Penicillin Resistance in Nasopharyngeal Streptococcus pneumoniae among Children with Sickle Cell Disease Immunized with 7-Valent Pneumococcal Conjugate Vaccine

To assess the prevalence, the antimicrobials resistance and to identify risk factors of nasopharyngeal colonization by Streptococcus pneumoniae in children with sickle cell disease (SCD) using prophylactic penicillin and immunized with 7-valent pneumococcal conjugate vaccine. A total of 424 swabs were collected from the nasopharynx in 216 children with SCD and 109 samples from the control group, both from 2 to 60 months age range. Isolation and identification of pneumococci followed standard procedures. Minimum inhibitory concentration (MIC) for penicillin was determined by the E-test method. Prevalence of nasopharyngeal colonization by pneumococci in children with SCD was 17%, and 11% in the control group. The risk factors for increased colonization in children with SCD were the presence of more than five people at home, daycare/school attendance and low prophylaxis compliance. The prevalence of strains with penicillin resistance was 57.5% in patients with SCD and 25% in the control group. Conclusions: Prevalence of pneumococci nasopharyngeal colonization was similar among the study groups. Prophylactic use of penicillin may have increased the prevalence of resistant strains. The vaccine did not decrease the colonization with penicillin resistant strains.

Hemoglobin Values in the First Six Months of Life in Exclusively Breastfed Children

Objective: The inexistence of publications on hemoglobin values in the first six months of life gave us the objective of describing these values, month by month in healthy, iron sufficient exclusively breastfed infants. Methods: This was a cross-sectional descriptive study in 306 infants stratified according to age from one to six months, full-term births, weighing ≥2500 g, without intercurrences at birth, serum ferritin levels ≥10 ng/mL, followed by the public health service encouraging and supporting exclusive breastfeeding. An automated counter was used for measuring hemoglobin, and serum ferritin was determined using immunoenzymatic method. Student’s t-test was used to analyze differences between means, and Mann-Whitney test when distribution was non-normal. Level of statistical significance was p 0.05. Results: The hemoglobin values, according to gender, did not differ statistically in the different months;the results are presented without sample division according to gender. Hemoglobin means and standard deviations in g/dL were: 11.7(±1.6), 10.7(±1.5), 10.8(±1.3), 11.6(±1.5), 11.7(±1.7), and 11.8(±1.6), from the first to sixth month respectively. Conclusion: The hemoglobin values obtained in all the first six months of life, based on a healthy, exclusively breastfed infant population, may contribute to the reassessment of reference levels for the diagnosis of anemia in the studied age range.