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Centro de Investigaciones Regionales Dr. Hideyo Noguchi, Universidad Autónoma de Yucatán

2006, Number 1

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Rev Biomed 2006; 17 (1)

Recommendations and fundamentals for vaccination after splenectomy for trauma in adults. A practical viewpoint

García-Núñez LM, Cabello-Pasini R

Language: Spanish
References: 24
Page: 61-68
PDF size: 62.04 Kb.


ABSTRACT

Objective. To analyze the current recommendations for the practice of vaccination in the trauma-splenectomized adult patient.
Data-Source. Web-electronic and bibliographic research of the current recommendations for vaccination in the trauma-splenectomized adult patient.
Results. It is well known that the spleen plays a major role in immunity against infections due to capsulated-bacteria. Despite current practice supporting splenic salvage interventions (including non-operative management) splenectomy is indicated in some cases. These patients are susceptible to sustain septic complications secondary to capsulated-organisms. Prophylactic interventions such as long-term antibiotic administration and vaccination have been proposed. Although the clinical value of vaccination is unclear, it has shown its efficacy for increasing the levels of antibodies to protective titers.
Conclusions. For the trauma-splenectomized patient, current recommendations of the highest level of medical-evidence suggest triple-vaccination against S. pneumoniae, N. meningitidis and Haemophilus influenzae type b at 14th post-operative day, and re-vaccination at intervals between 3-5 years (depending on the specific vaccine).


REFERENCES

  1. 1.- Gangemi JJ, Binns OA, Young JS. Splenic injury after athtetic trauma: a case report of splenic rupture induced by Lacrosse Ball. J Trauma 1999; 46:736-7.

  2. 2.- Garcia F, Arango LA, Angel A. Trauma esplénico. Estudio retrospectivo en 9 años (1982-1990). Rev Col Cirugía 1994; 9:33-6.

  3. 3.- Sixto DA, Sixto IB. La esplenectomía segmentaria sobrepasa los pronósticos. Rev Cub Cir 2003; 42:45-53.

  4. 4.- Wisner DH, Blaidsdell FW. When to save the ruptured spleen. Surgery 1992; 111:121-2.

  5. 5.- Rose AT, Newman MI, Debelak J, Pinson CW, Morris JA Jr, Harley DD, et al. The incidence of splenectomy is decreasing: lessons learned from trauma experience. Am Surg 2000; 66:481-6.

  6. 6.- Zoli G, Corazza GR, Wood S, Bartoli R, Gasbarrini G, Farthing MJG. Impaired splenic function and tuftsin deficiency in patients with intestinal failure on long term intravenous nutrition. Gut 1998; 43:759-62.

  7. 7.- Leemans R, Manson W, Snijder JAM, Smit JW, Klasen HJ, The T, et al. Immune response capacity after human splenic autotransplantation. Ann Surg 1999; 229(2):279-85.

  8. 8.- Fielding AK. Prophylaxis against late infection following splenectomy and bone marrow transplant. Blood Reviews 1994; 8:179-91.

  9. 9.- Remouñan BC, Sanchez GC, Vázquez VL, Davas SR, Reyes PM, Valdés GMC. Fallo multiorgánico secundario a sepsis post-esplenectomía. Presentación de un caso. Rev Cubana Med 1999; 38:67-70.

  10. 10.- Shatz DV. Vaccination practices among North American trauma surgeons in splenectomy for trauma. J Trauma 2002; 53:950-6.

  11. 11.- Waghorn DJ. Overwhelming infection in asplenic patients: current best practice preventive measures are not being followed. J Clin Pathol 2001; 54:214-8.

  12. 12.- Locker GL, Wagner A, Peter A, Staudinger T, Marosi C, Rintelen C, et al. Lethal Waterhouse-Friderichsen syndrome in posttraumatic asplenia. J Trauma 1995; 39:784-6.

  13. 13.- Chattopadway B. Splenectomy, pneumococcal vaccination and antibiotic prophylaxis. Br J Hosp Med 1989; 41:172-4.

  14. 14.- Waghorn DJ. Prevention of post-splenectomy sepsis. Lancet 1993; 341:248-9.

  15. 15.- Machesky KK, Cushing RD. Overwhelming post-splenectomy infection in a patient with penicillin-resistant Streptococcus pneumoniae. Arch Fam Med 1998; 7:178-80.

  16. 16.- Department of Surgical Education – Orlando Regional Medical Center. Splenic vaccine prophylaxis. Practical Guidelines [serial on line] 2003 January [cited 2003 April 24]; 1 (1): [4 screens] Available from URL: http://www.surgicalcriticalcare.net/Guidelines/PDF/splenicvaccineprophylaxis.pdf.

  17. 17.- Hosea SW, Burch CG, Brown EJ, Berg RA, Frank MM. Impaired response of splenectomized patients to polyvalent pneumococcal vaccine. Lancet 1981; 11:804-7.

  18. 18.- Pharmacologic description – Pneumovax 23 (Pneumococcal vaccine polyvalent). [serial on line] 1986 January-March [cited 2005 August 4];1(1):[8 screens] Available from:URL: www.merck.com/product/usa/pi_circulars/pneumovax_23/pneumovax_pi_pdf-.

  19. 19.- Southern Health Board. Guidelines for the prevention and treatment of infection in patients with absent or dysfunctional spleen. Department of Public Health and Infectious Diseases – Southern Health Board J 2002; 1:1-8.

  20. 20.- Golemathis B, Tzardis P, Legakis N, Persidou-Golemati P. Report about the efficacy of anti-pneumococcal vaccination and antibiotic prophylaxis in asplenic patients. Mt Sinai J Med 1989; 56:97-8.

  21. 21.- AHFS. Meningococcal Polysaccharide Vaccine Groups A,C, Y and W-135 Combined – Menomune - A/C/Y/W-135. [serial on line] 2003 January [cited 2005 June 16];1(1):[5 screens]. Available from: URL: www.vaccinesshope.com/us_pdf/menomune_4813.4875_12.03pdf-.

  22. 22.- Melton KA. Pneumococcal vaccine. Prim Care Update Ob/Gyns 2001; 8:44-7.

  23. 23.- Recommendation W10461C004 – Wyeth Pharmaceuticals. Haemophilus b conjugate vaccine (Diphteria CRM197 Protein Conjugate) HibTITER®. [serial on line] 2002 March-April [cited 2005 May 12];1(1):[31 screens]. Available from: www.vaccinesshope.com/us_pdf/menomune_4813.4875_12.03pdf-.

  24. 24.- Saffle JR. A comprehensive practice guideline is needed to make vaccination practices more consistent. J Trauma 2002; 53:1026-7.




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