Department of Community Medicine and Global Health, Faculty of Medicine, University of Oslo, Oslo, Norway; Division for Infection Control, Norwegian Institute of Public Health, Oslo, Norway.
Department of Community Medicine and Global Health, Faculty of Medicine, University of Oslo, Oslo, Norway; Division for Infection Control, Norwegian Institute of Public Health, Oslo, Norway.
Vaccine. 2023 Jul 12;41(31):4579-4585. doi: 10.1016/j.vaccine.2023.06.034. Epub 2023 Jun 17.
The spleen is responsible for blood filtration and mounting an immune response against pathogens. In some people the spleen must be surgically removed because of traumatic events or oncological and hematological conditions. These patients are at higher risk of developing diseases caused by encapsulated bacteria throughout their lives. Thus, immunisations are advised for splenectomised persons to prevent infection caused by Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae type b (Hib). This study assessed vaccination coverage (VC) among Norwegian patients with surgical asplenia. Using the Nomesco Classification of Surgical Procedures codes, patient information (age, sex, date of initial diagnosis and date of surgery) was acquired from the Norwegian Patient Registry. The National Immunization Register provided information on vaccination status and data of any subsequent invasive bacterial infections were obtained from the Norwegian Surveillance System for Communicable Diseases. From the total population of Norway, 3155 patients who had undergone complete splenectomy were identified. Of these, 914 (29.0%) had received at least one dose of pneumococcal conjugate vaccine (PCV), 1324 (42.0%) at least one dose of pneumococcal polysaccharide vaccine and 589 (18.7%) had received both. Only 4.2% of the patients had received two doses of a meningococcal ACWY conjugate vaccine, while 8.0% of 1467 patients splenectomised after 2014 had received at least two doses of a serogroup B meningococcal vaccine. The VC for Hib was 18.7%. Nearly all splenectomised children under the age of 10 were vaccinated with Hib and PCV as these vaccines are included in the childhood immunisation program. For all vaccines, VC decreased with age. Twenty-nine invasive bacterial infections were registered post-splenectomy in 25 patients. Vaccination according to national recommendations could have prevented at least 8 (28%) of these infections. Our study showed that efforts are required to increase VC of splenectomised individuals in Norway.
脾脏负责过滤血液并对病原体产生免疫反应。由于创伤事件或肿瘤和血液学疾病，有些人必须进行脾切除术。这些患者一生中发生由囊膜细菌引起的疾病的风险更高。因此，建议对脾切除患者进行免疫接种，以预防由肺炎链球菌、脑膜炎奈瑟菌和乙型流感嗜血杆菌（Hib）引起的感染。本研究评估了挪威接受手术性无脾症患者的疫苗接种覆盖率（VC）。使用 Nomesco 手术程序分类代码，从挪威患者登记处获取患者信息（年龄、性别、初次诊断日期和手术日期）。国家免疫登记处提供疫苗接种状况信息，任何后续侵袭性细菌感染的数据均从挪威传染病监测系统获得。在挪威总人口中，确定了 3155 名接受过完全脾切除术的患者。其中，914 名（29.0%）患者至少接受了一剂肺炎球菌结合疫苗（PCV），1324 名（42.0%）患者至少接受了一剂肺炎球菌多糖疫苗，589 名（18.7%）患者同时接受了两种疫苗。仅有 4.2%的患者接受了两剂脑膜炎球菌 ACWY 结合疫苗，而在 2014 年后接受脾切除术的 1467 名患者中，有 8.0%的患者至少接受了两剂 B 型脑膜炎球菌疫苗。Hib 的 VC 为 18.7%。由于这些疫苗包含在儿童免疫计划中，因此几乎所有 10 岁以下的脾切除儿童都接种了 Hib 和 PCV。对于所有疫苗，VC 随年龄而降低。在 25 名患者中，脾切除术后共登记了 29 例侵袭性细菌感染。根据国家建议进行疫苗接种至少可以预防其中 8 例（28%）感染。我们的研究表明，需要努力提高挪威脾切除患者的 VC。
