Pneumococcal vaccine administration associated with splenectomy: The need for improved education, documentation, and the use of a practical checklist

Brigden, Malcolm L.; Pattullo, Andrew; Brown, Gail

doi:10.1002/1096-8652(200009)65:1<25::aid-ajh4>3.3.co;2-#

Cited by 13 publications

(16 citation statements)

References 12 publications

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“…in splenectomized patients have been estimated between 11% and 80.6%. Vaccination prior to surgery has been estimated to 20% in Canada . Vaccination rates in splenectomized patients in France seem higher but remain low as regards S.p .…”

Section: Discussionmentioning

confidence: 99%

Need for an improved vaccination rate in primary immune thrombocytopenia patients exposed to rituximab or splenectomy. A nationwide population‐based study in France

Moulis

Lapeyre‐Mestre

Mahévas³

et al. 2015

American J Hematol

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International guidelines on immune thrombocytopenia (ITP) management recommend vaccination against Streptococcus pneumoniae (S.p.), Haemophilus influenza b (Hib) and Neisseiria meningitidis (N.m.) before splenectomy. French guidelines also recommend these vaccinations before rituximab. The aim of this study was to assess the application of these recommendations. The French Adult ITP: a French pHarmacoepidemiological study (FAITH, n ENCEPP 4574) is aimed at following in the French national health insurance system database (SNIIRAM) the cohort of all incident and persistent or chronic primary ITP adults treated in France. We assessed vaccine exposure in the 1,106 patients who entered the FAITH cohort between 2009 and 2011. Vaccination was said "recommended" if performed at least 2 weeks before rituximab or splenectomy accordingly with French guidelines. Among the 423 non-splenectomized patients exposed to rituximab, vaccination rates against S.p., Hib and N.m. were respectively 32.4%, 18.9%, and 3.8%. It was recommended in 12.8%, 6.6%, and 1.2% of the patients, respectively. Among the 178 splenectomized patients, vaccination rates were 70.2%, 47.0%, and 11.9%, respectively (recommended: 60.1%, 35.7%, and 9.5%). Among the splenectomized patients previously exposed to rituximab (n 5 67), 53.3% of the vaccinations occurred during the semester following a rituximab infusion that is during the maximal B-cell depletion period. In multivariate analyses, a disease duration exceeding 3 months was the sole factor associated to recommended vaccination in rituximab-treated patients as well as in splenectomized patients. This study stresses the need of better and earlier vaccination of ITP patients.

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Section: Discussionmentioning

confidence: 99%

Need for an improved vaccination rate in primary immune thrombocytopenia patients exposed to rituximab or splenectomy. A nationwide population‐based study in France

Moulis

Lapeyre‐Mestre

Mahévas³

et al. 2015

American J Hematol

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“…The encapsulated bacterium Streptococcus pneumoniae is the causative pathogen in 80% of cases of PSS [7,8]. Although often preceded by nonspecific symptoms, PSS deteriorates in hours rather than days to a severe septic state that is associated with a high mortality of 50-70 % [7,9,10]. The incidence of sepsis in post-splenectomy patients is estimated to be 600 times greater than in the general population [11].…”

