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. 2018 Jan 6;66(2):244-253.
doi: 10.1093/cid/cix739.

Trends in Invasive Pneumococcal Disease in Cancer Patients After the Introduction of 7-valent Pneumococcal Conjugate Vaccine: A 20-year Longitudinal Study at a Major Urban Cancer Center

Yeon Joo Lee  1   2 , Yao-Ting Huang  1 , Seong Jin Kim  1 , Marina Kerpelev  3 , Victoria Gonzalez  1 , Anna Kaltsas  1   2 , Genovefa Papanicolaou  1   2
Affiliations

Trends in Invasive Pneumococcal Disease in Cancer Patients After the Introduction of 7-valent Pneumococcal Conjugate Vaccine: A 20-year Longitudinal Study at a Major Urban Cancer Center

Yeon Joo Lee et al. Clin Infect Dis. .

Abstract

Background: Rates of invasive pneumococcal disease (IPD) declined since routine childhood immunization with the 7-valent pneumococcal conjugate vaccine (PCV7) in 2000. We studied the impact of PCV7 on the incidence of IPD in cancer patients.

Methods: This was a retrospective analysis of adult and pediatric patients treated at Memorial Sloan Kettering Cancer Center from 1992 to 2012. Recovery of Streptococcus pneumoniae from a sterile site defined IPD. IPD incidence was calculated as cases per 1,000 unique patient-visits per year (UPV). IPD incidence was calculated for the periods: "before PCV7" (1992-2000), "after PCV7" (2001-2010) and "after PCV13" (2011-2012).

Results: Of 343 IPD cases, 165, 155, and 23 cases occurred "before PCV7," "after PCV7" and "after PCV13" respectively. The IPD incidence declined from 0.43 "before PCV7" to 0.17 "after PCV7" (95% confidence interval [CI]: 0.33-0.46, P < .001) and 0.11 "after PCV13" (95% CI: 0.42-0.96, P = .004). Adults with hematologic malignancies and children had the highest incidence. In patients 1-4 years old, the incidence declined from 11.2 "before PCV7" to 2.38 "after PCV7" (79% decrease, 95% CI: 0.1-0.4, P < .001). In patients with hematologic malignancies, the incidence declined from 2.55 "before PCV7" to 0.92 "after PCV7" (64% decrease, 95% CI: 0.27-0.47, P < .001).

Conclusions: The incidence of IPD among cancer patients sharply declined after introduction of PCV7; especially in high risk groups. The decline in adults suggests an indirect effect from PCV7 childhood vaccination.

Keywords: cancer; invasive pneumococcal disease; pneumococcal conjugate vaccine.

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Figures

Figure 1.
Figure 1.
Overall IPD incidence by study period: “before PCV7,” “after PCV7,” and “after PCV13.” IPD incidence was compared with the immediately preceding period. The IPD incidence was lower “after PCV7” (P < .001) and “after PCV 13” (P = .04). Unique patient-visits per period: “before PCV7,” 3.9 × 105; “after PCV7,” 9.3 × 105 and “after PCV13,” 2.1 × 105. Abbreviations: CI, confidence interval; IPD, invasive pneumococcal disease; PCV7, 7-valent pneumococcal conjugate vaccine; PCV13, 13-valent pneumococcal conjugate vaccine.
Figure 2.
Figure 2.
IPD incidence in children. Upper panel: IPD incidence in children with hematologic malignancies: In children aged 1–4 years, IPD decreased by 44% “after PCV7” (P = NS). There were no IPD cases “after PCV13.” In children aged 5–14 years, IPD incidence was lower “after PCV7” (P = .05). Lower panel: IPD incidence in children with solid tumors: In children aged 1–4, IPD incidence declined “after PCV7” (P < .001). Abbreviation: IPD, invasive pneumococcal disease; CI, confidence interval; PCV7, 7-valent pneumococcal conjugate vaccine; PCV13, 13-valent pneumococcal conjugate vaccine.
Figure 3.
Figure 3.
IPD incidence in adults. Upper panel: IPD incidence in adults with hematologic malignancies: In patients aged 15–64 and ≥65 years, IPD incidence declined “after PCV7.” Lower panel: IPD incidence in adults with solid tumors: In patients aged 15–64 and ≥65 years, IPD incidence declined “after PCV7.” The decline “after PCV13” was significant for patients 15–64 (P = .009). Abbreviation: IPD, invasive pneumococcal disease; CI, confidence interval; PCV7, 7-valent pneumococcal conjugate vaccine; PCV13, 13-valent pneumococcal conjugate vaccine.
Figure 4.
Figure 4.
(A) Annual IPD incidence in children with hematologic malignancies. In children aged 5–14 years, IPD incidence declined abruptly in 2000. (B) Annual IPD incidence in children with solid tumors. There was a trend for decreased incidence after 2000. Abbreviation: IPD, invasive pneumococcal disease; PCV7, 7-valent pneumococcal conjugate vaccine; PCV13, 13-valent pneumococcal conjugate vaccine.
Figure 5
Figure 5
(A) Annual IPD incidence in adults with hematologic malignancies. In adults with hematologic malignancies, there was an abrupt IPD decrease in 2000. (B) Annual IPD incidence in adults with solid tumors. In adults with solid tumors, there was a trend for lower IPD incidence after 2000. Adults with solid tumors had a 10-fold lower rate compared to adults with hematologic malignancies. Abbreviation: IPD, invasive pneumococcal disease; PCV7, 7-valent pneumococcal conjugate vaccine; PCV13, 13-valent pneumococcal conjugate vaccine.
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