Recommended vaccinations for asplenic and hyposplenic adult patients

Abstract

Asplenic or hyposplenic (AH) individuals are particularly vulnerable to invasive infections caused by encapsulated bacteria. Such infections have often a sudden onset and a fulminant course. Infectious diseases (IDs) incidence in AH subjects can be reduced by preventive measures such as vaccination. The aim of our work is to provide updated recommendations on prevention of infectious diseases in AH adult patients, and to supply a useful and practical tool to healthcare workers for the management of these subjects, in hospital setting and in outpatients consultation. A systematic literature review on evidence based measures for the prevention of IDs in adult AH patients was performed in 2015. Updated recommendations on available vaccines were consequently provided. Vaccinations against S. pneumoniae, N. meningitidis, H. influenzae type b and influenza virus are strongly recommended and should be administered at least 2 weeks before surgery in elective cases or at least 2 weeks after the surgical intervention in emergency cases. In subjects without evidence of immunity, 2 doses of live attenuated vaccines against measles-mumps-rubella and varicella should be administered 4–8 weeks apart from each other; a booster dose of tetanus, diphtheria and pertussis vaccine should be administered also to subjects fully vaccinated, and a 3-dose primary vaccination series is recommended in AH subjects with unknown or incomplete vaccination series (as in healthy people). Evidence based prevention data support the above recommendations to reduce the risk of infection in AH individuals.

Preventing infectious complications when treating non‐malignant immune‐mediated hematologic disorders

“…Asplenia ‐ either due to surgery or auto‐infarction such in sickle cell disease ‐ is an important risk factor for invasive infections, particularly with encapsulated bacteria such as Streptococcus pneumoniae (responsible for more than 50% of infections), Haemophilus influenzae type b , and Neisseria meningitidis . Overwhelming post‐splenectomy infection, a rapidly developing and often fatal syndrome, can progress from a mild flu‐like illness to fulminant sepsis in a matter of hours, with a mortality rate up to 50% regardless of maximal treatment . Death can occur within 24 to 72 hours of onset of infections symptoms .…”

“…The estimated incidence of overwhelming post‐splenectomy infection in asplenic patients is around 0.23‐0.42% per year, with a lifetime risk of 5%. The highest frequency of life‐threatening infectious episodes is observed during the first 2 years (30% of episodes occur within the first year, 50% within the first 2 years after splenectomy) . Sickle cell anemia and thalassemia major carry the highest risk for infections, likely from poorly controlled iron overload .…”

“…Pneumococcal vaccine strategy should include pneumococcal 13‐valent conjugate vaccine (PCV13) and pneumococcal polysaccharide vaccine (PPSV23) . In patients without previous history of pneumococcal vaccination, one dose of PCV13, followed by one dose of PPSV23, at least 8 weeks later, is recommended, with a booster of PPSV23, 5 years after first PPSV23, and then no more booster until age 65 when one more dose of PPSV23 is recommended.…”

“…Meningococcal vaccine strategy should include MenACWY and MenB vaccines (see eculizumab, vaccination section for details) . Tdap booster should be given every 10 years.…”

Pseudocisto Esplênico Não Parasítico: Um Relato De Caso

“…Após a esplenectomia, os pacientes apresentam maior risco de infecções graves. As vacinas contra S. pneumoniae, N. meningitidis, H. influenzae tipo B e vírus influenza são altamente recomendadas e devem ser administradas pelo menos 2 semanas antes de cirurgias eletivas e 2 semanas após cirurgias de emergência 13 . O paciente apresentou boa evolução no pós-operatório.…”