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Preventing infections in children and adults with asplenia
1Division of Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA.
Insights
Individuals with asplenia face lifelong risks of severe infections from encapsulated bacteria. Lifelong vigilance, including vaccinations and antibiotic prophylaxis, is crucial for preventing sepsis in this vulnerable population.
Area of Science:
- Infectious Diseases
- Immunology
- Public Health
Background:
- Approximately 1 million individuals in the US have functional or anatomic asplenia or hyposplenia.
- Asplenia increases susceptibility to severe infections from encapsulated organisms (e.g., Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae), posing a lifelong risk of sepsis.
- Patients with asplenia are also vulnerable to less common pathogens like Capnocytophaga, Babesia, and malaria.
Purpose of the Study:
- To review current strategies for preventing infectious complications in patients with asplenia.
- To highlight the importance of lifelong adherence to preventive measures, including antibiotic prophylaxis and vaccinations.
- To emphasize the need for improved care monitoring and patient education to bridge the gap in managing asplenia-related risks.
Main Methods:
- Review of current guidelines and literature on the prevention of infections in asplenic patients.
- Analysis of recommended vaccines for asplenic individuals, including pneumococcal, meningococcal, H. influenzae type b, and influenza vaccines.
- Discussion of antibiotic prophylaxis strategies and their recommended durations and targets.
Main Results:
- Infectious complications can be severe and fatal, occurring throughout a patient's lifetime, even decades after splenectomy.
- Current preventive strategies include antibiotic prophylaxis, recommended vaccinations (with booster doses), and patient education.
- Adherence to preventive measures remains a challenge, despite their proven effectiveness.
Conclusions:
- Lifelong risk of infection necessitates continuous preventive strategies for asplenic patients.
- Dedicated clinics and educational programs can significantly improve vaccine coverage and reduce infection risk.
- Future efforts should focus on monitoring care quality to ensure optimal management of this high-risk population.
Abstract:
An estimated 1 million people in the United States have functional or anatomic asplenia or hyposplenia. Infectious complications due to encapsulated organisms such as Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae can lead to fulminant sepsis and death, particularly in young children, in the period shortly after splenectomy, and in immunocompromised patients. Patients with asplenia are also at risk for less common infections due to Capnocytophaga, Babesia, and malaria. Antibiotic prophylaxis, vaccines, and patient and family education are the mainstays of prevention in these at-risk patients. Recommendations for antibiotic prophylaxis typically target high-risk periods, such as 1 to 3 years after splenectomy, children ≤5 years of age, or patients with concomitant immunocompromise. However, the risk for sepsis is lifelong, with infections occurring as late as 40 years after splenectomy. Currently available vaccines recommended for patients with asplenia include pneumococcal vaccines (13-valent pneumococcal conjugate vaccine followed by the 23-valent pneumococcal polysaccharide vaccine), meningococcal vaccines (meningococcal conjugate vaccines for serogroups A, C, Y and W-135 and serogroup B meningococcal vaccines), H. influenzae type b vaccines, and inactivated influenza vaccines. Ongoing booster doses are also recommended for pneumococcal and meningococcal vaccines to maintain protection. Despite the availability of prevention tools, adherence is often a challenge. Dedicated teams or clinics focused on patient education and monitoring have demonstrated substantial improvements in vaccine coverage rates for individuals with asplenia and reduced risk of infection. Future efforts to monitor the quality of care in patients with asplenia may be important to bridge the know-do gap in this high-risk population.
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