Risk of Invasive Pneumococcal Disease in Children with Sickle Cell Disease in England: A National Observational Cohort Study, 2010–2015

Oligbu, Godwin; Collins, Sarah; Sheppard, Carmen; Fry, Norman K.; Dick, Moira; Streetly, Allison; Ladhani, Shamez

doi:10.1136/archdischild-2017-313611

Cited by 14 publications

(18 citation statements)

References 27 publications

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“…All these factors probably explain the low rate of CSBI (4.1%) and bacteremia (1.9%) in this cohort, similarly to that in other studies performed in developed countries . We did not find any episodes of confirmed pneumococcal infection, unlike some recent studies that reported cases of invasive pneumococcal disease by serotypes not included in pneumococcal conjugated vaccines . When including patients with confirmed and possible SBI, however, the percentage of cases was higher (21.8%), most of them (78.2%) diagnosed with pneumonia or ACS, also according to other publications …”

Section: Discussionsupporting

confidence: 78%

Low‐risk factors for severe bacterial infection and acute chest syndrome in children with sickle cell disease

Rincón-López

Gómez

Matos

et al. 2019

Pediatric Blood & Cancer

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Introduction The rate of bacterial infections in children with sickle cell disease (SCD) has decreased in recent years, mainly due to penicillin prophylaxis and vaccination. Objectives To determine the rate of severe bacterial infection (SBI) in a cohort of children with SCD and to describe low‐risk factors for confirmed SBI (CSBI) and acute chest syndrome (ACS). Methods This 11‐year retrospective cohort study included children with febrile SCD admitted to a reference hospital in Spain. A case‐control study was performed comparing patients diagnosed with SBI to those without SBI, and subanalyses for groups with CSBI and ACS were carried out. Results A total of 316 febrile episodes were analyzed; 69 (21.8%) had confirmed or possible SBI. Thirteen of those had CSBI (4.1%), eight urinary tract infection, and five bacteremia/sepsis. Among the cases of possible SBI, the majority had ACS (54/56; 96.4%). Age >3 years, absence of central venous catheter, hemodynamic stability, and procalcitonin <0.6 ng/ml were low‐risk factors for CSBI, whereas normal oxygen saturation and C‐reactive protein <3 mg/dl were low‐risk factors for ACS, with negative predictive values (NPV) of 98.3%, 97.4%, 96%, 97.2%, 87.5%, and 85.8%, respectively. Conclusion In this cohort of children with SCD who were well vaccinated and received adequate prophylaxis, we found a low rate of bacteremia and CSBI. We described several low‐risk factors for CSBI and ACS, all of them with a high NPV. These findings may help to develop a risk score to safely select the patients that could be managed with a more conservative approach.

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Section: Discussionsupporting

confidence: 78%

Low‐risk factors for severe bacterial infection and acute chest syndrome in children with sickle cell disease

Rincón-López

Gómez

Matos

et al. 2019

Pediatric Blood & Cancer

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“…pre-or post-PCV era); this study was excluded. The remaining 16 studies were included in the final analysis (Halasa et al, 2007;Adamkiewicz et al, 2008;Rogovik et al, 2010;McCavit et al, 2011;Narang et al, 2012;Baskin et al, 2013;Chang et al, 2013;Ellison et al, 2013;Patel et al, 2013;Payne et al, 2013;Shihabuddin & Scarfi, 2014;Soothill et al, 2016;Brown et al, 2017;Navalkele et al, 2017;Martin et al, 2018;Oligbu et al, 2018). We found large variations in study methodology and quality.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Most studies were from the United States (75%, n = 12/16), followed by two studies from Africa (13%, n = 2), and one study each from Canada (6%, n = 1) and Europe (6%, n = 1). Three studies reported detailed co-morbidities among IPD cases (Narang et al, 2012;Martin et al, 2018;Oligbu et al, 2018) while two studies reported the presence of central venous lines (CVL) as a possible contributing factor for IPD (Chang et al, 2013;Ellison et al, 2013).…”

Section: Study Characteristicsmentioning

confidence: 99%

Risk of invasive pneumococcal disease in children with sickle cell disease in the era of conjugate vaccines: a systematic review of the literature

et al. 2019

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Summary Pneumococcal conjugate vaccines (PCVs) are highly effective in preventing invasive pneumococcal diseases (IPD) in children, including those with sickle cell disease (SCD). A systematic review of the English literature published between 2000 and 2017 was undertaken to evaluate the serotype distribution, clinical presentation and outcomes of IPD in children with SCD in PCV programmes. We identified 475 potential studies and included 16 publications, involving 9438 children up to 22 years of age with SCD and 182 IPD episodes (prevalence, 1·9%. 95% confidence interval [CI], 1·7–2·2%). Septicaemia was the most prevalent clinical presentation (84/137; 61%) followed by lower respiratory tract infection (39/137; 29%) and meningitis (12/137, 9%). More than half the serotypes associated with IPD (88/148; 59·5%) were not included in the 13‐valent PCV; of these, 54% (44/82) were due to serogroup 15. The crude case fatality rate was 11·5% (21/182 cases; 95% CI, 7·3–17·1%). Most cases of IPD in children with SCD were due to serotypes that are not included in any of the licensed PCVs. IPD in children with SCD remains associated with high morbidity and mortality, highlighting the importance of strict adherence to daily penicillin prophylaxis. Until a serotype‐independent pneumococcal vaccine becomes available, higher‐valent PCVs should include serogroup 15 to protect this highly vulnerable group of children.

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“…Also in this issue, Oligbu and colleagues7 document that despite the effectiveness and accuracy of newborn screening in England, children with sickle cell disease were still 49 times more likely to develop invasive pneumococcal disease than unaffected children. Equally important was the observation that most of these infections, including those with fatal outcomes, were caused by bacterial serotypes not included in the PCV-13 vaccine.…”

mentioning

confidence: 99%

“…But danger still lurks for this high-risk patient population, and we must always strive to transition universal screening into universal protection. These two important studies by Oligbu et al 7 and Streetly et al 6 highlight not only the strengths of newborn haemoglobinopathy screening in England but also the need for continuous vigilance and process analyses to improve the long-term outcomes.…”

mentioning

confidence: 99%

Effective screening leads to better outcomes in sickle cell disease

Shook

Ware

2018

Arch Dis Child

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Risk of Invasive Pneumococcal Disease in Children with Sickle Cell Disease in England: A National Observational Cohort Study, 2010–2015

Cited by 14 publications

References 27 publications

Low‐risk factors for severe bacterial infection and acute chest syndrome in children with sickle cell disease

Low‐risk factors for severe bacterial infection and acute chest syndrome in children with sickle cell disease

Risk of invasive pneumococcal disease in children with sickle cell disease in the era of conjugate vaccines: a systematic review of the literature

Effective screening leads to better outcomes in sickle cell disease

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