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MacDonald SE, Palichuk A, Slater L, Tripp H, Reifferscheid L, Burton C. Gaps in knowledge about the vaccine coverage of immunocompromised children: a scoping review. Hum Vaccin Immunother 2021; 18:1-16. [PMID: 34270376 PMCID: PMC8920240 DOI: 10.1080/21645515.2021.1935169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Immunocompromised children are at increased risk of severe illness from vaccine-preventable infections. However, inadequate vaccine coverage remains a concern. This scoping review sought to determine the current state of knowledge regarding vaccine coverage of immunocompromised children. Bibliographic databases were searched for primary research from any year. Data were analyzed quantitatively and narratively. Ninety-seven studies met inclusion criteria. The most commonly studied vaccines were pneumococcal (n = 46), influenza (n = 44), diphtheria/tetanus/pertussis/poliomyelitis/Haemophilus influenzae type B/hepatitis B-containing (n = 36), and measles- and/or mumps- and/or rubella-containing (n = 29). Immunocompromising conditions studied included cancer/stem cell transplants (n = 24), solid organ transplants (n = 23), sickle cell disease (n = 21), immunosuppressive therapy (n = 14), human immunodeficiency virus (n = 12), splenectomy (n = 4), and primary immunodeficiency (n = 2). As more children are treated with immunosuppressive therapies, it is critical to identify whether they are being appropriately vaccinated for age and condition. We identified gaps in the current state of knowledge for specific vaccine types in specific immunocompromised populations.
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Affiliation(s)
| | | | - Linda Slater
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, Canada
| | - Hailey Tripp
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | | | - Catherine Burton
- Faculty of Medicine and Dentistry, Department of Pediatrics, University of Alberta, Edmonton, Canada
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Hammerquist RJ, Messerschmidt KA, Pottebaum AA, Hellwig TR. Vaccinations in asplenic adults. Am J Health Syst Pharm 2017; 73:e220-8. [PMID: 27099328 DOI: 10.2146/ajhp150270] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE The recommended immunizations for adult asplenic patients are reviewed. SUMMARY Patients without a spleen are at risk of developing overwhelming postsplenectomy infections due to encapsulated organisms, mainly pneumococcal, meningococcal, and Haemophilus influenzae type b (Hib). Due to the high mortality rates associated with these infections, vaccinations are recommended as a preventive measure. It is challenging to ensure optimal immunizations in these high-risk patients due to the number of recommended vaccines, the availability of multiple formulations, and the inability to administer specific formulations at the same time, as well as differences in subsequent vaccine administration schedules. Pharmacists play a key role in recommending specific vaccines and timing for these patients in order to achieve the most robust immune response. This article reviews the specific recommendations for pneumococcal, meningococcal, Hib, and influenza vaccinations in asplenic patients. CONCLUSION In order to prevent potentially life-threatening infections, asplenic individuals should be vaccinated against S. pneumoniae, N. meningitidis, Hib, and influenza. The optimal timing of vaccination in relation to splenectomy depends on the nature of the splenectomy.
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Affiliation(s)
| | - Kimberly A Messerschmidt
- Department of Pharmacy Practice, South Dakota State University College of Pharmacy, Brookings, SD, and Sanford USD Medical Center, Sioux Falls, SD
| | | | - Thaddaus R Hellwig
- Department of Pharmacy Practice, South Dakota State University College of Pharmacy, Brookings, SD, and Sanford USD Medical Center, Sioux Falls, SD
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Abstract
Overwhelming postsplenectomy sepsis is a rare but devastating and often lethal disease. Although vaccines are available, their proper use may be questioned. Standardization of protocols for the immunization of asplenic patients should be universal, thus, likely improving on their use. This article reviews the vaccines to be administered to the asplenic patient.
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Affiliation(s)
- David V Shatz
- Department of Surgery, Division of Trauma, Burns, and Surgical Critical Care, University of Miami School of Medicine, PO Box 016960 (D-40), Miami, FL 33101, USA.
