Later Onset of Infections After Splenectomy Seen With Vaccination

By Will Boggs MD

September 03, 2019

NEW YORK (Reuters Health) - Vaccination is associated with later onset of infection in adults who undergo splenectomy, according to findings from the Rochester (Minnesota) Epidemiology Project (REP).

"Typically, we think of vaccinations as a childhood issue," Dr. Martin D. Zielinski from Mayo Clinic, in Rochester, Minnesota, told Reuters Health by email. "We must expand this thinking to patients who are immunosuppressed including post-splenectomy patients, particularly in face of their comorbidities."

Dr. Zielinski's team used REP data from 724 adult patients who underwent splenectomy to evaluate the long-term incidence and outcomes of postsplenectomy infection.

After splenectomy, the overall rate of receipt of pneumococcal, meningococcal, and Hemophilus influenza b (Hib) vaccines was 62%, and complete vaccination rates approached 100% in the most recent decade.

The rates of booster vaccine reception were much lower (30.8% for streptococci, 4.4% for meningococcal, 1.9% for Hib, and 0.8% for all three), the researchers report in Surgery, online August 1.

At last follow-up, 268 patients had developed infection a median two years after splenectomy, and 55% presented with sepsis.

The median time to infection was significantly shorter in nonvaccinated patients than in vaccinated patients (1.5 vs. 3.3 years, P=0.01).

More than a quarter of patients (27%) with postsplenectomy infection died, 70% of them because of the infection.

"The most surprising result for me was the high rate of postsplenectomy infection no matter if the patients received complete vaccinations or not," Dr. Zielinski said. "Certainly, these patients have multiple chronic medical issues that won’t necessarily improve after splenectomy, including malignancy, non-malignant hematologic disorders, and post-traumatic trauma complications. This highlights the need for close monitoring of patients’ vaccination status."

Dr. Winfried V. Kern of Freiberg University Medical Center, in Germany, who has reported the causative pathogens and clinical presentations of patients with overwhelming postsplenectomy infection (OPSI), told Reuters Health by email, "The paper is interesting in showing a persistently elevated risk of OPSI following splenectomy."

"It provides some rationale (for me, enough) in favor of revaccination (which we recommend to do every 5-6 years)," he said. "There is no real analysis in this paper of the role of vaccination/revaccination for OPSI prevention and survival; nevertheless, the continued risk for OPSI over time argues in favor of revaccination."

SOURCE: https://bit.ly/2Zfa9ve

Surgery 2019.

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