Polyvalent Pneumococcal-Polysaccharide Immunization of Patients with Sickle-Cell Anemia and Patients with Splenectomy

Abstract

To reduce the risk of infection from Streptococcus pneumoniae in hyposplenic patients we administered octavalent pneumococcal vaccine to 77 patients with sickle-cell disease and 19 asplenic persons and compared their response with 82 controls (38 age-matched normal persons and 44 normal black African children). Fifty micrograms each of pneumococcal-polysaccharide Types 1, 3, 6, 7, 14, 18, 19, and 23 were administered subcutaneously. Post-immunization serums (three to four weeks) were available from 52 of 77 patients with sickle-cell disease; the percent responding and the magnitude of the indirect hemagglutination response were comparable to those of the controls. Within two years after immunization we observed eight Str. pneumoniae infections in 106 age-matched unimmunized patients with sickle-cell disease, but none in the 77 immunized (P less than 0.025). We conclude that pneumococcal polysaccharides are immunogenic in hyposplenic patients and may protect against systemic Str. pneumoniae infection.

Acute Chest Syndrome in Sickle Cell Disease

“…2,7,[11][12][13][14][15] This apparent change may be the result of more rigorous research methodology or therapies developed specifically to prevent pneumococcal disease such as prophylactic penicillin and vaccine administration. 13,16,17 Chlamydia pneumoniae and Mycoplasma pneumoniae are now the most common documented infectious causes of ACS. 7,13,18,19 Other viral and bacterial organisms that have been linked to ACS include Haemophilus influenzae, Staphylococcus aureus, Klebsiella pneumoniae, adenovirus, influenza viruses, parainfluenza viruses, respiratory syncytial virus, parvovirus B19, and cytomegalovirus.…”

“…Pneumococcal polysaccharide vaccine was the first pneumococcal immunization developed. 16,95 The effectiveness of the vaccine is limited by a poor antibody response in children younger than 2 years. Recently, the heptavalent pneumococcal conjugate vaccine Prevnar (Lederle Laboratories, Pearl River, NY) was approved for use in children starting at 2 months of age.…”

Prevention and therapy of bacterial infections for children with asplenia or hyposplenia

“…The unconjugated polysaccharide-based 23-valent pneumococcal vaccine, the only one currently available, should be given to children at two years of age or older (27,28). Revaccination is recommended three years later for children who were immunized when they were younger than five years of age, and five years later for older children.…”

“…In these children, oral penicillin V (125 mg twice daily) reduced the incidence of severe bacterial infection by 84% in comparison with children who received placebo. Though the efficacy of prophylactic antibiotics has been proven only in children with sickle cell disease, it is recommended that all children with asplenia receive prophylactic antibiotics (Table 1) (27,28).…”

Pneumococcal Vaccination in the United States: Current Recommendations and Strategies to Improve Vaccination Coverage

“…Antibody responses in the elderly and in patients with alcoholic cirrhosis, chronic obstructive pulmonary disease (COPD) , and insulin-dependent diabetes mellitus may be lower than those in healthy young adults ( 1,6). Asplenic persons, and those with sickle cell disease and functional asplenia generally have antibody responses similar to those of healthy persons of similar ages (7). Antibody responses to pneumococcal vaccination are often absent or reduced in immunocompromised patients, including those with leukemia, lymphoma , multiple myeloma , chronic renal failure requiring dialysis, renal transplantation or nephrotic syndrome (1).…”