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May 28, 1982

Pneumococcal Infections and Sickle Cell Disease-Reply

Author Affiliations

Marshall University School of Medicine Huntington, WVa

JAMA. 1982;247(20):2782. doi:10.1001/jama.1982.03320450020024

In Reply.—  I agree with Dr Eustatia that children with sickle cell disease suffer high risk of bacteremic pneumococcal disease and fatal outcome. It is likely that their underlying functional hyposplenism or autosplenectomy accounts for this unique susceptibility to serious pneumococcal infections. The incidence of pneumococcal infection in persons with sickle cell anemia is 40/1,000/yr and of pneumococcal meningitis it is 5.8/ 1,000/yr. These important points were emphasized in my article. Additionally, some persons with sickle cell anemia have a defect in the alternate pathway of complement activation.1 This is another reason to administer pneumococcal vaccine, since it induces antibody that can activate the classic pathway of complement.I am pleased to learn that pneumococcal vaccine is given to all children with sickle cell disease residing in Curaçao. Such a program can be expected to reduce the incidence of serious pneumococcal infection in these children. Immunization with pneumococcal vaccine