Penicillin prophylaxis and pneumococcal vaccination are routinely used in the United States and in Europe to prevent invasive pneumococcal diseases (IPD) in children with sickle cell disease (SCD). Their usefulness in African children with SCD has been recently challenged.1 Indeed, a study of blood cultures in 155 SCD children with temperatures >38°C cared for in one medical centre in Uganda identified Streptococcus pneumoniae in only 6% of episodes. We agree with the authors that large, well-constructed studies assessing the risk of IPD in Africa are in order. However, we would like to suggest that their relatively small and monocentric …