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Published on: February 23, 2014
Invasive pneumococcal disease in children with acute lymphoblastic leukaemia
Linny Kimly Phuong1,2,3, Amanda Gwee1,2,3,4, Christopher C Blyth5,6,7
1Infection & Immunity Theme Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
Insights
Children with acute lymphoblastic leukaemia (ALL) face a significantly higher risk of invasive pneumococcal disease (IPD) even after pneumococcal conjugate vaccine (PCV) use. Most IPD cases were caused by non-PCV13 serotypes, highlighting the need for better vaccination strategies.
Area of Science:
- Paediatric Oncology
- Infectious Diseases
- Immunology
Background:
- Widespread use of pneumococcal conjugate vaccines (PCVs) has reduced invasive pneumococcal disease (IPD) in the general population.
- Children undergoing cancer treatment, particularly acute lymphoblastic leukaemia (ALL), may have altered immune responses and remain vulnerable to infections.
Purpose of the Study:
- To assess the incidence, serotype distribution, and clinical outcomes of IPD in children with ALL post-PCV implementation.
- To compare IPD rates in children with cancer against the general paediatric population.
Main Methods:
- A multicentre cohort study was conducted across two tertiary paediatric oncology centres in Australia.
- Data on pneumococcal vaccination status, IPD episodes, serotypes, and clinical outcomes were collected for children with cancer, including a subgroup with ALL.
Main Results:
- 29 IPD episodes occurred in 28 children with cancer (19 with ALL).
- The incidence of IPD in children with ALL was 190-360 times higher than in healthy children.
- Most IPD cases (83%) were caused by non-PCV13 serotypes (e.g., 23B), and additional pneumococcal vaccination uptake was low.
Conclusions:
- Children with ALL have a substantially increased risk of IPD despite PCV use, primarily due to non-PCV13 serotypes.
- Low uptake of additional pneumococcal vaccine doses was observed.
- Optimized vaccination and prophylactic strategies are crucial for this vulnerable paediatric oncology population.
Objective:
To determine the incidence, serotype distribution and clinical outcomes of invasive pneumococcal disease (IPD) in children with acute lymphoblastic leukaemia (ALL) following widespread use of pneumococcal conjugate vaccines (PCVs).
Design:
Multicentre cohort study.
Setting:
Two tertiary paediatric oncology centres in Australia-Royal Children's Hospital-Melbourne and Perth Children's Hospital.
Patients:
Children with cancer, including a defined subgroup with ALL.
Interventions:
All children were assessed for provision of pneumococcal vaccines before and after their diagnosis of cancer.
Main Outcome Measures:
Incidence of IPD in cancer (ALL and non-ALL) compared with the general paediatric population, serotype distribution, vaccination status and clinical outcomes.
Results:
A total of 29 episodes of IPD in 28 children with cancer were included, of whom 19 had ALL. Less than a quarter had received additional pneumococcal vaccinations beyond the standard PCV schedule. The incidence of IPD in children with ALL was 190-360 times higher than in healthy children (1360 per 100 000 person-years). The majority of episodes (83%) were due to non-PCV13 serotypes, most commonly 23B. Clinical presentation was predominantly bacteraemia. Most patients recovered within 30 days, but there was one death attributable to IPD.
Conclusions:
Children with ALL remain at substantially increased risk of IPD despite widespread PCV use, with disease largely caused by non-PCV13 serotypes. Uptake of additional pneumococcal doses was low. These findings underscore the need for optimised vaccination and prophylactic strategies in paediatric oncology populations.
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