Adherence to vaccination guidelines post splenectomy: A five year follow up study

Abstract

Following a splenectomy patients are at increased risk of significant infections. In its most severe form, overwhelming post-splenectomy infection (OPSI) has a mortality rate of up to 80%. In this study we aim to establish the adherence to vaccination and antibiotic national guidelines in splenectomised patients. A retrospective study of 100 patients who underwent splenectomy (21 emergency, 79 elective), in two teaching hospitals was undertaken over a five-year period. Patients were followed up for five years. Hospital and GP records were reviewed for adherence to pre, intra and postoperative vaccination, thromboprophylaxis and antibiotic guidance. Eighty-six eligible patients (91.5%) received their Haemophilus influenzae B, meningococcal C and pneumococcus vaccinations peri-operatively. Eighty-one (86%) received post-operative antibiotics. Ninety-nine percent of patients received thromboprophylaxis treatment. Eighty-nine (95%) were treated with long-term antibiotic prophylaxis. Only 20 patients (23%) had an emergency supply of antibiotics. Ninety-five percent of patients were administered an annual influenza vaccination and 84% of eligible patients received a five-year pneumococcal booster vaccination. Improvement in the management of this patient cohort can be achieved by a multidisciplinary approach involving adherence to national guidelines, standardised trust protocols, patient information leaflets and advice detailing risk of infection, standardised GP letters and a splenectomy register to monitor and manage this vulnerable group of patients.

Prevention of infection in asplenic adult patients by general practitioners in France between 2013 and 2016

“…However the vaccination rate against MenB still remains low. Finally, the proportion of asplenic patients receiving antibiotic prophylaxis is slightly lower than previously reported [ 10 , 13 , 26 , 27 ].…”

<p>Post-splenectomy sepsis: preventative strategies, challenges, and solutions</p>

“…The persistent risk of OPSI may also partly be explained by sub-optimal uptake of interventions and levels of patient education 62,63,89,90. Our experience with Spleen Australia has shown us the challenges in optimizing uptake with expensive vaccines, supporting ongoing adherence with updated recommendations, engaging long-term registrants, and back-tracking to find old splenectomy patients who have never received education about their risk of infection nor received vaccines for their post-splenectomy risk of infection.…”

Adherence to vaccination recommendations after traumatic splenic injury

“…Booster administration of the vaccines was also evaluated by Wang et al; [3] they reported it to be 76.9% between 2 and <10 years, 82.2% between 10 and <30 years, and 76.7% for ≥30 years after splenectomy. Boam et al [18] studied the adherence to vaccination recommendations after splenectomy for all indications and reported that 91.5% of their patients received HIB, meningococcus C, and pneumococcus vaccinations peri-operatively, with 84% booster dose administrations for pneumococcus and that 95% of the patients received annual influenza vaccine. They stated that utilizing electronic health records by general practitioners improved the documentation of health records so that vaccinations can be better administered.…”