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Asplenic patients and invasive pneumococcal disease-how bad is it these days?
Thomas J Marrie1, Gregory J Tyrrell2, Sumit R Majumdar3
1Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
Insights
Asplenic patients with invasive pneumococcal disease (IPD) experience more severe infections but similar mortality rates compared to those with a spleen. Serotype 22B predominance warrants further investigation into vaccination strategies.
Area of Science:
- Infectious Diseases
- Immunology
- Public Health
Background:
- Splenectomy increases the risk of severe invasive pneumococcal disease (IPD).
- The impact of childhood pneumococcal conjugate vaccine programs on IPD in asplenic individuals is not well understood.
Purpose of the Study:
- To investigate the current status of IPD in asplenic patients within a population utilizing a pediatric pneumococcal conjugate vaccine program.
- To compare the clinical characteristics and outcomes of IPD in asplenic versus non-asplenic patients.
Main Methods:
- Prospective collection of all IPD cases in Northern Alberta, Canada (2000-2014).
- Comparison of socio-demographic, clinical, and outcome data between asplenic and non-asplenic patients using statistical tests.
Main Results:
- 1.5% of IPD patients (37/2435) were asplenic.
- Asplenic patients had higher rates of mechanical ventilation, ICU admission, and complications like acute kidney injury.
- In-hospital mortality rates were similar (19% vs. 16%).
- Pneumococcal serotype 22B was 33-fold more prevalent in asplenic patients.
Conclusions:
- Asplenic patients with IPD face more severe infections but not higher mortality compared to spleen-possessing individuals.
- The significant increase in serotype 22B in asplenic patients requires further research and may necessitate adjustments to current vaccination strategies.
Objectives:
Most are aware of pneumococcal infection as a complication of splenectomy and the increased risk of severe invasive pneumococcal disease (IPD) in asplenic patients. However little is known of the current status of this entity in a population with an active pneumococcal conjugate vaccine program for children.
Methods:
All IPD cases reported from 2000 to 2014 in Northern Alberta, Canada were collected prospectively. Socio-demographic variables, clinical characteristics, and IPD-related outcomes were compared between patients with and without a spleen using the Student t-test, Chi-square test, or Fisher's exact test, as appropriate.
Results:
Thirty-seven of 2435 patients with IPD (1.5%) were asplenic. Asplenic patients were significantly more likely to require mechanical ventilation or admission to the intensive care unit and had more complications (e.g., acute kidney injury). However, in-hospital mortality rates were similar in those with and without a spleen (19% vs. 16%, p=0.58). Pneumococcal serotype 22B was 33-fold higher in asplenic patients compared to those with a spleen.
Conclusions:
In patients with IPD, those who are asplenic have a more severe infection than those with a spleen; however, the mortality rate is not significantly different. The reason for the predominance of serotype 22B requires further investigation and if replicated may warrant attention to current vaccination strategies.
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