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Inicio Allergologia et Immunopathologia Comparison of pneumococcal vaccination response in children with sickle cell dis...
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Vol. 47. Issue 6.
Pages 564-569 (November - December 2019)
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Vol. 47. Issue 6.
Pages 564-569 (November - December 2019)
Original Article
DOI: 10.1016/j.aller.2019.04.003
Comparison of pneumococcal vaccination response in children with sickle cell disease: HbSS and HbSC
X. Le Ng, M. Alikhan, J.M. Stark, R.A. Mosquera, S. Shahrukh Hashmi, T. Gonzales, D.L. Brown, T.T. Nguyen, A. Yadav
Corresponding author

Corresponding author.
Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
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Figures (1)
Tables (2)
Table 1. Comparison of demographic and medical history between HbSS and HbSC patients.
Table 2. Median titer values and percentage of patients with titer values ≥1.3mcg/ml for each serotype.
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Sickle cell disease (SCD) children are at increased risk of invasive pneumococcal disease and rely on penicillin prophylaxis and vaccination for infection prevention. Post-vaccination antibody levels in SCD may wane overtime. HbSC are believed to have better immunological response than HbSS.


To compare antibody response to 23-valent pneumococcal polysaccharide vaccine (PPSV-23) between HbSS and HbSC.


Patients with HbSS (n=33) and HbSC (n=11), aged 7–18 years, were prospectively recruited. Luminex pneumococcal antibody levels were measured for 23-serotypes, after two PPSV-23 doses.


Absolute median titer for 20 of the 23 serotypes was higher in HbSC than HbSS and significantly higher for serotypes 22 (3.9 vs. 1.6mcg/ml; p=0.039) and 43 (2.9 vs. 0.8mcg/ml; p=0.007). HbSC mounted a better immune anti-pneumococcal response compared to HbSS (≥1.3mcg/ml) for 18 of 23 serotypes, albeit not significant for any of the serotypes. More HbSC (64%) than HbSS (42%) were good vaccine responders (p=0.303). Two of 21 (10%) good vaccine responders and nine of 23 (39%) poor vaccine responders SCD participants subsequently developed acute chest syndrome or pneumonia (p=0.036). None of the HbSC patients developed ACS after receiving PPSV-23. HbSS poor vaccine responders were at increased future recurrence risk for ACS (p=0.003), pneumonia (p=0.036) or both (p=0.011), compared to good vaccine responders.


HbSC possess better pneumococcal vaccine response than HbSS. Poor vaccine response is concerning for future acute pulmonary events. Current vaccination strategy for SCD sub-types are lacking, therefore further study to evaluate utility of vaccine boosters is necessary.

Sickle cell disease


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