High mortality from pneumococcal meningitis seen for SCD children
Study: Meningitis mainly caused by bacterial strains not covered by vaccines
Meningitis — an inflammation of the protective membranes surrounding the brain and spinal cord — remains associated with a case-fatality rate of nearly 30% in children with sickle cell disease (SCD), according to the findings of a new two-decade study from France.
This is despite vaccinations for SCD children against the pneumococcal bacteria that cause meningitis and other diseases.
Per the researchers, this study demonstrated that, in most cases, meningitis was mainly caused by bacterial serotypes, or strains, that were not covered by vaccines. In fact, the team noted that strains of Streptococcus pneumoniae, or S. pneumoniae, “were identified in 39%” of the patients in the study.
“Combined preventive strategies such as generalized neonatal screening, systematic antibiotic [prevention], and enhanced pneumococcal [vaccination] must be pursued with fervor to limit … mortality due to S. pneumoniae in these children at high risk of invasive infections,” the researchers wrote.
The study, “High Mortality Due to Pneumococcal Meningitis in Children With Sickle Cell Disease: A French Multicenter Observational Study From 2001 to 2021,” was published in The Pediatric Infectious Disease Journal.
SCD is caused by the production of an abnormal version of hemoglobin — the protein responsible for carrying oxygen in red blood cells — that causes the cells to acquire a sickle-like shape. These cells are prone to die prematurely and tend to stick together inside blood vessels, blocking blood flow and impairing oxygen delivery to tissues.
French researchers analyzed cases over a 20-year period
Children with SCD are more susceptible to bacterial infections, including those caused by S. pneumoniae, a type of pneumococcal bacteria. Although vaccination against pneumococcal bacteria has reduced the risk of invasive pneumococcal disease in these children, it remains higher than in the general population.
To learn more, a team of researchers from institutions across France retrospectively analyzed all cases of pneumococcal meningitis occurring in children and adolescents younger than 18 from the French National Registry of Pediatric Bacterial Meningitis. Their research spanned the years from 2001 to 2021. The registry is estimated to cover 61% of the cases across several centers.
The implementation of new serotype-expanded [pneumococcal conjugate vaccine] may have a potentially positive impact on this vulnerable population.
From a total of 2,145 cases of pneumococcal meningitis, 25 (1.2%) occurred in children with SCD. These children had a mean age of 4.6 years at the time of diagnosis; nearly two-thirds were girls.
Most of the children had received at least three doses of a pneumococcal conjugate vaccine, or PCV, while about half received at least one dose of a pneumococcal polysaccharide vaccine.
The disease was most commonly caused by bacteria serotypes that were not covered by these vaccines (60%), while in eight children (32%), it was caused by bacteria strains that were included in the vaccines. In two cases, bacteria serotypes couldn’t be determined. In most cases (61%), the bacteria causing the infection was susceptible to penicillin, an antibiotic.
According to researchers, these results indicate “the implementation of new serotype-expanded PCV may have a potentially positive impact on this vulnerable population.”
Nearly three-quarters of patients in study needed blood transfusions
The initial symptoms of pneumococcal meningitis were often nonspecific but included fever (100%) and typically digestive problems such as vomiting and diarrhea (92%). Neurological symptoms such as headache and seizures were seen in 83% of children, and respiratory issues like shortness of breath and cough were experienced by 33%.
At the time of diagnosis, most children (80%) were on long-term treatment with penicillin and 16% were taking hydroxyurea, also known as hydroxycarbamide.
A total of 20 children started treatment with an antibiotic belonging to the class of cephalosporins, usually within 24 hours.
Treatment with corticosteroids was added for 40% of the children, and 72% required blood transfusions. Overall, the children stayed in the hospital for an average of 18 days, and 44% were admitted to the intensive care unit. Four children remained with long-term neurological or hearing issues, and seven (28%) died.
The children who died had a mean age of 5 and six were girls. Their disease was most commonly caused by bacteria strains that were covered by the vaccines (five children).
“The deaths reported in our study were often associated with immediate severe clinical presentations and usually occurred within 24 hours, indicating the need for early empiric antibiotics,” the researchers wrote.
The researchers called for increased and more widespread vaccinations for children with SCD.
“However, it will be necessary to remain vigilant with the emergence of [nonvaccine serotypes] and resistant strains,” the team noted.
About the Author
