Asplenia primary prevention: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Asplenia}} | {{Asplenia}} | ||
{{CMG}} {{AE}} | {{CMG}}; {{AE}}{{Kalpana Giri}} | ||
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==Overview== | ==Overview== | ||
Effective measures for the primary prevention of infection in asplenic patients include immunizations against Streptococcus pneumoniae, Haemophilus influenzae type b (Hib), and Neisseria meningitidis, antibiotic prophylaxis, and malaria prophylaxis. | |||
==Primary Prevention== | ==Primary Prevention== | ||
===Vaccination=== | |||
*Up to 87% of asplenic patients were found to have been infected with Streptococcus pneumoniae, one of the most common bacterial pathogen leading to infection in patients with asplenia.<ref name="pmid11253134">{{cite journal| author=Waghorn DJ| title=Overwhelming infection in asplenic patients: current best practice preventive measures are not being followed. | journal=J Clin Pathol | year= 2001 | volume= 54 | issue= 3 | pages= 214-8 | pmid=11253134 | doi=10.1136/jcp.54.3.214 | pmc=1731383 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11253134 }} </ref> | |||
*All patients with [[asplenia]] should receive the standard childhood and adolescent [[immunizations]] at the recommended age.<ref name="pmid24855431">{{cite journal| author=Salvadori MI, Price VE, Canadian Paediatric Society, Infectious Diseases and Immunization Committee| title=Preventing and treating infections in children with asplenia or hyposplenia. | journal=Paediatr Child Health | year= 2014 | volume= 19 | issue= 5 | pages= 271-8 | pmid=24855431 | doi= | pmc=4029242 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24855431 }} </ref> | |||
*Immunizations against [[Streptococcus pneumoniae]], [[Haemophilus influenzae type b]] (Hib), and [[Neisseria meningitidis]] should be ensured and may be administered on an earlier schedule than is routine, due to the risk of [[fulminant]] [[sepsis]] from [[encapsulated bacteria]]. | |||
**[[Pneumococcal vaccine]]: Both the conjugated 13-valent pneumococcal vaccine and the 23-valent polysaccharide vaccine is recommended for the asplenic patient. | |||
**[[Meningococcal vaccine]]: The conjugate quadrivalent meningococcal vaccine (MCV4) should be given. | |||
**[[Haemophilus influenzae type b]] (Hib): Children with [[asplenia]] should receive the Hib vaccine, who present with a life-threatening Hib [[infection]] because the [[infection]] itself does not confer [[lifelong]] protection. | |||
**[[Influenza vaccine]]: is recommended yearly, starting at six months of age, to lower the risk of [[secondary]] [[bacterial infections]]. | |||
**All asplenic patients may be at risk of [[Salmonella infection]] while travelling to less developed areas of the world and should be [[immunized]] for [[Salmonella typhi]]. | |||
**All [[age-appropriate]] [[vaccines]] and the yearly [[influenzae]] [[vaccine]] should be given to [[household]] contacts of [[asplenic patients]]. | |||
**Before [[splenectomy]] and after the [[surgical removal]], [[vaccinations]] are also recommended.<ref name="pmid26130882">{{cite journal| author=Huebner ML, Milota KA| title=Asplenia and fever. | journal=Proc (Bayl Univ Med Cent) | year= 2015 | volume= 28 | issue= 3 | pages= 340-1 | pmid=26130882 | doi=10.1080/08998280.2015.11929267 | pmc=4462215 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26130882 }} </ref> | |||
**[[Patient]] with [[functional asplenia]] or [[autosplenectomy]], it is also advised to continue [[aggressive]] [[vaccination]] [[schedules]]. Recommended vaccinations in these patients are the [[pneumococcal conjugate vaccine]] (PCV-13) 8 weeks in advance, as well as the [[pneumococcal polysaccharide vaccine]] (PPSV-23), [[Haemophilus influenzae type B]] vaccine (Hib), and the [[quadrivalent]] [[meningococcal conjugate]] [[vaccine]] before [[14 days]] of [[planned surgery]] for [[splenectomy]]. | |||
*'''Revaccination''': In [[asplenia]] or [[splenic dysfunction]] patients [[antibody levels]] are likely to decline rapidly therefore [[revaccination]] with 23-valent PPV is recommended [[every five years]]. There is no required for testing of antibodies prior to vaccination. | |||
==Antibiotic prophylaxis== | |||
