Combined schedule of 7-valent pneumococcal conjugate vaccine followed by 23-valent pneumococcal vaccine in children and young adults with sickle cell disease,☆☆,,★★

https://doi.org/10.1016/S0022-3476(98)70235-5Get rights and content

Abstract

We compared the immunogenicity of 7-valent pneumococcal-conjugate vaccine plus 23-valent pneumococcal vaccine to immunization with 23-valent vaccine only in individuals ≥2 years of age with sickle cell disease. IgG pneumococcal antibody concentrations were higher in the combined schedule group with no increase in side effects observed after immunization with 23-valent vaccine. (J Pediatr 1998;133:275-8)

Section snippets

Study Population

Charts of patients with SCD seen at least once since 1989 in the Children’s Hospital (Boston, Mass.) Hematology Clinic were reviewed. Patients <2 years of age or those who had received pneumococcal vaccine within the previous 2 years were excluded. Eligible patients were contacted by mail. The study was approved by the Children’s Hospital Committee on Clinical Investigation. Informed consent was obtained from each participant or parent/guardian.

Study Design

Subjects were randomized to receive a single dose

Subject Characteristics (Table I)

One hundred eighty-one eligible patients were identified. Six had moved out of state, 59 could not be contacted by mail or phone, and 93 declined participation. The remaining 23 patients were enrolled, and all subjects completed the study.

. Clinical characteristics of subjects in the study

Empty Cell23V Vaccine only group (n = 12)7V + 23V Vaccine group (n = 11)
DiagnosisEmpty CellEmpty Cell
 Hgb SS76
 Hgb SC24
 Hgb S-β Thal021
 Hgb S-β Thal+10
Median age in years (range)14 (4-30)13 (4-27)
Male:female7:53:8
Previous splenectomy02
Previous

Discussion

In our study subjects who received two doses of pneumococcal-conjugate vaccine followed by 23-valent vaccine achieved higher GMC for all serotypes contained in the conjugate vaccine compared with those who received 23-valent vaccine only. For subjects who received conjugate vaccine (which contains only 2 to 4 μg of each capsular polysaccharide compared with 25 μg of each polysaccharide in the 23-valent vaccine), GMC increased significantly after the first dose for all serotypes except 6B. This

Acknowledgements

The authors thank Donna Ambrosino, MD, for review of the article, the nursing and administrative staff of Children’s Hospital General Clinical Research Center for their assistance, and the respective vaccine manufacturers for donating vaccine for the study.

References (12)

There are more references available in the full text version of this article.

Cited by (104)

  • Sickle Cell Disease: A Brief Update

    2017, Medical Clinics of North America
    Citation Excerpt :

    As a result, maintaining updated immunizations and routine prophylactic penicillin for all children younger than 5 years is paramount to prevent poor outcomes associated with these infections. All people with SCD should be vaccinated against Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae type B, as well as for hepatitis B virus and seasonal influenza in addition to all other standard vaccines.43–45 It is equally important to educate patients of all ages and their families to seek medical care should they develop signs of infection, for example, for any temperature higher than 101.3°F or 38.5°C due to the risk for bacterial infections.32

View all citing articles on Scopus

From the Laboratory of Infectious Diseases, Dana-Farber Cancer Institute, Boston, Massachusetts; the Department of Epidemiology and Biostatistics, Boston University School of Public Health, Boston, Massachusetts; and the Division of Hematology/Oncology, Children’s Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts.

☆☆

Supported in part by a General Clinical Research grant to Children’s Hospital from the National Institutes of Health (M01RR02172). Dr. Vernacchio was supported by a Boston University School of Public Health training grant in Perinatal, Infant, and Child Epidemiology from the National Institutes of Health (5T32HD0748802). Dr. Neufeld was a fellow of the Lucille P. Markey trust.

Reprint requests: Deborah C. Molrine, MD, MPH, Dana-Farber Cancer Institute, 44 Binney St., Boston, MA 02115.

★★

0022-3476/98/$5.00 + 0  9/22/90348

View full text