982 CHANGING PATTERN OF SEPTICEMIA IN SICKLE CELL DISEASE: POSSIBLE EFFECT OF PNEUMOCOCCAL IMMUNIZATION

Since 1978 we have routinely immunized all sickle cell patients 18 mo. of age or older with pneumococcal polysaccharide vaccine (PPS). To determine if this immunization program decreased the

incidence of septicemia or altered the organism responsible, we reviewed the documented septic episodes in a total of 241 sickle cell patients ages 1 mo. to 16 yrs. seen in our program from

1975-77 compared to 1978-80. The results are shown below:

The number of septic episodes was the same during both periods, however, H. Influenza (H.I.) increased and Strep. pneumoniae (S.P.) decreased since 1978. Septic episodes were only found in

young patients (4 yr). Only one immunized patient (PPS) developed S.P. sepsis, and that with a non-vaccine type, Type 5. Four of seven episodes of H.I. sepsis occurred in patients who had

previously received PPS. There were 3 S.P. and 3 H.I. septic episodes in Hb SC patients. These results suggest a changing pattern of septicemia since beginning routine PPS immunization, H.I.

rather S.P., and support our previous reports of PPS efficacy in Sickle Cell patients over 18 mo. of age. They also suggest that Hb SC patients are at significant risk of bacterial

septicemia. Supported by NHLB Grant No. HL 20985-2 from NIH.

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