Skip to main content

Advertisement

SpringerLink
Log in

Vaccination coverage and mortality after splenectomy: results from an Italian single-centre study

  • IM - ORIGINAL
  • Published:
Internal and Emergency Medicine Aims and scope Submit manuscript

Abstract

Splenectomy is a well-recognised risk factor for life-threatening overwhelming post-splenectomy infection (OPSI). To prevent OPSI, immunisations against encapsulated bacteria (S. pneumoniae, N. meningitidis, H. influenzae) and influenza virus are recommended. However, there is still a lack of uniformity and poor compliance with these recommendations. Following a local physicians’ awareness campaign regarding the importance of vaccine prophylaxis of splenectomised patients, we aimed to register vaccination coverage, mortality and infection rates in all patients who underwent splenectomy at our hospital, over a six-year time span. Reasons for splenectomy, patients’ compliance with vaccinations, mortality and infectious events were recorded. The reasons for splenectomy in the 216 identified patients (mean age 58.2 ± 14; M:F ratio 1.4:1) were haematologic disorders (38.8%), solid tumours (28.7%), traumatic rupture (22.7%) and other causes (9.7%). A total of 146 patients (67.6%) received at least one of the four vaccines. Overall, the mortality rate was significantly greater in unvaccinated compared to vaccinated patients (p < 0.001), although after the adjustment for the cause of splenectomy the statistical significance was lost (p = 0.085) due to the burden of solid tumour-related mortality. Among the 21 reported cases of OPSI, eight were fatal and five were potentially vaccine-preventable. Our results show that two-thirds of splenectomised patients comply with vaccine prophylaxis. Future interventional studies or ad hoc registries might overcome barriers to vaccination or intentional non-compliance.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

CI:

Confidence interval

OPSI:

Overwhelming post-splenectomy infection

References

  1. Di Sabatino A, Carsetti R, Corazza GR (2011) Post-splenectomy and hyposplenic states. Lancet 378:86–97. doi:10.1016/S0140-6736(10)61493-6

    Article  PubMed  Google Scholar 

  2. Wardemann H, Boehm T, Dear N, Carsetti R (2002) B-1a B cells that link the innate and adaptive immune responses are lacking in the absence of the spleen. J Exp Med 195:771–780. doi:10.1084/jem.20011140

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Waghorn D, Mayon-White R (1997) A study of 42 episodes of overwhelming post-splenectomy infection: is current guidance for asplenic individuals being followed? J Infect 35:289–294. doi:10.1016/S0163-4453(97)93232-1

    Article  CAS  PubMed  Google Scholar 

  4. Bisharat N, Omari H, Lavi I, Raz R (2001) Risk of infection and death among post-splenectomy patients. J Infect 43:182–186. doi:10.1053/jinf.2001.0904

    Article  CAS  PubMed  Google Scholar 

  5. Styrt B (1990) Infection associated with asplenia: risks, mechanisms, and prevention. Am J Med 88:33N–42N

    Article  CAS  PubMed  Google Scholar 

  6. Green JB, Shackford SR, Sise MJ, Fridlund P (1986) Late septic complications in adults following splenectomy for trauma: a prospective analysis in 144 patients. J Trauma 26:999–1004

    Article  CAS  PubMed  Google Scholar 

  7. Di Cataldo A, Puleo S, Li Destri G et al (1987) Splenic trauma and overwhelming postsplenectomy infection. Br J Surg 74:343–345

    Article  PubMed  Google Scholar 

  8. Working Party of the British Committee for Standards in Haematology Clinical Haematology Task Force (1996) Guidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen. BMJ 312:430–434. doi:10.1136/bmj.312.7028.430

    Article  Google Scholar 

  9. Davies JM, Barnes R, Milligan D, British Committee for Standards in Haematology, Working Party of the Haematology/Oncology Task Force (2002) Update of guidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen. Clin Med 2:440–443

    Article  CAS  Google Scholar 

  10. Davies JM, Lewis MP, Wimperis J, Rafi I, Ladhani S, Bolton-Maggs PH, British Committee for Standards in Haematology (2011) Review of guidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen: prepared on behalf of the British Committee for Standards in Haematology by a working party of the Haemato-Oncology task force. Br J Haematol 155:308–317. doi:10.1111/j.1365-2141.2011.08843.x

    Article  CAS  PubMed  Google Scholar 

  11. Kuchar E, Miśkiewicz K, Karlikowska M (2015) A review of guidance on immunization in persons with defective or deficient splenic function. Br J Haematol 171:683–694. doi:10.1111/bjh.13660

    Article  PubMed  Google Scholar 

  12. Brigden ML, Pattullo A, Brown G (2000) Pneumococcal vaccine administration associated with splenectomy: the need for improved education, documentation, and the use of a practical checklist. Am J Hematol 65:25–29

