Pneumococcal vaccines for sickle cell disease

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Abstract
People with sickle cell disease are particularly susceptible to pneumococcal infection, which may be fatal. Infants (children aged up to 23 months) are at particularly high risk, but conventional polysaccharide pneumococcal vaccines may be ineffective in this age group. New conjugate pneumococcal vaccines are now available, which may help to reduce the incidence of infection in people with sickle cell disease. To determine the efficacy of pneumococcal vaccines for reducing morbidity and mortality in people with sickle cell disease. We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register, comprising of references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. In addition, we contacted relevant pharmaceutical companies and experts in the field. Date of most recent search of Group's Haemoglobinopathies Trials Register: 09 December 2011. All randomised and quasi‐randomised controlled trials comparing a polysaccharide or conjugate pneumococcal vaccine regimen with a different regimen or no vaccination in people with sickle cell disease. Two authors independently selected studies for inclusion, extracted data and assessed trial quality. Nine trials were identified in the searches and five trials, with a total of 547 participants, met the inclusion criteria. Only one trial reported incidence of pneumococcal infection, and this demonstrated that the polysaccharide pneumococcal vaccine used (PPV14) failed to reduce significantly the risk of infection in children under three years of age, but was associated with only minor adverse events. Three trials of conjugate pneumococcal vaccines found that antibody responses were increased compared to control groups, including those in infants, although clinical outcomes were not measured in these trials. Previous trials have shown that conjugate pneumococcal vaccines are safe and effective in normal healthy individuals, including those under the age of two years. The controlled trials included in this review have demonstrated immunogenicity (the ability to induce the body's immune response, without which there is no protection) of these vaccines, and observational studies in people with sickle cell disease support these findings. We therefore recommend that conjugate pneumococcal vaccines are used in people with sickle cell disease. Randomised trials in people with sickle cell disease will be needed to determine the optimal vaccination regimen when further, potentially more effective vaccines become available. Such trials should measure clinical outcomes of effectiveness. The trials included in this review were published between 1983 and 2003. We have not identified any further relevant trials up to December 2011. We therefore do not plan to update this review until new trials are published. 肺炎鏈球菌疫苗(pneumococcal vaccines)用於鐮刀型貧血症(sickle cell disease) 鐮刀型貧血症患者特別容易受到肺炎鏈球菌感染，且可能致命。嬰兒(0到23個月大的兒童)特別處於高風險，但傳統的多醣體肺炎鏈球菌疫苗(polysaccharide pneumococcal vaccines)此年齡層可能對無效。新的接合型肺炎鏈球菌疫苗(conjugate pneumococcal vaccines)現已上市，可能有助於減少鐮刀型貧血症患者的感染率。 探討肺炎鏈球菌疫苗降低鐮刀型貧血症患者併發症和死亡率的療效。 我們搜尋了Cochrane Cystic Fibrosis and Genetic Disorders Group Haemoglobinopathies Trials Register資料庫，其主要是由廣泛搜尋電子資料庫所找到的參考文獻，以及手動搜尋相關期刊及研討會大會手冊之摘要。此外，我們連絡相關藥廠與該領域的專家。最近搜尋本組Haemoglobinopathies Trials Register的時間：2007年3月。 針對鐮刀型貧血症患者，所有比較多醣體或接合型肺炎鏈球菌疫苗與不同打法(regimen)或未施打疫苗的隨機或半隨機對照試驗(randomised or quasirandomised controlled trials)。 有2位作者分別選擇所引用的研究、選取資料並評估試驗品質。 搜尋共找到9個試驗，其中有5個試驗、共547位病人符合引入條件。只有1個試驗有報告肺炎鏈球菌感染的發生率，其所採用的多醣體肺炎鏈球菌疫苗(PPV14)無法顯著降低3歲以下兒童的感染風險，但只與輕微副作用有關。有3個接合型肺炎鏈球菌疫苗的試驗發現抗體反應比對照組來得強，包括在嬰兒身上亦然，但這些試驗並沒有檢測臨床結果。 先前的研究顯示，接合型肺炎鏈球菌疫苗在健康個體是安全有效的，包括年齡2歲以下者。本篇文獻回顧所引入的對照試驗，證明了這些疫苗的免疫生成性(immunogenicity，即促進身體產生免疫反應的能力，若缺乏則沒有保護力)，且對鐮刀型貧血症患者的觀察性研究(observational studies)也支持這些發現。因此，我們推薦鐮刀型血球貧血症患者使用接合型肺炎鏈球菌疫苗。當可能更有效的疫苗問世時，需針對鐮刀型貧血症患者進行隨機試驗，以探討合適的疫苗施打法。這樣的試驗應包含臨床結果與療效的檢測。 本摘要由臺灣大學附設醫院劉彥麟翻譯。 此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。 肺炎鏈球菌疫苗可增強鐮刀型貧血症患者對肺炎鏈球菌感染的免疫力。...

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