Health care in the US and Canada

Abstract

coli are also important potential pathogens after splenectomy.' We report two recent deaths from fulminant meningococcal septicaemia in people in Western Australia who had undergone splenectomy.The first patient was a 36 year old woman who had a splenectomy at the age of 30 for spontaneous rupture of the spleen during the third trimester of pregnancy. She had mild upper respiratory symptoms for four days and then collapsed suddenly; she died four hours later. Blood cultures subsequently grew N meningitidis serogroup W135.The second patient was a 16 year old girl, who was not related to the previous patient. She had had a splenectomy during childhood for hereditary spherocytosis. She initially presented to her local hospital with fever and symptoms suggestive of tonsillitis with bacteraemia. Her condition deteriorated rapidly, and she was evacuated to Perth for intensive care but died the next day. N meningitidis was cultured from her blood and cerebrospinal fluid and yielded a positive result on testing with serogroup XYZW135 polyvalent antiserum.The adult woman had received neither pneumococcal nor meningococcal vaccines, while the 16 year old girl had received one dose of pneumococcal vaccine since her splenectomy. Tetravalent ACYW meningococcal vaccine is now available in many countries. It is used in Britain for immunoprophylaxis of close contacts of an index patient with invasive disease caused by serogroup A, C, Y, or W135 of N meningitidis,4 and a similar policy is being considered by an advisory panel to Australia's National Health and Medical Research Council.The two cases we report here emphasise the importance of offering tetravalent meningococcal vaccine (in addition to polyvalent pneumococcal vaccine) to patients who have had a splenectomy.Information on when to offer revaccination is scarce, but the duration of protection against disease provided by meningococcal vaccine' suggests that an interval of five years would be appropriate, and this would coincide with revaccination with pneumococcal vaccine.4 Immunisation with one of the H influenzae type b conjugate vaccines should also be considered.