    Article  CAS  PubMed  Google Scholar 

  13. Bruni L, Bayas JM, Vilella A, Conesa A (2006) Vaccination coverage in adults undergoing splenectomy: evaluation of hospital vaccination policies. Epidemiol Infect 134:837–844. doi:10.1017/S0950268805005704

    Article  CAS  PubMed  Google Scholar 

  14. Lammers AJ, Hoekstra JB, Speelman P, Lombarts KM (2011) Physicians report barriers to deliver best practice care for asplenic patients: a cross-sectional survey. PLoS ONE 6:e17302. doi:10.1371/journal.pone.0017302

    Article  PubMed  PubMed Central  Google Scholar 

  15. Di Carlo I, Primo S, Pulvirenti E, Toro A (2008) Should all splenectomised patients be vaccinated to avoid OPSI? Revisiting an old concept: an Italian retrospective monocentric study. Hepatogastroenterology 55:308–310

    PubMed  Google Scholar 

  16. Martino C, Gallone MS, Quarto M, Germinario C, Tafuri S (2016) Immunization coverage among splenectomized patients: results of an ad hoc survey in Puglia Region (South of Italy). Hum Vaccin Immunother 12:1277–1279. doi:10.1080/21645515.2015.1138025

    Article  PubMed  PubMed Central  Google Scholar 

  17. Schwartz PE, Sterioff S, Mucha P, Melton LJ 3rd, Offord KP (1982) Postsplenectomy sepsis and mortality in adults. JAMA 248:2279–2283

    Article  CAS  PubMed  Google Scholar 

  18. Kinnersley P, Wilkinson CE, Srinivasan J (1993) Pneumococcal vaccination after splenectomy: survey of hospital and primary care records. BMJ 307:1398–1399

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Kyaw MH, Holmes EM, Chalmers J, Jones IG, Campbell H (2002) A survey of vaccine coverage and antibiotic prophylaxis in splenectomised patients in Scotland. J Clin Pathol 55:472–474

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Ramachandra J, Bond A, Ranaboldo C, Cullis J (2003) An audit of post-splenectomy prophylaxis—are we following the guidelines? Ann R Coll Surg Engl 85:252–255. doi:10.1308/003588403766274962

    Article  PubMed  PubMed Central  Google Scholar 

  21. Meerveld-Eggink A, de Weerdt O, Rijkers GT, van Velzen-Blad H, Biesma DH (2008) Vaccination coverage and awareness of infectious risks in patients with an absent or dysfunctional spleen in the Netherlands. Vaccine 26:6975–6979. doi:10.1016/j.vaccine.2008.09.052

    Article  CAS  PubMed  Google Scholar 

  22. Langley JM, Dodds L, Fell D, Langley GR (2010) Pneumococcal and influenza immunization in asplenic persons: a retrospective population-based cohort study 1990-2002. BMC Infect Dis 10:219. doi:10.1186/1471-2334-10-219

    Article  PubMed  PubMed Central  Google Scholar 

  23. Coignard-Biehler H, Lanternier F, Hot A et al (2011) Adherence to preventive measures after splenectomy in the hospital setting and in the community. J Infect Public Health 4:187–194. doi:10.1016/j.jiph.2011.06.004

    Article  PubMed  Google Scholar 

  24. Kuchar E, Nitsch-Osuch A, Stolarczyk C et al (2013) Immunization coverage against capsular bacteria in splenectomized patients. Adv Exp Med Biol 788:139–145. doi:10.1007/978-94-007-6627-3_21

    Article  CAS  PubMed  Google Scholar 

  25. Kristinsson SY, Gridley G, Hoover RN, Check D, Landgren O (2014) Long-term risks after splenectomy among 8,149 cancer-free American veterans: a cohort study with up to 27 years follow-up. Haematologica 99:392–398. doi:10.3324/haematol.2013.092460

    Article  PubMed  PubMed Central  Google Scholar 

  26. Davies IL, Cho J, Lewis MH (2014) Splenectomy results from an 18-year single centre experience. Ann R Coll Surg Engl 96:147–150. doi:10.1308/003588414X13814021677593

    Article  PubMed  PubMed Central  Google Scholar 

  27. Meier-Stephenson V, McNeil S, Kew A, Sweetapple J, Thompson K, Slayter K (2014) Effects of a pharmacy-driven perisplenectomy vaccination program on vaccination rates and adherence to guidelines. Can J Hosp Pharm 67:262–267

    PubMed  PubMed Central  Google Scholar 

  28. Nived P, Jørgensen CS, Settergren B (2015) Vaccination status and immune response to 13-valent pneumococcal conjugate vaccine in asplenic individuals. Vaccine 33:1688–1694. doi:10.1016/j.vaccine.2015.02.026

    Article  CAS  PubMed  Google Scholar 

  29. Meriglier E, Puyade M, Carretier M, Roblot F, Roblot P (2017) Long-term infectious risks after splenectomy: a retrospective cohort study with up to 10 years follow-up. Rev Med Interne. doi:10.1016/j.revmed.2016.12.023 (Epub ahead of print)

