Prevention of Invasive Pneumococcal Disease Among Black or African American Children With and Without Sickle Cell Disease in the United States After Introduction of 13-Valent Pneumococcal Conjugate Vaccine, 2005 Through 2019

Background

Administration of pneumococcal vaccines and oral penicillin prophylaxis has been recommended for children with sickle cell disease (SCD) to reduce the risk of invasive pneumococcal disease (IPD). Characterizing changes in IPD cases among children with SCD after 13-valent pneumococcal conjugate vaccine (PCV13) introduction could help inform the need for additional prevention measures.

Methods

Using data from Active Bacterial Core surveillance, we characterized IPD cases among Black or African American (Black) children aged less than 18 years with SCD, non-SCD IPD risk factors, and no IPD risk factors across three time periods (pre-PCV13 [2005–2009], early-PCV13 [2010–2014], and late-PCV13 [2015–2019]), and assessed proportion of IPD cases caused by serotypes in new pneumococcal conjugate vaccines (PCV15, PCV20) recommended after 2019. We analyzed IPD incidence among children with and without SCD.

Results

From 2005 to 2019, 1725 IPD cases were reported among Black children (6.9% with SCD). IPD incidence among children with SCD declined by 50% between pre-PCV13 and late-PCV13 periods (from 332 to 167 per 100,000), although IPD incidence among children with SCD was 42 times that of children without SCD in late-PCV13 period. During late-PCV13 period, greater than 95% of IPD cases among children with SCD were non-PCV13 serotypes; PCV15/non-PCV13 and PCV20/non-PCV15 serotypes caused 19% and 22% of cases, respectively. Increase in penicillin-nonsusceptible IPD cases was not observed.

Conclusions

Despite reductions in IPD incidence after PCV13 introduction, children with SCD are at increased risk of IPD compared to children without SCD. Use of higher valency PCVs may help reduce remaining IPD burden.