Bibliographic information
GuidelineWHO consolidated guidelines for the management of common childhood illness: management of sickle-cell disease in children and adolescents
Year of Publication2026
Issuing InstitutionWorld Health Organization
Recommendation
New
In children aged older than 5 years with sickle-cell disease (SCD), who have not completed pneumococcal vaccination series, or who have a history of splenectomy or prior invasive pneumococcal infection, prophylactic penicillin is suggested, regardless of vaccination status.
Recommended in favor
Conditional
Certainty of evidence
Low
Notes and Remarks
- Children aged older than 5 years with SCD who are unvaccinated, who have undergone surgical splenectomy or who have a history of invasive pneumococcal infection are considered at high risk of serious infections and may benefit from continued penicillin prophylaxis.
- In contrast, children aged older than 5 years with fully developed immune systems and no additional risk factors are at lower risk of pneumococcal disease, and the benefit of continued prophylaxis is likely to be minimal.
- The potential benefit of extended penicillin use in older children should be carefully weighed up against the risk of promoting antimicrobial resistance, particularly in the context of global antimicrobial stewardship efforts.
- Where vaccination records are unavailable or uncertain, health care providers should use clinical judgement based on caregiver reports and local immunization practices to determine the child’s likely vaccination status.
- Children with SCD should receive, and remain up to date with recommended vaccinations, including pneumococcal, Haemophilus influenzae type b and meningococcal vaccines along with booster or catch-up doses as appropriate.