Incidence of invasive Haemophilus influenzae infections in children with sickle cell disease

• Type of Material: Article
• Authors: Marianne Yee, Emory University; Nitya Bakshi, Emory University; Sara H. Graciaa, Childrens Healthcare Atlanta; Peter Lane Jr, Emory University; Robert Jerris, Emory University; Yun Wang, Emory University; Inci Yildirim, Emory University
• Language: English
• Date: 2019-06-01
• Publisher: Wiley
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2019 John Wiley & Sons, Inc. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1002/pbc.27642
• Title of Journal or Parent Work: Pediatric Blood & Cancer
• Volume: 66
• Issue: 6
• Start Page: e27642
• End Page: e27642
• Grant/Funding Information: This study was supported by a grant from the Abraham J. & Phyllis Katz Foundation.; Nitya Bakshi is supported from a grant from the National Heart, Lung and Blood Institute of the NIH (1K23HL140142–01A1).
• Keywords: Hematology; Pediatrics; Prophylaxis; Life Sciences & Biomedicine; Haemophilus influenzae; Epidemiology; Science & Technology; bacteremia; Oncology; sickle cell disease; Pneumococcal disease; Pencilin; United States
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Oncology; Biology, Cell

Abstract

Background: Children with sickle cell disease (SCD) are at increased risk for invasive infection with encapsulated bacteria. Antibiotic prophylaxis and immunizations against Streptococcus pneumoniae and Haemophilus influenzae type b (Hib) have decreased the overall incidence of invasive infections and have shifted distribution of serotypes causing disease toward those not covered by immunizations. We sought to determine the current incidence of invasive H. influenzae infections in children with SCD and to describe the clinical features and management of these infections. Methods: Microbiology reports of a large pediatric tertiary care center were reviewed to identify all isolates of H. influenzae detected in sterile body fluid cultures from January 1, 2010 to December 31, 2017. Results were compared with the center's comprehensive clinical database of all children with SCD to identify all cases of children ages 0 to18 years with SCD with invasive H. influenzae disease for the same time period. Results: We captured 2444 patients with SCD, with 14,336 person-years. There were eight episodes of H. influenzae bacteremia in seven children with SCD (five type f, two non-typable, one type a). Most episodes (7 of 8) were in children < 5 years. The incidence rate of invasive H. influenzae in SCD was 0.58/1000 person-years for ages 0 to 18 years and 1.60/1000 person-years for children age < 5 years. There were no deaths from H. influenzae infection. Conclusions: In the era of universal antibiotic prophylaxis and immunization against Hib, invasive H. influenzae disease due to nonvaccine serotypes remains a risk for children with SCD, particularly those under five years of age.