*Only [[Immunizations]] do not [[protect]] against [[infections]] with [[encapsulated bacteria]], [[antibiotic]] [[prophylaxis]] Should be given. All the patients younger than five years of age should receive [[antibiotic]] [[prophylaxis]].<ref name="pmid24855431">{{cite journal| author=Salvadori MI, Price VE, Canadian Paediatric Society, Infectious Diseases and Immunization Committee| title=Preventing and treating infections in children with asplenia or hyposplenia. | journal=Paediatr Child Health | year= 2014 | volume= 19 | issue= 5 | pages= 271-8 | pmid=24855431 | doi= | pmc=4029242 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24855431 }} </ref> | |||
*'''For children''' | |||
**'''Birth to three months''': Escherichia coli, Klebsiella is of concern in this age group.<ref name="pmid19750611">{{cite journal| author=Committee to Advise on Tropical Medicine and Travel (CATMAT)| title=Canadian recommendations for the prevention and treatment of malaria among international travellers--2009. | journal=Can Commun Dis Rep | year= 2009 | volume= 35 Suppl 1 | issue= | pages= 1-82 | pmid=19750611 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19750611 }} </ref> | |||
***Amoxicillin or clavulanate 10 mg/kg/dose PO q12h, with penicillin VK 125 mg per dose PO q12h OR amoxicillin 10 mg/kg/dose q12h, as an alternative, if not tolerated. | |||
**'''more than 3 months to five years''': | |||
***Penicillin VK 125 mg per dose PO q12h OR amoxicillin 10 mg/kg/dose PO q12h. | |||
**'''more than 5 years''': | |||
***Penicillin V 250 mg or 300 mg per dose q12h OR amoxicillin 250 mg per dose q12h. | |||
*'''For adult''' the [[infectious]] risk in [[asplenic]] patients is [[highest]] during the first 2 years following [[splenectomy]] and the [[risk]] [[decreases]] over time. In these patients along with [[vaccination]], [[antibiotic]] [[prophylaxis]] should be given. [[Prophylactic]] [[oral antibiotic]] [[phenoxymethylpenicillin]] is required for at least 2 years after [[splenectomy]] to cover the period during which the [[infectious]] risk is [[highest]] as a [[long term therapy]].<ref name="pmid32787857">{{cite journal| author=Quéffélec C, Billet L, Duffau P, Lazaro E, Machelart I, Greib C | display-authors=etal| title=Prevention of infection in asplenic adult patients by general practitioners in France between 2013 and 2016 : Care for the asplenic patient in general practice. | journal=BMC Fam Pract | year= 2020 | volume= 21 | issue= 1 | pages= 163 | pmid=32787857 | doi=10.1186/s12875-020-01237-3 | pmc=7425533 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32787857 }} </ref> | |||
===Malaria prophylaxis=== | |||
*Asplenic and hyposplenic children must be advised to take malaria prophylaxis as appropriate for their age and the type of malaria found in the area to which they are traveling and they should always seek travel advice due to the increased risk of severe malaria in these patients.<ref name="pmid19750611">{{cite journal| author=Committee to Advise on Tropical Medicine and Travel (CATMAT)| title=Canadian recommendations for the prevention and treatment of malaria among international travellers--2009. | journal=Can Commun Dis Rep | year= 2009 | volume= 35 Suppl 1 | issue= | pages= 1-82 | pmid=19750611 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19750611 }} </ref> | |||
==References== | ==References== | ||
{{ | {{Reflist|2}} | ||
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[[Category:Medicine]] | |||
[[Category:Oncology]] | |||
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[[Category:Immunology]] | |||
[[Category:Hematology]] | [[Category:Hematology]] | ||
[[Category: | [[Category:Emergency medicine]] | ||
Latest revision as of 14:39, 20 July 2021
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kalpana Giri, MBBS[2]
Overview
Effective measures for the primary prevention of infection in asplenic patients include immunizations against Streptococcus pneumoniae, Haemophilus influenzae type b (Hib), and Neisseria meningitidis, antibiotic prophylaxis, and malaria prophylaxis.
Primary Prevention
Vaccination
- Up to 87% of asplenic patients were found to have been infected with Streptococcus pneumoniae, one of the most common bacterial pathogen leading to infection in patients with asplenia.[1]
- All patients with asplenia should receive the standard childhood and adolescent immunizations at the recommended age.[2]
- Immunizations against Streptococcus pneumoniae, Haemophilus influenzae type b (Hib), and Neisseria meningitidis should be ensured and may be administered on an earlier schedule than is routine, due to the risk of fulminant sepsis from encapsulated bacteria.
