Reasons for Inadequate Vaccination after Splenectomy

Abstract

The aim of this study was to analyze the reasons why the guidelines for post-splenectomy vaccination are not being followed. Considering that vaccination reduces the risk of overwhelming post-splenectomy infection, it is important to determine the reasons for inadequate vaccination after splenectomy.Our research was a qualitative study based on interviews with six surgeons, one general practitioner and three patients who underwent splenectomy, and on the review of patient's medical charts and discharge summaries.This study has shown that health care team and patients lack sufficient knowledge about postsplenectomy vaccination. In addition, the study has shown that splenectomy registers, medical bracelets and up-to-date vaccination cards still have not become part of our current practice.Our study has shown that patient education and health care team education is crucial to follow the guidelines for post-splenectomy vaccination, which is similar to most other reports. In order to increase the level of post-splenectomy vaccination, we need to upgrade the education of health care teams and patients. Moreover, we need to start using splenectomy registers, medical bracelets and up-to-date vaccination cards. Key words: splenectomy, vaccination, qualitative, educationCorresponding author:Marko Tanasković e-mail: markotanaskovic55@gmail.com DOI: 10.1515DOI: 10. /afmnai-2015 Acta facultatis medicae Naissensis 2015;32(4):279-286 O r i g i n a l a r t i c l e I NT ROD U CT I ONSurgical removal of the spleen (splenectomy) is performed through emergency surgery due to trauma, and can also be performed for the treatment or diagnosis of malignant and benign diseases. Postsplenectomy sepsis is one of the most serious complications after splenectomy. Pneumococci, meningococci and Haemophilus influenzae are the most common pathogens that cause post-splenectomy sepsis. Almost all of pharmacotherapeutic handbooks recommend vaccination as a preventive measure for these complications two weeks prior to surgery or a week after surgery in emergencies when there is no time for vaccination prior to splenectomy. The use of vaccines is becoming increasingly important due to the appearance of antibiotic-resistant strains of pneumococci. Therefore, all patients before/after splenectomy should be vaccinated against pneumococcus, meningococcus and Haemophilus influenzae to be protected against post-splenectomy sepsis.While information that all patients should be vaccinated after splenectomy has been known since 1970, there are still patients who are not vaccinated or revaccinated after splenectomy. One study in the Netherlands found that out of 130 patients who underwent splenectomy only 103 (79.2%) were vaccinated against pneumococcus (1). The percentage of patients vaccinated against meningococcus and Haemophilus influenzae was even lower (27% and 32%, respectively). These results are unsatisfactory, especially when we take into account the efforts of the professional community to understand the importance of post-splenectomy vaccination. A...