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Preventing infections in children and adults with asplenia.
Lee, Grace M.
  • Lee GM; Division of Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA.
Hematology Am Soc Hematol Educ Program ; 2020(1): 328-335, 2020 12 04.
Article in English | MEDLINE | ID: covidwho-1024352
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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Full text: Available Collection: International databases Database: MEDLINE Main subject: Spleen / Vaccination / Infection Control / Primary Immunodeficiency Diseases / Infections / Anti-Bacterial Agents Type of study: Prognostic study Topics: Long Covid / Vaccines Limits: Adult / Child / Humans Language: English Journal: Hematology Am Soc Hematol Educ Program Journal subject: Hematology Year: 2020 Document Type: Article Affiliation country: HEMATOLOGY.2020000117

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Spleen / Vaccination / Infection Control / Primary Immunodeficiency Diseases / Infections / Anti-Bacterial Agents Type of study: Prognostic study Topics: Long Covid / Vaccines Limits: Adult / Child / Humans Language: English Journal: Hematology Am Soc Hematol Educ Program Journal subject: Hematology Year: 2020 Document Type: Article Affiliation country: HEMATOLOGY.2020000117