- Pneumococcal vaccine: Both the conjugated 13-valent pneumococcal vaccine and the 23-valent polysaccharide vaccine is recommended for the asplenic patient.
- Meningococcal vaccine: The conjugate quadrivalent meningococcal vaccine (MCV4) should be given.
- Haemophilus influenzae type b (Hib): Children with asplenia should receive the Hib vaccine, who present with a life-threatening Hib infection because the infection itself does not confer lifelong protection.
- Influenza vaccine: is recommended yearly, starting at six months of age, to lower the risk of secondary bacterial infections.
- All asplenic patients may be at risk of Salmonella infection while travelling to less developed areas of the world and should be immunized for Salmonella typhi.
- All age-appropriate vaccines and the yearly influenzae vaccine should be given to household contacts of asplenic patients.
- Before splenectomy and after the surgical removal, vaccinations are also recommended.[3]
- Patient with functional asplenia or autosplenectomy, it is also advised to continue aggressive vaccination schedules. Recommended vaccinations in these patients are the pneumococcal conjugate vaccine (PCV-13) 8 weeks in advance, as well as the pneumococcal polysaccharide vaccine (PPSV-23), Haemophilus influenzae type B vaccine (Hib), and the quadrivalent meningococcal conjugate vaccine before 14 days of planned surgery for splenectomy.
- Revaccination: In asplenia or splenic dysfunction patients antibody levels are likely to decline rapidly therefore revaccination with 23-valent PPV is recommended every five years. There is no required for testing of antibodies prior to vaccination.
Antibiotic prophylaxis
- Only Immunizations do not protect against infections with encapsulated bacteria, antibiotic prophylaxis Should be given. All the patients younger than five years of age should receive antibiotic prophylaxis.[2]
- For children
- Birth to three months: Escherichia coli, Klebsiella is of concern in this age group.[4]
- Amoxicillin or clavulanate 10 mg/kg/dose PO q12h, with penicillin VK 125 mg per dose PO q12h OR amoxicillin 10 mg/kg/dose q12h, as an alternative, if not tolerated.
- more than 3 months to five years:
- Penicillin VK 125 mg per dose PO q12h OR amoxicillin 10 mg/kg/dose PO q12h.
- more than 5 years:
- Penicillin V 250 mg or 300 mg per dose q12h OR amoxicillin 250 mg per dose q12h.
- Birth to three months: Escherichia coli, Klebsiella is of concern in this age group.[4]
- For adult the infectious risk in asplenic patients is highest during the first 2 years following splenectomy and the risk decreases over time. In these patients along with vaccination, antibiotic prophylaxis should be given. Prophylactic oral antibiotic phenoxymethylpenicillin is required for at least 2 years after splenectomy to cover the period during which the infectious risk is highest as a long term therapy.[5]
Malaria prophylaxis
- Asplenic and hyposplenic children must be advised to take malaria prophylaxis as appropriate for their age and the type of malaria found in the area to which they are traveling and they should always seek travel advice due to the increased risk of severe malaria in these patients.[4]
References
- ↑ Waghorn DJ (2001). "Overwhelming infection in asplenic patients: current best practice preventive measures are not being followed". J Clin Pathol. 54 (3): 214–8. doi:10.1136/jcp.54.3.214. PMC 1731383. PMID 11253134.
- ↑ 2.0 2.1 Salvadori MI, Price VE, Canadian Paediatric Society, Infectious Diseases and Immunization Committee (2014). "Preventing and treating infections in children with asplenia or hyposplenia". Paediatr Child Health. 19 (5): 271–8. PMC 4029242. PMID 24855431.
- ↑ Huebner ML, Milota KA (2015). "Asplenia and fever". Proc (Bayl Univ Med Cent). 28 (3): 340–1. doi:10.1080/08998280.2015.11929267. PMC 4462215. PMID 26130882.
- ↑ 4.0 4.1 Committee to Advise on Tropical Medicine and Travel (CATMAT) (2009). "Canadian recommendations for the prevention and treatment of malaria among international travellers--2009". Can Commun Dis Rep. 35 Suppl 1: 1–82. PMID 19750611.
- ↑ Quéffélec C, Billet L, Duffau P, Lazaro E, Machelart I, Greib C; et al. (2020). "Prevention of infection in asplenic adult patients by general practitioners in France between 2013 and 2016 : Care for the asplenic patient in general practice". BMC Fam Pract. 21 (1): 163. doi:10.1186/s12875-020-01237-3. PMC 7425533 Check
|pmc=value (help). PMID 32787857 Check|pmid=value (help).