L-688. Increased Incidence of Invasive Pneumococcal Disease in Patients with Underlying Malignancy
Session: Poster Session: The World of Community-Acquired Pneumonia
Saturday, October 25, 2008: 12:00 AM
Room: Hall C
The Streptococcus pneumoniae Alberta Team (SPAT) was formed to study various aspects of invasive pneumococcal disease (IPD) in the province of Alberta, Canada (pop. ~3.3 million). A retrospective chart review of all cases of IPD in the province from 2000-2004 was conducted. Prevalence data for solid-organ and hematological malignancies from 2000 to 2004 were obtained from the Alberta Cancer Registry. Relevant results are summarized in the following table:
Table 1: IPD & Underlying Malignancy
MalignancyIPD Cases between 2000-2004Attack Rate / 100,000 (95% CI)P-value (Fisher's Exact Test)
Lung cancer29 / 20198143.6 (91.36, 195.80)<0.001
Multiple myeloma18 / 2671673.9 (363.63, 984.18)<0.001
Chronic lymphocytic leukemia (CLL)10 / 8039124.4 (47.34, 201.45)<0.001
Other leukemia (AML/ALL)10 / 7740129.2 (49.17, 209.23)<0.001
Hodgkin's lymphoma4 / 838347.8 (0.97, 94.47)0.015
Non-Hodgkin's lymphoma12 / 1890563.5 (27.57, 99.38)<0.001

Compared to the overall adult population 18 years of age or older [11.0 cases/100,000/year, 95% CI 10.44-11.65], we identified a statistically significant increased rate of IPD in those with lung cancer, multiple myeloma, CLL, AML & ALL, Hodgkin’s lymphoma and Non-Hodgkin's lymphoma. There was an increased prevalence of serotype 6A in those with these underlying malignancies (11/83; 13.3%, vs. 48/1273; 4%, P=0.001), but no other serotypes predominated. Overall, 48/83 cases (58%) of cases were caused by serotypes in the experimental 13-valent pneumococcal conjugate vaccine.
The incidence of IPD in adults with some hematological and non-hematological malignancies is much larger than in the overall adult population. Such patients should be given pneumococcal polysaccharide vaccine and this population could be targeted for an expanded valency conjugate vaccine.
and the SPAT Group, Alexander Wong, MD, Division of Infectious Diseases, University of Alberta, Edmonton, AB, Canada, Gregory Tyrrell, PhD, National Centre for Streptococcus, James D. Kellner, MD, Alberta Children's Hospital, Calgary, AB, Canada, Thomas Marrie, MD, Walter C. Mackenzie Hlth. Sci. Ctr., Edmonton, AB, Canada and  A. Wong, None.