Outcomes after splenectomy in children: a 48-year population-based study

Gaps in knowledge about the vaccine coverage of immunocompromised children: a scoping review

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.

Pneumococcal vaccine coverage in Japan among patients with a history of splenectomy: Results of a retrospective administrative database study

BACKGROUND

Splenectomy results in immune deficiency and increases the risk of clinically significant infections, termed overwhelming post-splenectomy infection (OPSI). In Japan, vaccination with the 23-valent pneumococcal polysaccharide vaccine (PPSV23) is covered by the Japanese National Health Insurance (NHI) for post-splenectomy patients, but there are limited data about whether these patients receive PPSV23 vaccination.

METHODS

We performed retrospective analyses of the JMDC Claims Database comprising employees (including some retired individuals) and their families in Japan. We identified patients who underwent splenectomy (registration period: January 1, 2005-June 30, 2019) at ≥ 2 to ≤ 64 years old, and obtained information about PPSV23 vaccination, reasons for splenectomy, and prevalence/complications of pneumococcal infectious diseases (including OPSI-related disorders).

RESULTS

Among 7,394,182 registered individuals, splenectomy was performed in 475, with an incidence rate of 1.6 cases per 100,000 person-years. Of 414 patients who underwent splenectomy at ≥ 2 to ≤ 64 years of age, their mean ± standard deviation age was 45.4 ± 15.7 years and 63.3% were 45-64 years old. Splenectomy was incidental in 55.3%. Overall, 123/414 patients were prescribed PPSV23 vaccination, resulting in vaccination coverage of 29.7%. The median interval from splenectomy to vaccination was 1.0 month (range: -1 to 85 months).

CONCLUSION

This was the first study to document PPSV23 vaccination coverage after splenectomy in a Japanese real-world setting. PPSV23 coverage is quite low in Japan relative to that in other countries.

Laparoscopic surgery for splenic injuries in the era of non-operative management: current status and future perspectives

The spleen is one of the organs most commonly injured by blunt abdominal trauma. It plays an important role in immune response to infections, especially those sustained by encapsulated bacteria. Nonoperative management (NOM), comprising clinical and radiological observation with or without angioembolization, is the treatment of choice for traumatic splenic injury in patients who are hemodynamically stable. However, this strategy carries a risk of failure, especially for high-grade injuries. No clear predictors of failure have been identified, but minimally invasive surgery for splenic injury is gaining popularity. Laparoscopic surgery has been proposed as an alternative to open surgery for hemodynamically stable patients who require surgery, such as after failed NOM. We reviewed research articles on laparoscopic surgery for hemodynamically stable patients with splenic trauma to explore the current knowledge about this topic. After presenting an overview of the treatments for splenic trauma and the immunological function of the spleen, we try to identify the future indications for laparoscopic surgery in the era of NOM.

Vaccination and splenectomy in Olmsted County

OBJECTIVES

To determine the long-term impact of vaccination on any postoperative infection in adults who underwent splenectomy.

METHODS

All adults (≥18 years) who underwent splenectomy from 1965 to 2011 in Olmsted County, MN were identified using the Rochester Epidemiology Project. Descriptive statistics, Kaplan-Meier estimates, and Cox proportional hazard ratios were performed.

RESULTS

There were 724 patients who underwent splenectomy; 47% were female with a median age of 55 (35-69) years. Overall vaccination rate (pneumococcal, H influenza, meningococcal) was 62% (n = 449). There were 268 (36%) patients who developed a post-splenectomy infection; most presented with sepsis 148 (55%). The 3 most common infections included pneumonia (124, 17%), bloodstream (67, 9%), and urinary tract infection (49, 7%). Median time to infection was quicker in non-vaccinated compared with vaccinated patients (1.5 [0.1-4.3] vs 3.3 [1.9-9.8] years, P = .01).

CONCLUSION

In this population-based study, the highest risk of infection after splenectomy was in patients who did not receive complete vaccination. Lack of complete vaccination was associated with a reduced time to infection and increased rates of bloodstream infections at 5 years. Infectious complication risk reduced as vaccination protocols improved for all indications except for malignancy. Adults who underwent a splenectomy should continue to receive booster vaccines.