment area. Of these, 127 (4.1%) had SCD identified by medical chart review and 185 (6.0%) had 1 or more IPD risk factors, excluding SCD. Rates of IPD among children with SCD declined by 53% (1118 vs. 530 per 100,000) whereas the overall rates among African-American children declined by 74% (54 to 14 per 100,000). For all time periods, children with SCD and IPD were more likely to be hospitalized (84%–92% vs. 31%–56%) and more likely to die (6%–17% vs. 1%–2%) than children with no risk factors.

Conclusions: Although the rate of IPD in children with SCD has dropped dramatically since 7-valent pneumococcal conjugate vaccine introduction, the rate of IPD in children with SCD remains higher than that of the general population of African-American children, pointing to the need for more effective prevention efforts to prevent IPD in children with SCD.

From the *Division of Blood Disorders, Centers for Disease Control and Prevention; Respiratory Disease Branch, Centers for Disease Control and Prevention, Atlanta, GA; University of Texas Health Science Center, San Antonio, TX; and §Minnesota Department of Health, Minneapolis, MN.

Accepted for publication June 18, 2013.

The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

This work was supported by the Centers for Disease Control and Prevention (CDC), which provides funding for the Active Bacterial Core surveillance system, a collaboration of state health departments, academic institutions, local partners, and the CDC. J.J. has served on an advisory board for Beckton Dickinson, has served as a consultant for Accelerate Diagnostics and Merck, and has received grant funding from Merck and bioMerieux.

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Address for correspondence: Amanda B. Payne, MPH, Division of Blood Disorders, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop D02, Atlanta, GA 30333. E-mail:

© 2013 by Lippincott Williams & Wilkins, Inc.