Low booster vaccination rates after trauma splenectomy

Last Updated: 2017-12-20

By Will Boggs MD

NEW YORK (Reuters Health) - Timely booster vaccination rates are very low after trauma splenectomy, according to a study of medical records.

"This is perhaps a sad commentary on long-term follow-up after trauma care, but we weren't all that surprised by the results," Dr. Robert D. Winfield from the University of Kansas Medical Center, in Kansas City, told Reuters Health by email. "Having trained and worked at several different trauma centers, I don't think that this phenomenon is unique to ours, and this is a genuine public health opportunity."

Because of the spleen's role in immune surveillance and defense against encapsulated bacteria, patients that undergo splenectomy require immunizations against Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae. All three vaccines require subsequent boosters.

Dr. Winfield's team investigated compliance with the recommended eight-week vaccination booster against S. pneumoniae among 31 patients who underwent splenectomy secondary to trauma.

Only two of these patients received subsequent boosters during office or hospital visits, none of them during the recommended eight-week timeframe (median, 22 months; range, 12-32), the team reports in Surgery, online December 1.

Seven patients had at least one subsequent admission for infection or sepsis, including five patients who had multiple such readmissions. None of these patients had received subsequent boosters.

"I think the thing that struck a chord with us was the patient readmitted with S. pneumoniae meningitis and sepsis," Dr. Winfield said. "This was a life-threatening problem that was potentially preventable by compliance with preventive measures. From a health-systems and public-health standpoint, the cost of that one readmission would have paid for booster vaccines for all of the patients in the series several times over."

"In the absence of a single national health system, the follow-up approach will likely need to be tailored to local environments, but ensuring compliance in trauma patients will likely require taking advantage of every opportunity to interact with these patients (administering vaccines at orthopedic surgery follow up, for example) and explicitly coordinating post-discharge care with primary care physicians in the patient's home community," he said.

Dr. Ruth Lynne Carrico from the University of Louisville School of Medicine, in Kentucky, has conducted a similar study of vaccination-guideline adherence in trauma splenectomy patients. She told Reuters Health by email that the new "results mirror our own in that we continue to provide fragmented and episodic care. Although I am certain that patients receive information about the need for post-splenectomy immunization, the processes that enable and facilitate that are often lacking."

"If we feel immunization is important, then we need to do more than just share information with the patients," she said. "We need to have a process that makes it difficult to fail. As this is a consequence of their splenectomy, might post-splenectomy immunization be something led by the surgeon? This could occur by providing the vaccines in the office or by scheduling appointments for the patients with another provider (maybe the patient's own primary care provider)."

"Coordination of care does not happen by accident," Dr. Carrico said. "If we feel it is important, as providers we will design an approach that makes it easy to be successful and difficult to fail. Having said that, the whole notion of adult immunization lacks the level of championship necessary."

SOURCE: http://bit.ly/2BlPgrk

Surgery 2017.