This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Mode of splenectomy and immunogenicity of meningococcal vaccination in patients with hereditary spherocytosis. BJS 2008; 95: 466-471.
Published: 28th December 2007
Authors: G. A. Stoehr, J. Luecken, S. Zielen, S. W. Eber, R. Borrow, M. A. Rose et al.
Background
Splenectomy predisposes patients to invasive disease from pneumococci, meningococci, and Haemophilus influenzae; immunization is mandatory. However, data on the impact of the splenectomy on vaccine immunogenicity are scarce.
Method
A total of 41 children with hereditary spherocytosis (aged 5·8–14·4 years) had complete (16) or near‐total (25) splenectomy. All received one dose of monovalent meningococcal C conjugate vaccine (MCV‐C) and, 2 months later, a tetravalent meningococcal polysaccharide vaccine (MPV‐ACWY). Serum bactericidal activity and antibodies against serogroups A and C were determined before and after they received MCV‐C, and 4 weeks after they received MPV‐ACWY.
Results
Before vaccination, only four of the 16 children who had a complete splenectomy were protected against serogroup A, compared with 15 of the 25 who had near‐total splenectomy (P < 0·050), with the latter responding to immunization with significantly higher serogroup A serum bactericidal activity: geometric mean (95 per cent confidence interval) 1625.5 (49.9 to 3201.1) versus 980.6 (2.00 to 6204.1) (P < 0·050). All patients achieved putative protective serum bactericidal activity titres (at least 8) against serogroup C.
Conclusion
Near‐total splenectomy provides a favourable immunological basis for natural and vaccine‐induced protection against meningococcal serogroup A and C infections. Sequential meningococcal vaccination is immunogenic in patients splenectomized for hereditary spherocytosis. Copyright © 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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