Clinical Effectiveness of Conjugate Pneumococcal Vaccination in Hematopoietic Stem Cell Transplantation Recipients

Matthew B Roberts; Narin Bak; Li Yan A Wee; Rakchha Chhetri; David T Yeung; Ian Lewis; Devendra K Hiwase

doi:10.1016/j.bbmt.2019.10.006

Clinical Effectiveness of Conjugate Pneumococcal Vaccination in Hematopoietic Stem Cell Transplantation Recipients

Biol Blood Marrow Transplant. 2020 Feb;26(2):421-427. doi: 10.1016/j.bbmt.2019.10.006. Epub 2019 Oct 15.

Authors

Matthew B Roberts¹, Narin Bak¹, Li Yan A Wee², Rakchha Chhetri³, David T Yeung³, Ian Lewis⁴, Devendra K Hiwase⁵

Affiliations

¹ Infectious Diseases Unit, Royal Adelaide Hospital, Adelaide, Australia.
² Royal Adelaide Hospital, Adelaide, Australia; Cancer Theme, South Australian Health and Medical Research Institute. Department of Medicine, University of Adelaide, Adelaide, Australia.
³ Royal Adelaide Hospital, Adelaide, Australia; Cancer Theme, South Australian Health and Medical Research Institute. Department of Medicine, University of Adelaide, Adelaide, Australia; School of Medicine, University of Adelaide, Adelaide, Australia.
⁴ School of Medicine, University of Adelaide, Adelaide, Australia.
⁵ Royal Adelaide Hospital, Adelaide, Australia; Cancer Theme, South Australian Health and Medical Research Institute. Department of Medicine, University of Adelaide, Adelaide, Australia; School of Medicine, University of Adelaide, Adelaide, Australia. Electronic address: devendra.hiwase@sa.gov.au.

PMID: 31627016
DOI: 10.1016/j.bbmt.2019.10.006

Abstract

Hematopoietic stem cell transplantation (HSCT) recipients are vulnerable to invasive pneumococcal disease (IPD), with reported IPD rates ranging from 3.81 to 22.5/1000 HSCT. This IPD risk could relate to immunodeficiency, low vaccination uptake, and poor immunogenicity of pneumococcal polysaccharide vaccine (PPV). Literature comparing the clinical effectiveness of pneumococcal conjugate vaccination (PCV) and PPV after HSCT is limited. In this retrospective analysis of HSCT recipients at our center from 2004 to 2015, we evaluated vaccination uptake and compared IPD rates in patients receiving PPV (pre-2010 group) and PCV (post-2010 group). IPD was determined from microbiological results for all HSCT recipients from January 2004 to June 30, 2019. Eight hundred patients had a total of 842 HSCT events, including autologous HSCT (auto-HSCT; n = 562) and allogeneic HSCT (allo-HSCT; n = 280). More than 90% of the HSCT recipients were enrolled, and >93% of surviving HSCT recipients completed the vaccination protocol. Fifteen IPD episodes occurred in 13 patients between 2004 and June 30, 2019. Thirteen episodes occurred in the pre-2010 group, even though 9 of 13 (69%) serotyped isolates were covered by PPV. Two episodes occurred in the post-2010 group; neither serotype was covered by PCV. Thus, with PCV introduction, IPD rate was significantly reduced from 38.5/1000 unique HSCTs pre-2010 to 4.0/1000 unique HSCTs post-2010 (P < .001). A significant reduction was seen in both auto-HSCTs (from 29.4 to 3.1 /1000 unique auto-HSCTs; P = .011) and allo-HSCTs (from 58.3 to 5.6/1000 unique allo-HSCTs; P = .011). PCV demonstrated superior clinical effectiveness over PPV, highlighting its importance in preventing infectious complications after HSCT. Robust vaccination programs at transplantation centers are needed to optimize vaccination uptake and completion.

Keywords: Hematopoietic stem cell transplantation; Invasive pneumococcal disease; Pneumococcal vaccines.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Hematopoietic Stem Cell Transplantation*
Humans
Pneumococcal Vaccines*
Retrospective Studies
Treatment Outcome
Vaccination

Substances

Pneumococcal Vaccines