Sir.—In their article in the May issue of the Archives, Buchanan and Smith1 raise the flag again for those of us who treat patients with sickle cell disease; pneumococcal septicemia is still with us despite all of the work on the vaccine and prophylaxis with penicillin. Buchanan and Smith point out the failure of the vaccine when given before the second birthday. It is disturbing that only two of the pneumococcal serotypes are contained in the commercially available vaccine, which means that the six other episodes might not have been prevented regardless of the age at which the vaccine was given. Buchanan and Smith also point out the problem of compliance with penicillin prophylaxis. If compliance is a problem in their well-organized sickle cell clinic in a developed country, you can imagine the problem for those who work in less developed countries with limited resources, low socioeconomic status,
MALLOUH AA. Pneumococcal Septicemia in Sickle Cell Disease. Am J Dis Child. 1986;140(11):1092–1093. doi:10.1001/archpedi.1986.02140250018007
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