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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
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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
aravind.yadav@uth.tmc.edu

Corresponding author.
Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
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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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Abstract
Introduction

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.

Objective

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

Methods

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.

Results

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.

Conclusion

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.

Keywords:
Sickle cell disease
HbSS
HbSC
Immunity
Pneumococcus
Vaccine
Abbreviations:
IPD
NLHBI
PCV
PPSV-23
SCD
ACS

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