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Meerveld-Eggink A, de Weerdt O, Rijkers G, van Velzen-Blad H, Biesma D. Vaccination coverage and awareness of infectious risks in patients with an absent or dysfunctional spleen in the Netherlands. Vaccine 2008; 26:6975-9. [DOI: 10.1016/j.vaccine.2008.09.052] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2008] [Revised: 09/08/2008] [Accepted: 09/17/2008] [Indexed: 11/27/2022]
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5
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Fuentes-Ferrer ME, Cano-Escudero S, Mato-Chaín G, Mariano-Lázaro A, Fereres-Castiel J. Evolución de la cobertura vacunal frente a Streptococcus pneumoniae en pacientes esplenectomizados en un hospital de cuarto nivel (1999-2004). Enferm Infecc Microbiol Clin 2008; 26:194-8. [DOI: 10.1016/s0213-005x(08)72690-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Solid-organ transplant recipients are at risk from various infectious diseases, many of which can be prevented by immunizations that could reduce morbidity and mortality. However, it is not uncommon for children requiring transplantation to have received inadequate or no immunizations pre-transplant. Every effort should be made to immunize transplant candidates early in the course of their disease according to recommended schedules prior to transplantation. It is also important to immunize their household contacts and healthcare workers. In this review, we summarize the major immunization issues for children undergoing transplantation, the data currently available on immunization safety and efficacy, and suggest immunization practices to reduce vaccine-preventable disease. There is a real need for a standardized approach to the administration and evaluation of immunizations in this group of patients.
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Affiliation(s)
- Anita Verma
- Health Protection Agency, London, Region Laboratory, Department of Medical Microbiology, King's College Hospital, London, UK.
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Bruni L, Bayas JM, Vilella A, Conesa A. Vaccination coverage in adults undergoing splenectomy: evaluation of hospital vaccination policies. Epidemiol Infect 2005; 134:837-44. [PMID: 16371179 PMCID: PMC2870457 DOI: 10.1017/s0950268805005704] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2005] [Indexed: 11/07/2022] Open
Abstract
Vaccination coverage in 595 adult patients undergoing total splenectomy in the Hospital Clinic of Barcelona during 1992-2002 was studied. The rates of cover for pneumococcal, Haemophilus influenzae type b and meningococcal vaccines were 63, 63 and 61% respectively, during 2000-2002; 32, 17 and 22% in 1997-1999; and 24, 9 and 8% in 1992-1996. Multivariate analysis showed a greater risk of no vaccination in splenectomies due to trauma, malignant neoplasms of solid organs and incidental splenectomy compared with both neoplastic and non-neoplastic haematological disease, and those patients undergoing splenectomy before 2001. Coverage (>/=1 vaccine) since 1997 in patients with haematological diseases was 83.5% (71/85), haematological neoplasias 69.2% (18/26), solid organ neoplasms 38.3% (36/94), incidental splenectomy 35.6% (16/45), and traumas 28.4% (21/74). Mandatory hospital admission of patients undergoing splenectomy offers a good opportunity for vaccination of these patients. Specific vaccination policies should be developed to take advantage of this circumstance.
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Affiliation(s)
- L Bruni
- Preventive Medicine Service, Adult Vaccination Centre, Hospital Clínic -- IDIBAPS, Barcelona, Spain.
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Legrand A, Bignon A, Borel M, Zerbib P, Langlois J, Chambon JP, Lebuffe G, Vallet B. [Perioperative management of asplenic patients]. ACTA ACUST UNITED AC 2005; 24:807-13. [PMID: 15967628 DOI: 10.1016/j.annfar.2005.05.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2004] [Accepted: 05/17/2005] [Indexed: 01/19/2023]
Abstract
OBJECTIVE In 2003, asplenia had involved 250000 patients in France. These patients are at risk of severe infection, mostly with capsulated bacteria as pneumococci, meningococci and Haemophilus. The higher mortality and morbidity due to infection in asplenic patient led in June 2003 a French expert committee to propose preventive management based on vaccination and antibioprophylaxis. STUDY DESIGN Update article. DATA SYNTHESIS For vaccination, two vaccines against pneumococci are available. The first one, the antipolysaccharide (Pneumo 23) is recommended for adults. It is effective for the majority of the serotypes even if its efficacy can be variable. The second one a conjugated pneumococcal vaccine (Prenevar) is used for children under two years because it has higher activity on antibiotic resistant strains therefore increasing antibiotic prophylaxis efficiency. When splenectomy is required, vaccination against pneumococci, Haemophilus (b type) and C meningococci must be performed at least 15 days before surgery, in order to get better immune stimulation. In case of emergency, vaccines have to be administrated within 30 days after surgery. Antibioprophylaxis is based on cefazolin injection before splenectomy and by postoperative intravenous amoxicillin administration. As soon as oral intake is allowed, antibioprophylaxis is continued for at least two years in adults and five years in children. Both antibiotic and vaccination have been reported to reduce pneumococcus infections.
