Streptococcus pneumoniae pharyngeal colonization in school-age children and adolescents with cancer

Figures & data

Table 1. Demographic and clinical characteristics of 277 children and adolescents with cancer according to pneumococcal carriage

	All children (n = 277)	Carriers (n = 52)	Non-carriers (n = 225)	p-value
Age at enrolment
<10	124 (44.8)	35 (67.3)	89 (39.6)
10-14	102 (36.8)	12 (23.1)	90 (40.0)
≥15	51 (18.4)	5 (9.6)	46 (20.4)	<0.01
Sex
Male	183 (66.1)	34 (65.4)	149 (66.2)
Female	94 (33.9)	18 (34.6)	76 (33.8)	0.91
Ethnicity
Caucasian	257 (92.8)	50 (96.1)	207 (92.0)
Non-Caucasian	20 (7.2)	2 (3.9)	18 (8.0)	0.39
Diagnosis
Leukemia/lymphoma	235 (84.8)	47 (90.4)	188 (83.6)
Other cancers	42 (15.2)	5 (9.6)	37 (16.4)	0.22
Phase
Maintenance/In therapy	159 (57.4)	24 (46.1)	135 (60.0)
Therapy stopped within the last 6 months	118 (42.6)	28 (53.9)	90 (40.0)	0.07
Co-trimoxazole prophylaxis
No	57 (20.6)	18 (34.6)	39 (17.3)
Yes	220 (79.4)	34 (65.4)	186 (82.7)	<0.01
No. of siblings
0	61 (22.0)	16 (30.8)	45 (20.0)
1	133 (48.0)	22 (42.3)	111 (49.3)
2	56 (20.2)	9 (17.3)	47 (20.9)
≥3	27 (9.8)	5 (9.6)	22 (9.8)	0.28
Parental smoking habit
Both non-smokers	168 (60.6)	31 (59.6)	137 (60.9)
At least one smoker	109 (39.4)	21 (40.4)	88 (39.1)	0.87
Gestational age (weeks)^a
<37	18 (6.5)	4 (7.8)	14 (6.2)
≥37	258 (93.5)	47 (92.2)	211 (93.8)	0.75
Birth weight (g)^a
<2,500	10 (3.6)	1 (2.0)	9 (4.0)
≥2,500	265 (96.4)	50 (98.0)	215 (96.0)	0.69
Exclusive breastfeeding
No	61 (22.0)	12 (23.1)	49 (21.8)
Yes	216 (78.0)	40 (76.9)	176 (78.2)	0.84
Infections (last 3 months)
No	222 (80.1)	46 (88.5)	176 (78.2)
Yes	55 (19.9)	6 (11.5)	49 (21.8)	0.10
Allergy
No	230 (83.0)	46 (88.5)	184 (81.8)
Yes	47 (17.0)	6 (11.5)	41 (18.2)	0.25
Meningococcal vaccination^a
No	201 (73.6)	36 (69.2)	165 (74.7)
Yes	72 (26.4)	16 (30.8)	56 (25.3)	0.42
Influenza vaccination during current season
No	263 (94.9)	45 (86.5)	218 (96.9)
Yes	14 (5.1)	7 (13.5)	7 (3.1)	0.007

^a Some missing values.

Table 2. Association between selected demographic and clinical characteristics and pneumococcal carriage in children with cancer

	OR (95% CI)^a
Age at enrollment
<10	1 (reference)
10-14	0.34 (0.16-0.71)
≥15	0.30 (0.11-0.82)
Sex
Male	1 (reference)
Female	1.06 (0.52-2.15)
Diagnosis
Leukemia/lymphoma	1 (reference)
Other cancers	0.53 (0.18-1.52)
Phase
Maintenance/In therapy	1 (reference)
Therapy stopped within the last 6 months	1.35 (0.67-2.75)
Co-trimoxazole prophylaxis
No	1 (reference)
Yes	0.41 (0.19-0.89)
Siblings
No	1 (reference)
Yes	0.52 (0.24-1.11)
Parental smoking habit
Both non-smokers	1 (reference)
At least one smoker	0.90 (0.46-1.76)
Infections (last 3 months)
No	1 (reference)
Yes	0.48 (0.19-1.24)
Anti-infective therapy (last 3 months)
No	1 (reference)
Yes	0.52 (0.26-1.03)

^a Multivariate models included terms for age at enrollment, gender, siblings, parental smoking, disease phase, co-trimoxazole prophylaxis and diagnosis as well as other clinical characteristics.

CI: confidence interval; OR: odds ratio.