Section: Introductionmentioning

confidence: 99%

Management of post-splenectomy patients in the Netherlands

Lammers

Veninga

Lombarts

et al. 2010

Eur J Clin Microbiol Infect Dis

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After splenectomy, patients are at increased risk of sepsis with considerable mortality. The risk of sepsis can be reduced by immunising these patients and by prescribing antibiotic prophylaxis. The purpose of our study was to determine compliance with the international standards for the management of splenectomised patients in the Netherlands by investigating: (i) vaccination rates, (ii) the prescription of antibiotics and (iii) information in discharge letters. A retrospective review of the medical records and discharge correspondence of 609 splenectomy patients from 1997 to 2008 was performed. Data were collected from 28 hospitals. Adherence to vaccination guidelines and the prescription of antibiotics were assessed. It was found that 85.4% of post-splenectomy patients received pneumococcal vaccination, 39.4% received Haemophilus influenzae type B and 32.3% received meningococcal group C vaccination. Also, 12.4% of patients were discharged on prophylactic antibiotics. In less than 25% of cases were adequate recommendations regarding post-splenectomy management given to the general practitioner (GP). In the Netherlands, compliance with recommendations for the management of patients after splenectomy is insufficient. Fifteen percent of patients do not receive vaccination against pneumococci and the majority of patients do not receive antibiotic prophylaxis. The development and implementation of a national guideline for splenectomised patients is urgently required.

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“…13 Sixty eight percent of patients had received pneumococcal vaccination. Of the 55 patients who underwent elective surgery, only 11 received preoperative vaccination.…”

Section: Discussionmentioning

confidence: 99%

An audit of splenectomies in a teaching hospital in North India. Are postsplenectomy guidelines being complied with?

Deodhar

2004

J Clin Pathol

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Aims: Patients with an absent or dysfunctional spleen are at risk of infection by encapsulated and other bacteria. Overwhelming postsplenectomy infection (OPSI) causes most concern because it can result in significant mortality. A retrospective review of splenectomised patients in a tertiary care setting over an eight year period was carried out to determine whether current postsplenectomy guidelines were being followed. Methods: The cases were identified from the medical records and pathology files and data such as the reason for splenectomy, the preventive measures taken regarding vaccination, and antibiotic prophylaxis, together with their documentation in the discharge notes were assessed. Results: Fifty six patients were studied. Trauma, both blunt and penetrating, was the most common reason for splenectomy. Thirty six patients received pneumococcal vaccination, with 20 patients having no mention of vaccination in their case notes. The discharge notes of 50 patients mentioned their splenectomised status; however, documentation of vaccination details in the discharge summary was poor, with only three patients having the relevant information recorded. Documentation of the need for future vaccination and precautions required in the asplenic condition was also lacking. Nine patients had postsplenectomy complications, although there were no cases of OPSI. Conclusions: Adherence to standard guidelines for the management of splenectomised patients was unsatisfactory. There is a need for an improvement of the vaccination rate and careful documentation of this important health risk in the discharge summaries. Maintenance of a splenectomy registry could aid in optimising the management of these patients. The role of the spleen in the body's immune response to a variety of infections and the serious consequences of its removal have been increasingly recognised over the past 40-50 years.1 The asplenic condition results in an increased risk of life threatening sepsis as a result of encapsulated and Gram negative organisms, and carries considerable mortality. The overall incidence of septicaemia is low, but death rates from overwhelming post splenectomy infection (OPSI) have been reported to be 600 times greater than that for the general population, with an ominous estimated lifetime risk for OPSI of approximately 5%.2 With increasing awareness of the risk associated with the asplenic state, splenic salvage surgery is now gaining popularity.3 4 However, there are many clinical indications that warrant a total splenectomy, such as extensive splenic trauma or haematological disorders, resulting in a large population of asplenic patients.''Patient education and counselling at the time of splenectomy is just as important as appropriate vaccination and antibiotic prophylactic measures'' Vaccination strategies, which started with the use of the pneumococcal vaccine, have been modified since their inception in the 1970s to circumvent the emergence of antibiotic resistant strains and the recognition of other pathogens that cause...

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Pneumococcal vaccine administration associated with splenectomy: The need for improved education, documentation, and the use of a practical checklist

Cited by 13 publications

References 12 publications

Need for an improved vaccination rate in primary immune thrombocytopenia patients exposed to rituximab or splenectomy. A nationwide population‐based study in France

Need for an improved vaccination rate in primary immune thrombocytopenia patients exposed to rituximab or splenectomy. A nationwide population‐based study in France

Management of post-splenectomy patients in the Netherlands

An audit of splenectomies in a teaching hospital in North India. Are postsplenectomy guidelines being complied with?

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