Systemic pneumococcal disease after staging splenectomy for Hodgkin's disease 1969–1980 without pneumococcal vaccine protection: a follow‐up study 1994

Abstract

We surveyed, during 1994, all 325 patients who underwent staging laparotomy with splenectomy for Hodgkin's disease in Norway 1969–80, before pneumococcal vaccine was available in this country. The patients were thus not immunized preoperatively. Of 162 patients (49.8%) who died before 1994, 8 (2.4% of the total study) died from pneumococcal septicaemia and 16 (6.2%) from infections totally. Of 163 patients (50.2%) who were alive in 1994, 158 cooperated and filled in a questionnaire: 22 had been hospitalized for serious infections; 2 with pneumococcal septicaemia, and 6 with pneumonia, although lacking a specified microbiological diagnosis. We observed 325 patients representing 4420 patient‐years, 3066 patient‐years among survivors and 1354 patient‐years among the dead. This resulted in an incidence rate of systemic pneumococcal disease of 226 per 100,000 patient‐years, which is a relative risk of 20.5 compared to the general Norwegian population during 1994. Septicaemia for these patients most often had an abrupt clinical start even for relapse‐free individuals and occurred from 2 to 17 yr after splenectomy (mean 10 yr). The risk of developing an overwhelming pneumococcal septicaemia with high case‐fatality in asplenic patients seems to persist for these patients at about the same level even 15–20 yr after splenectomy. Only 12.7% of the survivors had been given pneumococcal vaccine in the autumn of 1993. Despite the fact that medical journals and media in Norway focused upon the problem of pneumococcal disease in asplenic individuals in the autumn of 1993 and spring of 1994, a substantial proportion of these patients (55.3%) still remained unimmunized when interviewed in the autumn of 1994. None of our systemic pneumococcal disease patients was vaccinated. Our data underline the need for prophylactic immunization with effective vaccines against pneumococcal infection in splenectomized Hodgkin's disease patients.

Risk of invasive pneumococcal disease in patients with asplenia/hyposplenism: A nationwide population-based study in Korea, 2009–2018

“…This population-based study shows the incidence of IPD in patients with asplenia/hyposplenism in the PCV era. The incidence rate of IPD in this study was 68.9 per 100,000 person-years in the crude analysis and 104.5 per 100,000 person-years after age adjustment, which is comparable to that reported in previous studies (36 to 3000 per 100,000 person-years, Table 3) (Aavitsland et al, 1994;Arnott et al, 2018;Backhaus et al, 2016;Bisharat et al, 2001;Choe et al, 2017;Cullingford et al, 1991;Eber et al, 1999;Ejstrud et al, 2000;Foss Abrahamsen et al, 1997;Holdsworth et al, 1991;Kyaw et al, 2006;Madenci et al, 2019;Marrie et al, 2016). Our data also showed that the risk of IPD was 17.9 (ageadjusted) to 32.0 (crude) times higher in the study population than in the general population.…”

Streptococcus pneumoniae: Epidemiology, Risk Factors, and Strategies for Prevention

“…160,196,198 Most IPD occur within 1 to 2 years of splenectomy, 160 but the risk may persist for > 15 years in some cases. 197 The incidence of IPD is even higher (up to 8.5%) among children with congenital asplenia. 160,161,199 Further, the case-fatality rate of IPD is higher among asplenic children.…”

“…195 SPLENECTOMY OR ASPLENIA Splenectomized patients or those with functional asplenia are at increased risk for life-threatening infections due to encapsulated bacteria (including pneumococcus). 160,169,170,196,197 The risk of IPD after surgical splenectomy among nonvaccinated children ranges from 1 to 9%. 160,196,198 Most IPD occur within 1 to 2 years of splenectomy, 160 but the risk may persist for > 15 years in some cases.…”

Overwhelming post-splenectomy sepsis in patients with asplenia and hyposplenia: a retrospective cohort study

“…In a review of 28 studies including 6942 patients with a median follow-up of 6•9 years, Bisharat and colleagues estimated that the cumulative incidence of invasive infection was around 3% [6]. However, different studies have used various definitions of post-splenectomy infection, including any hospitalization with an infectious diagnosis [7,8], invasive pneumococcal disease [9], pneumonia, meningitis or septicaemia [10], 'overwhelming' infection [10,11] and infection requiring ICU admission [12]. We found that our patient group had a similar cumulative incidence of infection compared to studies where a broader definition was used (patient self-report of infection requiring hospitalization for intravenous antibiotics); for example, a Victorian study using hospital administrative data found that 26% of patients with surgical splenectomies had a subsequent readmission with an infectious diagnosis [8].…”