    PubMed  Google Scholar 

  30. Boam T, Sellars P, Isherwood J et al (2017) Adherence to vaccination guidelines post splenectomy: a five year follow up study. J Infect Public Health. doi:10.1016/j.jiph.2017.01.006 (Epub ahead of print)

    PubMed  Google Scholar 

  31. Bonanni P, Ferro A, Guerra R et al (2015) Vaccine coverage in Italy and assessment of the 2012–2014 National Immunization Prevention Plan. Epidemiol Prev 39(S1):146–158

    PubMed  Google Scholar 

  32. Dubé E, Gagnon D, MacDonald NE, SAGE Working Group on Vaccine Hesitancy (2015) Strategies intended to address vaccine hesitancy: review of published reviews. Vaccine 33:4191–4203. doi:10.1016/j.vaccine.2015.04.041

    Article  PubMed  Google Scholar 

  33. Cullingford GL, Watkins DN, Watts AD, Mallon DF (1991) Severe late postsplenectomy infection. Br J Surg 78:716–721

    Article  CAS  PubMed  Google Scholar 

  34. Newland A, Provan D, Myint S (2005) Preventing severe infection after splenectomy. BMJ 331:417–418

    Article  PubMed  PubMed Central  Google Scholar 

  35. Shepard CW, Daneshvar MI, Kaiser RM et al (2004) Bordetella holmesii bacteremia: a newly recognized clinical entity among asplenic patients. Clin Infect Dis 38:799–804. doi:10.1086/381888

    Article  PubMed  Google Scholar 

  36. Bonanni P, Grazzini M, Niccolai G et al (2017) Recommended vaccinations for asplenic and hyposplenic adult patients. Hum Vaccin Immunother 13:359–368. doi:10.1080/21645515.2017.1264797

    Article  PubMed  Google Scholar 

  37. Rosado MM, Gesualdo F, Marcellini V et al (2013) Preserved antibody levels and loss of memory B cells against pneumococcus and tetanus after splenectomy: tailoring better vaccination strategies. Eur J Immunol 43:2659–2670. doi:10.1002/eji.201343577

    Article  CAS  PubMed  Google Scholar 

  38. Edgren G, Almqvist R, Hartman M, Utter GH (2014) Splenectomy and the risk of sepsis: a population-based cohort study. Ann Surg 260:1081–1087. doi:10.1097/SLA.0000000000000439

    Article  PubMed  Google Scholar 

  39. Leone G, Pizzigallo E (2015) Bacterial infections following splenectomy for malignant and nonmalignant hematologic diseases. Mediterr J Hematol Infect Dis 13(7):e2015057. doi:10.4084/MJHID.2015.057

    Article  Google Scholar 

  40. Buchbinder JH, Lipkoff CJ (1939) Splenosis: multiple peritoneal splenic implant following abdominal injury: a report of a case and review of the literature. Surgery 6:927–934

    Google Scholar 

Download references

Acknowledgements

We acknowledge Mrs. Susan West for having proofread the article before submission and Dr Laura Brunetti for helping in collecting data.

Author information

Authors and Affiliations

  1. First Department of Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy

    Antonio Di Sabatino, Marco Vincenzo Lenti & Gino Roberto Corazza

  2. Department of Surgery, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy

    Francesco Paolo Tinozzi & Andrea Pietrabissa

  3. Department of Infectious Diseases, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy

    Piero Marone

  4. Biometry and Clinical Epidemiology, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy

    Marina Lanave, Catherine Klersy & Carlo Marena

  5. Department of Preventive Medicine, ASL Pavia, Pavia, Italy

    Ivana Aquino

  6. Clinica Medica I, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 19, 27100, Pavia, Italy

    Antonio Di Sabatino

Authors
  1. Antonio Di Sabatino
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marco Vincenzo Lenti
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Francesco Paolo Tinozzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marina Lanave
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ivana Aquino
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Catherine Klersy
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Piero Marone
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Carlo Marena
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Andrea Pietrabissa
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Gino Roberto Corazza
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

CM, PM and ML designed the study; ADS and MVL interpreted data and wrote the manuscript; ADS, MVL, FPT, PM, IA and AP enrolled and followed up patients; CK made all statistical analyses; GRC made critical revision of the manuscript for important intellectual contents. All authors participated in drafting the article and gave final approval for its submission.

Corresponding author

Correspondence to Antonio Di Sabatino.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Statement of human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional or national research committee, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

All subjects gave their approval for anonymised publication of data.

Funding source

This research was not directly funded.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Di Sabatino, A., Lenti, M.V., Tinozzi, F.P. et al. Vaccination coverage and mortality after splenectomy: results from an Italian single-centre study. Intern Emerg Med 12, 1139–1147 (2017). https://doi.org/10.1007/s11739-017-1730-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11739-017-1730-9

Keywords

Search

Navigation