New Evidence of S Pneumoniae in Acute Chest Syndrome

Sickle cell disease (SCD) is generally accompanied by various complications, with acute chest syndrome (ACS) leading as one of the most severe. A new study examined the relationship between the 13-valent pneumococcal vaccine (PCV13) and the incidence of acute chest syndrome in children with sickle cell disease.

Based on the recent results, investigators wrote that Streptococcus pneumoniae (S pneumonaie) should be considered when making decisions related to public health going forward. Prior to this research, the significance of S pneumoniae's role in relation to acute chest syndrome wasn't clear.

However, when investigators assessed the association of PCV13 implementation in the general pediatric population with the incidence of acute chest syndrome in children with sickle cell disease, they found that the vaccine served as an important defense method since it reduced the prevalence of acute chest syndrome in this population.

Prevalence of Acute Chest Syndrome in Children with SCD

A team of investigators led by Zein Assad, MD, Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, conducted a cohort study using data from a national hospital-based French surveillance system.

The interrupted time-series analysis included patient records of children under the age of 18 with sickle cell disease who were hospitalized in France between January 2007-December 2019. Of the total 107,694 hospitalizations within these parameters, there were 4007 episodes of acute chest syndrome.

The main outcomes and measures included the monthly incidence of acute chest syndrome per 1000 children with SCD over time as analyzed by segmented linear regression with auoregressive error. Also, the monthly incidence of hospitalization for vaso-occlusive crisis (VOC), asthma crisis, and acute pyelonephritis per 1000 children with SCD within the same time period as the control outcomes.

Vaccination Reduced Acute Chest Syndrome

After PCV13 was implemented in 2010, there was a significant decrease in the incidence of acute chest syndrome with -0.9% per month. By 2019, investigators reported there was an estimated cumulative change of -41.8%.

There was little variation in results across different age groups and sensitivity analyses produced the same results, which included the incidence of acute chest syndrome that was adjusted for vaso-occlusive crisis over time. For the 3 control outcomes, no change was observed.

"PCV13 implementation was associated with an important reduction in the incidence of ACS in children with SCD," investigators wrote. "This vaccine benefit provides new evidence of the key role of S pneumoniae in ACS and should be considered when estimating outcomes associated with current PCVs and the potential benefit of next-generation PCVs in children."

The study, "Incidence of Acute Chest Syndrome in Children With Sickle Cell Disease Following Implementation of the 13-Valent Pneumococcal Conjugate Vaccine in France" was published in JAMA Network Open.