Vaccines for preventing severe salmonella infections in people with sickle cell disease

Review question

Does the routine administration of salmonella vaccines to people with sickle cell disease reduce the morbidity and mortality associated with infection.

Background

Salmonella organisms are probably second only to pneumococcus among bacterial causes of infection in people with sickle cell disease. Infection with these bacteria can lead to complications and reduce the quality of life of people with the disease and sometimes result in death. Immunization with salmonella vaccines is one of the interventions available to reduce infection by these bacteria. There are different types of vaccines available: the inactivated vaccines and the oral vaccines.

Search date

The evidence is up to date as of 17 October 2018.

Study characteristics

We did not find any randomized controlled trials assessing these vaccines in people with sickle cell diseases.

Key Results

We conclude that there is a need for a randomized controlled trial to assess the benefits and risks of the different types of vaccines to evaluate the potential for improving survival and decreasing mortality from salmonella infections in people with sickle cell disease. However, we believe that there are unlikely to be any trials published in this area, therefore, this review will no longer be regularly updated.

Authors' conclusions: 

It is expected that salmonella vaccines may be useful in people with sickle cell disease, especially in resource-poor settings where the majority of those who suffer from the condition are found. Unfortunately, there are no randomized controlled trials on the efficacy and safety of the different types of salmonella vaccines in people with sickle cell disease. We conclude that there is a need for a well-designed, adequately-powered, randomized controlled trial to assess the benefits and risks of the different types of salmonella vaccines as a means of improving survival and decreasing mortality from salmonella infections in people with sickle cell disease. However, we believe that there are unlikely to be any trials published in this area, therefore, this review will no longer be regularly updated.

Read the full abstract...
Background: 

Salmonella infections are a common bacterial cause of invasive disease in people with sickle cell disease especially children, and are associated with high morbidity and mortality rates. Although available in some centres, people with sickle cell anaemia are not routinely immunized with salmonella vaccines. This is an update of a previously published Cochrane Review.

Objectives: 

To determine whether routine administration of salmonella vaccines to people with sickle cell disease reduces the morbidity and mortality associated with infection.

Search strategy: 

We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register which comprises of references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings.

We also conducted a search of the LILACS database and the World Health Organization International Clinical Trials Registry Platform (www.who.int/trialsearch) and ClinicalTrials.gov (www.clinicaltrials.gov).

Date of most recent searches: 17 October 2018.

Selection criteria: 

We planned to select all randomized controlled trials that compared the use of either the inactivated vaccine or an oral attenuated vaccine with a placebo among people with sickle cell disease. Equally, studies that compared the efficacy of one vaccine type over another were to be selected for the review.

Data collection and analysis: 

No trials of salmonella vaccines in people with sickle cell disease were found.

Main results: 

There is an absence of randomized controlled trial evidence relating to the scope of this review.

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