[Splenectomy and pneumococcal vaccine. How to follow-up?]

The authors describe the case of an otherwise healthy man who died from pneumococcal septicemia 18 years after having undergone splenectomy. It is widely accepted that splenectomized patients run increased risk of serious bacterial infections. Meningitis and septicemia caused by encapsulated organisms, especially Streptococcus pneumoniae, are most important in this respect, with a reported mortality of 30-60%. Since 1977, splenectomized patients have been offered pneumococcal vaccine as a routine, but persons who was splenectomized before 1977 are not identified, and run an unknown risk of serious infectious disease. Possible approaches to this problem of identification are discussed.