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| |    Preventing Infection in Sickle Cell Disease by Lynn Cates, M.D., F.A.A.P. reviewed by Lewis Hsu, M.D., Ph.D. You may already know that sickle cell disease causes problems with red blood cells or even that it causes pain crises, but you may not realize that it also has a significant impact on a child's ability to fight infection. One of the most important things parents can do for a child with sickle cell disease is learn what actions to take when he shows any sign of infection. The principles for protecting children with sickle cell disease from infection include finding appropriate comprehensive health care, using good general infection-control precautions, and following specific recommendations for prevention of infections such as getting him immunized on time. It is extremely important for the family to tell healthcare providers that this is a child with sickle cell disease when discussing how to handle a fever. Advice given for fever in most children is not the same as advice for fever in a child with sickle cell. Since the stakes are higher for children with sickle cell disease who get what might otherwise be considered routine infections, we have put together a list of things that parents can do to help reduce the risk of infections: General measures
It has been clearly demonstrated that giving penicillin to children with sickle cell disease on a regular basis markedly decreases their chance of developing serious pneumococcal infections, such as bloodstream and brain infections such as meningitis. Penicillin prophylaxis (or preventive use) should be started no later than two months of age; it usually is started as soon as sickle cell disease is diagnosed. Penicillin prophylaxis should be given even after a child has received all of his doses of pneumococcal vaccine. The penicillin typically is given twice a day by mouth in liquid or pill form, although it occasionally is given monthly in the form of a shot. Children who are allergic to penicillin can be given erythromycin prophylaxis instead. It is very important that the child take all doses of antibiotic because the protective effect of each dose wears off by the time the next dose is due. The length of time each child receives penicillin prophylaxis is made on an individual basis, depending on his own medical history, but usually continues at least until he turns six. Experts generally agree that children who have had invasive pneumococcal disease should continue to take penicillin prophylaxis longer. It should be noted that recommendations for penicillin prophylaxis might change as more information becomes available about the newly licensed pneumococcal conjugate vaccine. Since children with sickle cell trait are not at increased risk of infection, they do not need penicillin prophylaxis. Immunizations Children with sickle cell disease should receive all the routinely recommended childhood immunizations, and it's enormously important that these immunizations be given on time. It's now possible to protect all children, including those with sickle cell disease, from pneumococcal disease beginning at age two months, due to the licensure of a pneumococcal conjugate vaccine. Children with sickle cell disease should get four doses of this vaccine (three doses, given six to eight weeks apart beginning at two months, and a fourth dose at 12 to 15 months), as well as one dose of pneumococcal polysaccharide vaccine at 24 months (at least six to eight weeks after the last dose of pneumococcal conjugate vaccine). Children with sickle cell disease also should get influenza vaccine every fall after they reach six months of age. In summary, it has been well documented that children with sickle cell disease have a markedly lower risk of developing serious infections with proper preventive care. However, because it is impossible to prevent all serious infections, parents must be able to recognize warning signs of infection and seek advice from their child's healthcare provider promptly. Prompt medical attention and antibiotics can be life-saving.
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