A Registry for Patients With Asplenia/Hyposplenism Reduces the Risk of Infections With Encapsulated Organisms

Arnott, Alicia; Jones, Penelope; Franklin, Lucinda; Spelman, Denis; Leder, Karin; Cheng, Allen

doi:10.1093/cid/ciy141

Cited by 39 publications

(31 citation statements)

References 18 publications

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“…The incidence of IMD is highest among children <1 year and adolescents/young adults [148]. In addition to age, there are other populations considered at high risk of IMD, including individuals with functional or anatomic asplenia, complement deficiency and human immunodeficiency virus (HIV) [12, [149][150][151]. Indeed, individuals with complement deficiency and HIV have an approximately 1000-fold and 10-fold increased risk of IMD, respectively [82,[152][153][154].…”

Section: Imd In High-risk Groupsmentioning

confidence: 99%

The Global Meningococcal Initiative meeting on prevention of meningococcal disease worldwide: Epidemiology, surveillance, hypervirulent strains, antibiotic resistance and high-risk populations

Acevedo

Bai

Borrow

et al. 2018

Expert Review of Vaccines

148

159

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2019) The Global Meningococcal Initiative meeting on prevention of meningococcal disease worldwide: Epidemiology, surveillance, hypervirulent strains, antibiotic resistance and highrisk populations, Expert Review of Vaccines, 18:1, 15-30, ABSTRACT Introduction: The 2018 Global Meningococcal Initiative (GMI) meeting focused on evolving invasive meningococcal disease (IMD) epidemiology, surveillance, and protection strategies worldwide, with emphasis on emerging antibiotic resistance and protection of high-risk populations. The GMI is comprised of a multidisciplinary group of scientists and clinicians representing institutions from several continents. Areas covered: Given that the incidence and prevalence of IMD continually varies both geographically and temporally, and surveillance systems differ worldwide, the true burden of IMD remains unknown. Genomic alterations may increase the epidemic potential of meningococcal strains. Vaccination and (to a lesser extent) antimicrobial prophylaxis are the mainstays of IMD prevention. Experiences from across the globe advocate the use of conjugate vaccines, with promising evidence growing for protein vaccines. Multivalent vaccines can broaden protection against IMD. Application of protection strategies to high-risk groups, including individuals with asplenia, complement deficiencies and human immunodeficiency virus, laboratory workers, persons receiving eculizumab, and men who have sex with men, as well as attendees at mass gatherings, may prevent outbreaks. There was, however, evidence that reduced susceptibility to antibiotics was increasing worldwide. Expert commentary: The current GMI global recommendations were reinforced, with several other global initiatives underway to support IMD protection and prevention. ARTICLE HISTORY

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Section: Imd In High-risk Groupsmentioning

confidence: 99%

The Global Meningococcal Initiative meeting on prevention of meningococcal disease worldwide: Epidemiology, surveillance, hypervirulent strains, antibiotic resistance and high-risk populations

Acevedo

Bai

Borrow

et al. 2018

Expert Review of Vaccines

148

159

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show abstract

“…They also reported reduced incidences of infections among this cohort [47]. In another retrospective cohort study, Arnott A. et al concluded that systemic, long-term approaches can significantly minimize the risk of infection with encapsulated pathogens among splenectomized individuals [48]. According to Premawardena C et al, major benefits of the registry were not related to the knowledge but in the delivery of the recommended vaccines and the use of a medical alert card [49].…”

Section: Benefits Of Having a Spleen Registrymentioning

confidence: 77%

Post-splenectomy Sepsis: A Review of the Literature

Tahir¹,

Ahmed²,

Malik³

2020

Cureus

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The spleen is an intraperitoneal organ that performs vital hematological and immunological functions. It maintains both innate and adaptive immunity and protects the body from microbial infections. The removal of the spleen as a treatment method was initiated from the early 1500s for traumatic injuries, even before the physiology of spleen was properly understood. Splenectomy has therapeutic effects in many conditions such as sickle cell anemia, thalassemia, idiopathic thrombocytopenic purpura (ITP), Hodgkin's disease, and lymphoma. However, it increases the risk of infections and, in some cases, can lead to a case of severe sepsis known as overwhelming post-splenectomy infection (OPSI), which has a very high mortality rate. Encapsulated bacteria form a major proportion of the invading organisms, of which the most common is Streptococcus pneumoniae. OPSI is a medical emergency that requires prompt diagnosis (with blood cultures and sensitivity, blood glucose levels, renal function tests, and electrolyte levels) and management with fluid resuscitation along with immediate administration of empirical antimicrobials. OPSI can be prevented by educating patients, vaccination, and antibiotic prophylaxis. This article summarizes the anatomy and physiology of the spleen and highlights its important functions. It primarily focuses on the pathophysiology of OPSI, its current management, and prevention strategies.

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“…We also still have limited data on the proportion of patients with asplenia or hyposplenism who are not registered in Victoria, Tasmania and Queensland. Vaccine uptake rates appear higher among registered cohorts 11 compared to non‐registered cohorts, 12 suggesting a mechanism for lower rates of preventable infections in those on the spleen registry 14 …”

Section: Discussionmentioning

confidence: 99%

“…Where vaccination was known, 57% were fully vaccinated and 43% were not. A study in Victoria suggested that registration is associated with a reduction in vaccine‐preventable disease rates of 69% 14 . The costs of treating a case of OPSI remains highly variable, with cases notified to Spleen Australia costing up to $280,000 (in 2014).…”

mentioning

confidence: 99%

Initial modelling and updates on cost effectiveness from the first 10 years of a spleen registry

Luu

Jones

Woolley

et al. 2018

Australian and New Zealand Journal of Public Health

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Objective: To validate our estimates from our original model and re-evaluate the costeffectiveness of Spleen Australia, the Australian post-splenectomy registry, using our original model with updated model parameters based on advances in the literature and experience of the registry over the past decade. Methods:We revisited a decision model from 2005, comparing 1,000 hypothetical registered patients with asplenia or hyposplenism against 1,000 who were not registered, and updated the model parameters. The cost-effectiveness of the registry was evaluated from a healthcare perspective in terms of additional cost per case of overwhelming post-splenectomy infection (OPSI) avoided and as additional cost per life year gained. Results:Over a cohort lifetime the registry was associated with an additional cost of $125,724 per case of OPSI avoided or $19,286 per life year gained. Conclusions:Despite our initial over-estimation of immunisation and chemoprophylaxis uptake and increases in unit costs, our re-evaluation confirmed use of the registry to be costeffective.Implications for public health: Improved outcomes for patients with asplenia or hyposplenism can be achieved by a cost-effective registry. Additional research into effectiveness of interventions, OPSI prevalence associated with varying intervention use, and compliance rates over time after registration would provide improved accuracy of cost-effectiveness estimates.

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A Registry for Patients With Asplenia/Hyposplenism Reduces the Risk of Infections With Encapsulated Organisms

Abstract: Systematic, long-term approaches to post-splenectomy care can significantly reduce the risk of infection with encapsulated organisms among individuals with asplenia/hyposplenism.

Cited by 39 publications

References 18 publications

The Global Meningococcal Initiative meeting on prevention of meningococcal disease worldwide: Epidemiology, surveillance, hypervirulent strains, antibiotic resistance and high-risk populations

The Global Meningococcal Initiative meeting on prevention of meningococcal disease worldwide: Epidemiology, surveillance, hypervirulent strains, antibiotic resistance and high-risk populations

Post-splenectomy Sepsis: A Review of the Literature

Initial modelling and updates on cost effectiveness from the first 10 years of a spleen registry

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