Invasive pneumococcal disease in children with acute lymphoblastic leukaemia.
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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.