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Affiliation(s)
- A Legrand
- Clinique d'anesthésie réanimation, CHRU Claude-Huriez, rue Michel-Polonovski, 59037 Lille cedex, France
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Greci LS, Katz DL, Jekel J. Vaccinations in pneumonia (VIP): pneumococcal and influenza vaccination patterns among patients hospitalized for pneumonia. Prev Med 2005; 40:384-8. [PMID: 15530591 DOI: 10.1016/j.ypmed.2004.06.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although the CDC ACIP (Advisory Committee on Immunization Practices) recommends that appropriate inpatients receive pneumococcal and influenza vaccines, adult vaccination rates for these remain low. We therefore examined perihospitalization vaccination rates for high-risk pneumonia inpatients. METHODS A retrospective chart review of all pneumonia patients admitted to one community hospital from 6/1/95 to 5/31/96. Vaccination history, co-morbidity, mortality, and prior and subsequent pneumonia admissions were recorded. Primary care providers and nursing homes were contacted to complete and verify vaccine histories. RESULTS For 173 total admissions (160 subjects), vaccine histories were documented in the hospital chart in less than 0.5% of patients. While 97% had indications for both vaccines at the time of admission, no vaccines were given in the hospital and less than 5% had documented vaccinations during the subsequent 3 years. CONCLUSIONS Despite clear indications, few patients had documented vaccination at any time. These data lend urgency to the recommendation that pneumococcal and influenza vaccines should be routinely administered to pneumonia inpatients at discharge. Furthermore, they illustrate the need for an improved method for tracking individual adult vaccinations.
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Affiliation(s)
- Laura S Greci
- Department of Preventive Medicine, Griffin Hospital, Yale University School of Medicine, Derby, CT 06418, USA.
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Abstract
This article reviews the current status of ABO-incompatible kidney transplantation in the pediatric population. ABO blood type incompatibility between a donor and recipient was generally considered a contraindication to kidney transplantation because of the associated high risk for hyperacute rejection. However, due to a severe shortage of suitable cadaveric allografts, much effort has been made over the last decade to investigate whether successful and effective kidney transplantation is possible across the ABO blood group barrier. At present, ABO-incompatible kidney transplantation has been shown to be a valid alternative even for children with end stage renal disease. In this review, we will discuss protocols available for successfully performing ABO-incompatible kidney transplantation in children: (1) pre-transplant extracorporeal immunomodulation with removal of pre-existing anti-A and/or anti-B antibodies; (2) immunosuppressive therapy and anti-rejection therapy; (3) splenectomy and the associated infectious complication in asplenic children. Also, we will speculate regarding the mechanisms underlying accommodation following transplantation.
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Affiliation(s)
- S Shishido
- Department of Pediatric Urology and Kidney Transplant, Tokyo Metropolitan Kiyose Children's Hospital, Tokyo, Japan.
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11
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O'Connell B. Prevention of infection post-splenectomy: time for implementation of guidelines. Ir J Med Sci 2005; 173:125. [PMID: 15693378 DOI: 10.1007/bf03167923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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12
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Raymond DP, Kuehnert MJ, Sawyer RG. Preventing antimicrobial-resistant bacterial infections in surgical patients. Surg Infect (Larchmt) 2003; 3:375-85. [PMID: 12697084 DOI: 10.1089/109629602762539599] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The Centers for Disease Control and Prevention (CDC) has identified the control of antimicrobial resistance as an important effort to reduce the morbidity and mortality associated with health care. Methods to prevent these infections in surgical patients have rarely been addressed specifically. METHODS The peer-reviewed literature and published guidelines were examined to identify proven or suggested techniques for controlling antimicrobial resistance that would be particularly relevant to surgeons and the surgical patient population. RESULTS A multi-step approach to the prevention of antimicrobial-resistant infections in surgical patients was developed. This program consists of four major strategies: Infection prevention, effective diagnosis and treatment of infection, optimal antibiotic utilization, and the prevention of transmission. CONCLUSION The control of antimicrobial resistance in bacteria is an important objective for all physicians, including surgeons. An approach to attain this goal in surgical populations is outlined. Further research will be needed to determine the value of these practices and to develop newer, even more effective interventions.
