Invasive pneumococcal disease among adults with hematological and solid organ malignancies: a population-based cohort study.

OBJECTIVES To determine the risk of IPD in adult cancer patients stratified by type of underlying malignancy, age and capsular serotype and to assess herd effects of childhood pneumococcal vaccination. METHODS All adult IPD cases reported to the Dutch pneumococcal surveillance system between 2004-2016 were included in this study. We calculated IPD incidence rates (IR) stratified by subtype of malignancy per 100,000 patient-years of follow-up. Incidence rate ratios (IRR) were calculated to compare IRs between groups. RESULTS We included 7167 IPD cases, of which 1453 had malignancies. For patients with hematological malignancies (HM) and solid organ malignancies (SoM), IRs were 482/100,000 and 79/100,000 respectively, compared with 15/100,000 in controls. The highest incidence was observed among patients with multiple myeloma, non-Hodgkin lymphoma, chronic lymphocytic leukemia, pancreatic cancer, lung cancer (3,299/100.000, 4,306/100.000, 538/100.000, 559/100.000 and 393/100.000 respectively), and in patients ≥ 50 years old. Among HM patients, the incidence of IPD declined significantly after the implementation of infant pneumococcal vaccination (IRR 0.65[0.51-0.84]); among SoM patients, the decline was not statistically significant (IRR 0.88[0.72-1.07]). CONCLUSIONS The IPD disease burden in cancer patients remains high. Large differences in IPD incidence between the different types of cancer demand tailored guidance regarding pneumococcal vaccination.