Foss Abrahamsen A, Høiby E A, Hannisdal E, Jørgensen O G, Holte H, Hasseltvedt V, Høst H
Department of Oncology, Norwegian Radium Hospital, Oslo, Norway.
Eur J Haematol. 1997 Feb;58(2):73-7. doi: 10.1111/j.1600-0609.1997.tb00927.x.
We surveyed, during 1994, all 325 patients who underwent staging laparotomy with splenectomy for Hodgkin's disease in Norway 1969-80, before pneumococcal vaccine was available in this country. The patients were thus not immunized preoperatively. Of 162 patients (49.8%) who died before 1994, 8 (2.4% of the total study) died from pneumococcal septicaemia and 16 (6.2%) from infections totally. Of 163 patients (50.2%) who were alive in 1994, 158 cooperated and filled in a questionnaire: 22 had been hospitalized for serious infections; 2 with pneumococcal septicaemia, and 6 with pneumonia, although lacking a specified microbiological diagnosis. We observed 325 patients representing 4420 patient-years, 3066 patient-years among survivors and 1354 patient-years among the dead. This resulted in an incidence rate of systemic pneumococcal disease of 226 per 100,000 patient-years, which is a relative risk of 20.5 compared to the general Norwegian population during 1994. Septicaemia for these patients most often had an abrupt clinical start even for relapse-free individuals and occurred from 2 to 17 yr after splenectomy (mean 10 yr). The risk of developing an overwhelming pneumococcal septicaemia with high case-fatality in asplenic patients seems to persist for these patients at about the same level even 15-20 yr after splenectomy. Only 12.7% of the survivors had been given pneumococcal vaccine in the autumn of 1993. Despite the fact that medical journals and media in Norway focused upon the problem of pneumococcal disease in asplenic individuals in the autumn of 1993 and spring of 1994, a substantial proportion of these patients (55.3%) still remained unimmunized when interviewed in the autumn of 1994. None of our systemic pneumococcal disease patients was vaccinated. Our data underline the need for prophylactic immunization with effective vaccines against pneumococcal infection in splenectomized Hodgkin's disease patients.
1994年，我们对1969年至1980年期间在挪威因霍奇金病接受分期剖腹脾切除术的所有325例患者进行了调查，当时该国尚未有肺炎球菌疫苗。因此，这些患者术前未接种疫苗。在1994年前死亡的162例患者（占总研究人数的49.8%）中，8例（占总研究人数的2.4%）死于肺炎球菌败血症，16例（占6.2%）死于各种感染。在1994年仍存活的163例患者（占50.2%）中，158例配合并填写了问卷：22例曾因严重感染住院；2例为肺炎球菌败血症，6例为肺炎，尽管缺乏明确的微生物学诊断。我们观察了325例患者，共4420患者年，其中存活者为3066患者年，死亡者为1354患者年。这导致全身性肺炎球菌疾病的发病率为每100,000患者年226例，与1994年挪威普通人群相比，相对风险为20.5。这些患者的败血症即使对于无复发个体通常也有突然的临床发作，发生在脾切除术后2至17年（平均10年）。即使在脾切除术后15至20年，脾切除患者发生致死率高的暴发性肺炎球菌败血症的风险似乎仍维持在大致相同水平。只有12.7%的存活者在1993年秋季接种了肺炎球菌疫苗。尽管挪威的医学期刊和媒体在1993年秋季和1994年春季关注了脾切除个体的肺炎球菌疾病问题，但在1994年秋季接受访谈时，这些患者中仍有相当一部分（55.3%）未接种疫苗。我们的全身性肺炎球菌疾病患者均未接种疫苗。我们的数据强调了对脾切除的霍奇金病患者进行预防性免疫接种以预防肺炎球菌感染的必要性。
