Vaccination coverage in adults undergoing splenectomy: evaluation of hospital vaccination policies

Abstract

Vaccination coverage in 595 adult patients undergoing total splenectomy in the Hospital Clinic of Barcelona during 1992-2002 was studied. The rates of cover for pneumococcal, Haemophilus influenzae type b and meningococcal vaccines were 63, 63 and 61% respectively, during 2000-2002; 32, 17 and 22% in 1997-1999; and 24, 9 and 8% in 1992-1996. Multivariate analysis showed a greater risk of no vaccination in splenectomies due to trauma, malignant neoplasms of solid organs and incidental splenectomy compared with both neoplastic and non-neoplastic haematological disease, and those patients undergoing splenectomy before 2001. Coverage (>/=1 vaccine) since 1997 in patients with haematological diseases was 83.5% (71/85), haematological neoplasias 69.2% (18/26), solid organ neoplasms 38.3% (36/94), incidental splenectomy 35.6% (16/45), and traumas 28.4% (21/74). Mandatory hospital admission of patients undergoing splenectomy offers a good opportunity for vaccination of these patients. Specific vaccination policies should be developed to take advantage of this circumstance.

Fig. 1

Vaccines administered in the first visit to the vaccination centre according to the year of administration. Percentage of vaccines administered in the same year. PN, pneumococcal. Hib, H. influenzae type b. Menin, meningococcal vaccine (MAC or MCC). The coverage indicates the percentage of patients vaccinated in the same year as the splenectomy.

Fig. 2

Percentage distribution of vaccinations with respect to vaccination before, during or after admission for splenectomy for each aetiological group. HaemD, Non-neoplastic haematological disease; MHN, malignant haematological neoplasms; MSON, malignant solid organ neoplasms; IS, incidental splenectomy.