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Affiliation(s)
- Daniel P Raymond
- Department of Surgery, University of Virginia, Charlottesville, Virginia 22906, USA
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Shatz DV, Romero-Steiner S, Elie CM, Holder PF, Carlone GM. Antibody responses in postsplenectomy trauma patients receiving the 23-valent pneumococcal polysaccharide vaccine at 14 versus 28 days postoperatively. THE JOURNAL OF TRAUMA 2002; 53:1037-42. [PMID: 12478024 DOI: 10.1097/00005373-200212000-00001] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND We have previously demonstrated, using functional antibody assays, that patients undergoing splenectomy for trauma exhibit a better response to pneumococcal immunization when vaccinated at 14 days postoperatively versus 1 or 7 days. However, patients immunized at 14 days failed to reach the response of normal controls. This study was conducted to determine whether even later immunization would improve the antibody response. METHODS Forty surviving patients undergoing emergent splenectomy were randomized to receive Pneumovax at 14 or 28 days after splenectomy. Blood samples were drawn at the time of vaccination (prevaccination) and 4 weeks later (postvaccination). A control group of 24 healthy adults was used for comparison. Antibody titers to four of the most common serotypes were determined by enzyme-linked immunosorbent assay and opsonophagocytic assay (OPA). RESULTS Samples from 38 patient were analyzed. Each serotype and each group tested demonstrated a statistically significant increase in geometric mean enzyme-linked immunosorbent assay immunoglobulin G antibody concentration (microg/mL) and OPA titer (1/dilution) after vaccination. There were no statistically significant differences (p >or= 0.07) in the immunoglobulin G antibody concentrations and OPA titers between the 14-day or the 28-day study groups when compared with normal healthy adults regardless of the serotype tested. In addition, there were no differences in the antibody responses between the 14-day and the 28-day study groups. CONCLUSION Despite our previous study suggesting that delay in vaccination after emergent splenectomy resulted in improved antibody response, antibody response was not improved any further by delaying vaccination to 28 days.
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Affiliation(s)
- David V Shatz
- Department of Surgery, University of Miami School of Medicine, Florida 33101, USA.
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14
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Gudiol F. [Prevention of fulminant sepsis in splenectomized patients: we keep forgetting health education]. Med Clin (Barc) 2001; 117:776-7. [PMID: 11784507 DOI: 10.1016/s0025-7753(01)72256-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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15
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Galán Alvarez P, Oliva Berini E. [Review of infectious prophylaxis in splenectomized patients in the island of Menorca]. Med Clin (Barc) 2001; 117:771-2. [PMID: 11784504 DOI: 10.1016/s0025-7753(01)72253-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Splenectomized patients are at higher risk of severe infection. PATIENTS AND METHOD This retrospective study was performed to evaluate compliance with guidelines in patients who underwent a splenectomy between 1978 and 2000. Seventy-five patients were identified and their hospital records were reviewed. RESULTS 62.7% of patients who had a splenectomy received a pneumococcal vaccine and were aware of the infectious risks related to an asplenic status. CONCLUSIONS Rapidly lethal overwhelming sepsis in some asplenic patients demands greater prevention efforts by physicians.
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Affiliation(s)
- P Galán Alvarez
- Servicio de Hematología, Hospital Verge del Toro, Mahón, Menorca, Spain.
