Nived Per, Jørgensen Charlotte Sværke, Settergren Bo
Department of Infectious Diseases, Central Hospital, Kristianstad, Sweden.
Department of Microbiological Diagnostics & Virology, Statens Serum Institut, Copenhagen, Denmark.
Vaccine. 2015 Mar 30;33(14):1688-94. doi: 10.1016/j.vaccine.2015.02.026. Epub 2015 Feb 21.
Overwhelming post-splenectomy infection (OPSI) is immediately life-threatening and vaccination against encapsulated bacteria, in particular pneumococci, decreases its incidence. First, we investigated the adherence to vaccination guidelines in a retrospective study of the hospital records of splenectomised patients. Second, patients were asked to complete a questionnaire and invited to participate in a study where 12-valent pneumococcal serotype-specific IgG concentrations were determined before and 4 to 6 weeks after vaccination with PCV13. Of 79 individuals who underwent splenectomy between 2000 and 2012: 81.0% received pneumococcal vaccine, 51.9% received vaccine against Haemophilus influenzae type B and 22.8% received meningococcal vaccine. 31 individuals were deceased. 33 individuals completed questionnaires and accepted participation in the second part of the study. The participants consisted of two groups: (1) prior PPV23 (n=24) and (2) prior PPV23+PCV13 (n=9). In group 1, pre-PCV13 GMC's≥0.35μg/mL were observed for serotypes 1, 4, 6B, 7F, 9V, 14, 18C, 19A, 19F and 23F, and GMC's<0.35μg/mL for serotypes 3 and 5, significant increases pre- to post-PCV13 were found for serotypes 1, 3, 4, 5, 7F, 18C, 19A, 23F (p≤0.001) and 19F (p=0.01) and all 12 serotypes-specific GMC were above 0.35μg/mL after vaccination. Group 2 did not receive vaccine in this study, but blood tests showed all 12 serotype-specific GMC>0.35μg/mL. Adherence to guidelines regarding primary pneumococcal vaccination was adequate but only a minority received the recommended meningococcal vaccination. High levels of pneumococcal serotype-specific antibodies were observed in the previous PPV23 vaccinated group, and more pronounced in the previous PCV13 group, and our data suggests that PCV13 is immunogenic for serotypes 1, 3, 4, 5, 7F, 18C, 19A, 19F and 23F, if used as a booster dose in asplenic patients with previous PPV23 vaccination.
脾切除术后暴发性感染（OPSI）会立即危及生命，针对包膜细菌特别是肺炎球菌的疫苗接种可降低其发病率。首先，我们通过对脾切除患者的医院记录进行回顾性研究，调查了疫苗接种指南的遵循情况。其次，要求患者填写一份问卷，并邀请他们参与一项研究，在接种13价肺炎球菌结合疫苗（PCV13）前及接种后4至6周测定12种肺炎球菌血清型特异性IgG浓度。在2000年至2012年间接受脾切除术的79名个体中：81.0%接种了肺炎球菌疫苗，51.9%接种了B型流感嗜血杆菌疫苗，22.8%接种了脑膜炎球菌疫苗。31人已死亡。33人完成了问卷并接受参与研究的第二部分。参与者分为两组：（1）先前接种23价肺炎球菌多糖疫苗（PPV23）组（n = 24）和（2）先前接种PPV23+PCV13组（n = 9）。在第1组中，观察到血清型1、4、6B、7F、9V、14、18C、19A、19F和23F在接种PCV13前的几何平均浓度（GMC）≥0.35μg/mL，而血清型3和5的GMC<0.35μg/mL，接种PCV13前后血清型1、3、4、5、7F、18C、19A、23F（p≤0.001）和19F（p = 0.01）有显著升高，接种疫苗后所有12种血清型特异性GMC均高于0.35μg/mL。第2组在本研究中未接种疫苗，但血液检测显示所有12种血清型特异性GMC>0.35μg/mL。对原发性肺炎球菌疫苗接种指南的遵循情况良好，但只有少数人接种了推荐的脑膜炎球菌疫苗。在先前接种PPV23的组中观察到高水平的肺炎球菌血清型特异性抗体，在先前接种PCV13的组中更明显，我们的数据表明，如果将PCV13用作先前接种PPV23的无脾患者的加强剂量，它对血清型1、3、4、5、7F、18C、19A、19F和23F具有免疫原性。
