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

Antonio Di Sabatino, Marco Vincenzo Lenti, Francesco Paolo Tinozzi, Marina Lanave, Ivana Aquino, Catherine Klersy, Piero Marone, Carlo Marena, Andrea Pietrabissa, Gino Roberto Corazza

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
Pages (from-to)1139-1147
Number of pages9
JournalInternal and Emergency Medicine
Volume12
Issue number8
DOIs
Publication statusPublished - Dec 1 2017

Keywords

  • Meningococcal
  • Overwhelming post-splenectomy infection
  • Pneumococcal
  • Prophylaxis
  • Splenectomy

ASJC Scopus subject areas

  • Internal Medicine
  • Emergency Medicine

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