Table 3. Relationship between pneumococcal vaccination status and pneumococcal carriage in children with cancer.^ab

	Vaccinated with PCV7 (n = 58)	Not vaccinated against pneumococcus (n = 216)	OR (95% CI)
Pneumococcal carrier status
Any serotype
Non-carriers	39 (67.2)	183 (84.7)	1 (reference)
Carriers	19 (32.8)	33 (15.3)	1.70 (0.79-3.65)
Serotypes in PCV7
Non-carriers	43 (74.1)	190 (88.0)	1 (reference)
Carriers	15 (25.9)	26 (12.0)	1.51 (0.65-3.49)
Six additional serotypes in PCV13
Non-carriers	53 (91.4)	211 (97.7)	1 (reference)
Carriers	5 (8.6)	5 (2.3)	2.69 (0.62-11.7)
Subgroup aged	(n = 39)	(n = 85)
Any serotype
Non-carriers	22 (56.4)	67 (78.8)	1 (reference)
Carriers	17 (43.6)	18 (21.2)	2.05 (0.81-5.20)
Serotypes in PCV7
Non-carriers	25 (64.1)	71 (83.5)	1 (reference)
Carriers	14 (35.9)	14 (16.5)	1.79 (0.66-4.91)
Six additional serotypes in PCV13
Non-carriers	34 (87.2)	83 (97.6)	1 (reference)
Carriers	5 (12.8)	2 (2.4)	4.33 (0.63-29.5)
Subgroup aged 10-14 years	(n = 14)	(n = 86)
Any serotype
Non-carriers	13 (92.9)	75 (87.2)	1 (reference)
Carriers	1 (7.1)	11 (12.8)	0.76 (0.08-7.47)
Serotypes in PCV7
Non-carriers	14 (100.0)	78 (90.7)	1 (reference)
Carriers	0 (0.0)	8 (9.3)	NE
Six additional serotypes in PCV13
Non-carriers	14 (100.0)	84 (97.7)	1 (reference)
Carriers	0 (0.0)	2 (2.3)	NE

^a ORs adjusted for age at enrollment, gender, siblings, parental smoking, disease phase, co-trimoxazole prophylaxis and diagnosis.

^b No information concerning the pneumococcal vaccination status of three children.

CI: confidence interval; NE: not estimable; OR: odds ratio; PCV7: 7-valent pneumococcal conjugate vaccine; PCV13: 13-valent pneumococcal conjugate vaccine.

Table 4. Carriage of specific pneumococcal subtypes in children with cancer according to pneumococcal vaccination status^a

	Vaccinated with PCV7 (n = 58)	Not vaccinated against pneumococcus (n = 216)	OR (95% CI)^b
Carriers of PCV13 serotypes	15 (25.9)	26 (12.0)	1.60 (0.68-3.73)
Number of PCV13 serotypes carried
1	6 (10.3)	13 (6.0)	0.91 (0.28-2.97)
≥2	9 (15.5)	13 (6.0)	2.30 (0.80-6.61)
Serotype carried
Positive for serotype 1	0 (0.0)	1 (0.5)	NE
Positive for serotype 3	1 (1.7)	1 (0.5)	4.15 (0.09-183.0)
Positive for serotype 4	6 (10.3)	6 (2.8)	3.11 (0.77-12.49)
Positive for serotype 5	2 (3.4)	2 (0.9)	2.82 (0.30-26.92)
Positive for serotype 6A	1 (1.7)	0 (0.0)	NE
Positive for serotype 6B	0 (0.0)	1 (0.5)	NE
Positive for serotype 7F	0 (0.0)	1 (0.5)	NE
Positive for serotype 9V	1 (1.7)	4 (1.8)	1.09 (0.09–13.68)
Positive for serotype 14	0 (0.0)	0 (0.0)	NE
Positive for serotype 18C	0 (0.0)	0 (0.0)	NE
Positive for serotype 19A	2 (3.4)	0 (0.0)	NE
Positive for serotype 19F	14 (24.1)	25 (11.6)	1.43 (0.60–3.40)
Positive for serotype 23F	0 (0.0)	1 (0.5)	NE
Carriers of non-PCV13 serotypes	4 (6.9)	7 (3.2)	2.06 (0.52–8.09)

^a Three subjects had missing information on pneumococcal vaccination.

^b ORs adjusted for age at enrollment, gender, siblings, parental smoking, disease phase, co-trimoxazole prophylaxis and diagnosis. For the analyses on single serotypes, the reference category is non-carrier of each corresponding serotype.

CI: confidence interval; NE: not estimable; OR: odds ratio; PCV7: 7-valent pneumococcal conjugate vaccine.