title: Streptococcus pneumoniae pharyngeal colonization in school-age children and adolescents with cancer.
abstract: Patients with cancer, particularly those with hematologic malignancies, are at an increased risk of invasive pneumococcal disease (IPD) and they are included in the list of subjects for whom pneumococcal vaccination is recommended. The main aim of this study was to evaluate Streptococcus pneumoniae colonization in school-aged children and adolescents with cancer to determine the potential protective efficacy of 13-valent pneumococcal conjugate vaccine (PCV13). An oropharyngeal swab was obtained from 277 patients (age range 6-17 years) with cancer during routine clinical visits and analyzed for S. pneumoniae using real-time polymerase chain reaction. S. pneumoniae was identified in 52 patients (18.8%), including 47/235 (20.0%) with hematologic malignancies and 5/42 (11.9%) with solid tumors. Colonization declined significantly with an increase in age (odds ratio [OR] 0.34, 95% confidence interval [CI] 0.16-0.71, and OR 0.30, 95% CI 0.11-0.82 in children aged 10-14 and ≥15 years, respectively, as compared to those <10 years). Carriage was more common among patients with leukemia or lymphoma than in children with solid tumors. Co-trimoxazole prophylaxis was significantly associated with reduced pneumococcal carriage (OR 0.41, 95% CI 0.19-0.89). A total of 15/58 (25.9%) and 26/216 (12.0%) children were colonized by PCV13 serotypes among cancer patients previously vaccinated and not vaccinated with 7-valent pneumococcal conjugate vaccine (PCV7), respectively. In conclusion, this study indicates that children and adolescents with cancer are frequently colonized by S. pneumoniae. Because most of the carried serotypes are included in PCV13, this vaccine is presently the best solution to reduce the risk of IPD in these patients.
authors.affiliation: a Pediatric Highly Intensive Care Unit ; Department of Pathophysiology and Transplantation; Università degli Studi di Milano; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico ; Milan , Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Principi
authors.affiliation: a Pediatric Highly Intensive Care Unit ; Department of Pathophysiology and Transplantation; Università degli Studi di Milano; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico ; Milan , Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Preti
authors.affiliation: b Department of Pediatric Hematology and Oncology ; IRCCS Bambino Gesù Children's Hospital ; Rome , Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Gaspari
authors.affiliation: c Paediatric Haematology-Oncology Department and "Tettamanti" Research Center ; Milano-Bicocca University; "Fondazione MBBM;" San Gerardo Hospital ; Monza , Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Colombini
authors.affiliation: d Pediatric Hematology-Oncology and Research Laboratories; Fondazione IRCCS Policlinico San Matteo ; Pavia , Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Zecca
authors.affiliation: a Pediatric Highly Intensive Care Unit ; Department of Pathophysiology and Transplantation; Università degli Studi di Milano; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico ; Milan , Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Terranova
authors.affiliation: b Department of Pediatric Hematology and Oncology ; IRCCS Bambino Gesù Children's Hospital ; Rome , Italy.
authors.forename: Maria Giuseppina
authors.initials: MG
authors.lastname: Cefalo
authors.affiliation: a Pediatric Highly Intensive Care Unit ; Department of Pathophysiology and Transplantation; Università degli Studi di Milano; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico ; Milan , Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Ierardi
authors.affiliation: e Department of Epidemiology ; IRCCS Istituto di Ricerche Farmacologiche Mario Negri ; Milan , Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Pelucchi
authors.affiliation: a Pediatric Highly Intensive Care Unit ; Department of Pathophysiology and Transplantation; Università degli Studi di Milano; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico ; Milan , Italy.
authors.forename: Susanna
authors.initials: S
authors.lastname: Esposito
mesh_terms: D000293:Adolescent; D002353:Carrier State / Q000382:microbiology*; D002648:Child; D004269:DNA, Bacterial / Q000235:genetics; D005260:Female; D000069443:Heptavalent Pneumococcal Conjugate Vaccine / Q000276:immunology*; D006801:Humans; D008297:Male; D009305:Nasopharynx / Q000382:microbiology*; D009369:Neoplasms; D011008:Pneumococcal Infections / Q000382:microbiology / Q000517:prevention & control; D022242:Pneumococcal Vaccines / Q000276:immunology*; D060888:Real-Time Polymerase Chain Reaction; D065288:Serogroup; D013296:Streptococcus pneumoniae / Q000145:classification / Q000235:genetics*; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D014611:Vaccination; D018074:Vaccines, Conjugate / Q000276:immunology*
chemical_list: C538862:13-valent pneumococcal vaccine; D004269:DNA, Bacterial; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate; D015662:Trimethoprim, Sulfamethoxazole Drug Combination
keywords: Streptococcus pneumoniae; cancer; children; pediatrics; pneumococcal conjugate vaccine; pneumococcal infection; pneumococcal vaccine; tumor