Original Papers

Pneumonia and other respiratory infections

Increased risk of invasive pneumococcal disease in haematological and solid-organ malignancies

A. WONG^a1 c1, T. J. MARRIE^a1, S. GARG^a2, J. D. KELLNER^a3, G. J. TYRRELL^a4a5 and the SPAT Group

^a1 Division of Infectious Diseases, University of Alberta, Edmonton, Alberta, Canada

^a2 EPICORE Centre, University of Alberta, Edmonton, Alberta, Canada

^a3 Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada

^a4 Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada

^a5 The National Centre for Streptococcus, The Provincial Laboratory for Public Health (Microbiology), Edmonton, Alberta, Canada

SUMMARY

Large-scale population-based studies have reported a significant increase in invasive pneumococcal disease (IPD) in those with underlying haematological or solid-organ malignancy, but limited condition-specific data are available on rates of IPD in the adult population. A retrospective chart review of all patients with IPD (identified prospectively) in the province of Alberta, Canada (population ~3·3 million) was conducted from 2000 to 2004 to study the epidemiology of IPD. Rates of IPD in patients with various haematological and solid-organ malignancies were determined by obtaining the number of these patients at risk from the provincial cancer registry. Compared to the attack rate of IPD in the adult population aged ⩾18 years (11·0 cases/100 000 per year, 95% CI 10·44–11·65), there were significantly increased rates of IPD in those with lung cancer (143·6 cases/100 000 per year, OR 13·4, 95% CI 9·3–19·4, P<0·001) and multiple myeloma (673·9 cases/100 000 per year, OR 62·8, 95% CI 39·6–99·8, P<0·001). More modestly increased rates of IPD were found in those with chronic lymphocytic leukaemia, acute myeloid leukaemia, acute lymphoblastic leukaemia, and Hodgkin's and non-Hodgkin's lymphoma. There was an increased prevalence of serotype 6A in those with these underlying malignancies, but no other serotypes predominated. Fifty-three percent (48/83) of cases were caused by serotypes in the investigational 13-valent pneumococcal conjugate vaccine (PCV13), and 57/83 (69%) of the cases were caused by serotypes in the 23-valent pneumococcal polysaccharide vaccine (PPV23). The incidence of IPD in adults with certain haematological and solid-organ malignancies is significantly greater than the overall adult population. Such patients should be routinely given pneumococcal polysaccharide vaccine; this population could also be targeted for an expanded valency conjugate vaccine.

(Accepted March 25 2010)

(Online publication April 30 2010)

Key Words:

• Invasive pneumococcal disease;
• malignancy;
• pneumococcus;
• serotype;
• vaccine

Correspondence:

^c1 Author for correspondence: Dr A. Wong, Division of Infectious Diseases, University of Alberta, 2E4.16 Walter Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada T6G 2B7. (Email: alexander.wong@ualberta.ca)