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16
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Waghorn DJ. Overwhelming infection in asplenic patients: current best practice preventive measures are not being followed. J Clin Pathol 2001; 54:214-8. [PMID: 11253134 PMCID: PMC1731383 DOI: 10.1136/jcp.54.3.214] [Citation(s) in RCA: 233] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
AIMS Patients without spleens are at increased risk of overwhelming infection. Recently, greater efforts, including the publication of national guidelines, have been made to improve the management of asplenic individuals. In theory, risks of serious sepsis can be reduced by good advice, immunisation, and antibiotic prophylaxis. In practice, such preventive measures might not be followed or may fail. A study of recent cases of overwhelming postsplenectomy infection (OPSI) was undertaken to examine specific associated factors and to determine whether currently recommended preventive measures are being followed. METHODS Cases of OPSI were identified and reported mainly by microbiologists across the country using a specifically designed proforma. Data including the nature of the infection and vaccination/ antibiotic prophylaxis history since splenectomy were obtained. RESULTS Seventy seven cases were reported. The age range varied from 3 months (congenital asplenia) to 87 years. In those who had undergone surgical splenectomy, the time interval between surgery and OPSI varied from 24 days to 65 years. Overall mortality reached 50%, with underlying haematological malignancy associated with the highest death rate. Streptococcus pneumoniae caused approximately 90% episodes. Only 31% individuals had received pneumococcal vaccination before OPSI. Seven of 17 pneumococcal infections in immunised cases could be considered vaccine failures. Few patients had been adequately advised on antibiotic prophylaxis or other measures. CONCLUSIONS Currently accepted best practice for managing asplenic patients is not being followed. Some OPSI cases may still be preventable but many asplenic individuals remain unrecognised. The compilation of asplenic patient registers might help to implement agreed policies with audit necessary to evaluate compliance. More is needed to ensure optimal management for this cohort of the population.
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Affiliation(s)
- D J Waghorn
- Department of Microbiology, Wycombe General Hospital, Buckinghamshire, UK
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Brigden ML, Pattullo A, Brown G. Pneumococcal vaccine administration associated with splenectomy: the need for improved education, documentation, and the use of a practical checklist. Am J Hematol 2000; 65:25-9. [PMID: 10936859 DOI: 10.1002/1096-8652(200009)65:1<25::aid-ajh4>3.0.co;2-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
An audit was performed of the documentation of pneumococcal vaccination in splenectomy patients in three major hospitals involving a geographical population base of 350,000 patients in British Columbia, Canada. Overall, 111 of the 164 hospitalized splenectomy patients (68%) had received pneumococcal vaccination. Of elective splenectomy cases, only 11 of 55 (20%) had been vaccinated prior to surgery, as is currently recommended. One hundred fifty-five patients (95%) had splenectomy status mentioned in the discharge summary. However, only 35 (21%) had mention of vaccination status, 10 (6%) mention of the need for future revaccination, and only 8 (5%) notation of the possibility of future infectious risks. The rate of pneumococcal vaccination was as satisfactory as any reported in the literature to date. However, there is need for improved education in relation to the timing of vaccination and discharge summary documentation. A checklist for potential splenectomy patients may aid in improving this situation as may geographically based splenectomy registries.
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Affiliation(s)
- M L Brigden
- Department of Medical Oncology, BC Center Agency, Cancer Centre for the Southern Interior, Kelowna, BC, Canada.
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Burroughs M, Moscona A. Immunization of pediatric solid organ transplant candidates and recipients. Clin Infect Dis 2000; 30:857-69. [PMID: 10852737 DOI: 10.1086/313823] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/1999] [Revised: 11/17/1999] [Indexed: 01/19/2023] Open
Abstract
Organ transplantation has evolved from an experimental procedure to an accepted treatment for otherwise irreversible or congenital disorders. The immunosuppression necessary to prevent rejection enhances the severity of many infectious diseases and may potentially attenuate the response to vaccines designed to prevent disease. In spite of the frequency and severity of infectious diseases in organ transplant recipients, many children are not fully vaccinated before transplantation. The safety and efficacy of many of the currently available vaccines for solid organ transplant recipients have not been evaluated. We review the currently available data on immunization safety and efficacy, discuss experimental vaccines, and outline strategies to avoid vaccine-preventable diseases in pediatric organ transplant recipients.
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Affiliation(s)
- M Burroughs
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Recanati-Miller Transplant Institute, Mount Sinai School of Medicine, New York, NY 10029, USA.
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Abstract
Splenectomy was one of the most common operations in abdominal surgery. During the past decade, an increased rate of late complications, especially septic and thromboembolic complications occurring after splenectomy, have been reported. The septic complications are well documented. The risk is related to the indication of splenectomy, and is less than 1% in adults without immunodeficiency. However, these overwhelming postsplenectomy infections are associated with a high mortality rate, about 50%. The best treatment of these infections is preventive measures which are based on vaccination and education of asplenic patients. The thromboembolic complications are rare, little studied, and specific preventive procedures have not been implemented.
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Affiliation(s)
- S Benoist
- Service de chirurgie viscérale et digestive, Hôpital Lariboisière, Paris, France
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