The spleen is an important organ in the defense of the body against pathogenic bacteria. Major functions of the spleen include antibody production and mechanical filtration of blood. Anatomically or functionally asplenic individuals are at increased risk of fulminant infection by encapsulated bacteria, particularly Streptococcus pneumoniae, Hemophilus influenzae, and Neisseria meningitidis. Polysaccharide vaccines are available against some strains of these pathogenic bacteria. More data are required to define specific age and risk groups. A search for better and more immunogenic vaccines, which may prove effective in a wider variety of patients, is currently under way. Although the current vaccines are not always effective and future revaccination may increase the incidence of adverse effects, most asplenic persons should receive the currently available vaccines to minimize their risk of life-threatening infection.
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References
1.
BohnsackJF, BrownEJ. The role of the spleen in resistance to infection.Annu Rev Med1986; 37: 49–59.
2.
LinneT, ErickssonM, LannergrenK, TordaiP, CzarweidhagenB, SwedbergK.Splenic function after nonsurgical management of splenic rupture.J Pediatr1984; 105: 263–5.
3.
Centers for Disease Control.Recommendations of the Immunization Practices Advisory Committee (ACIP): polysaccharide vaccine for prevention of Haemophilus influenzae type b disease.MMWR1985; 34: 201–5.
4.
BarrettDJ. Human immune responses to polysaccharide antigens; an analysis of bacterial polysaccharide vaccines in infants.Adv Pediatr1985; 32: 139–58.
5.
Prevention of serious infections after splenectomy.Med Lett Drugs Ther1977; 19: 2–4.
RobertsRB. Streptococcus pneumoniae. In: MandellGL, DouglasRGJr., BennettJE, eds. Principles and practice of infectious diseases.New York: John Wiley and Sons, 1979; 1589–604.
8.
CraigJB, PowellBL. Overwhelming infection after splenectomy: a challenge to preventive medicine.N Carolina Med J1986; 46: 570–1.
9.
AustrianR.Assessment of pneumococcal vaccine (editorial).N Engl J Med1984; 310: 651–3.
RobbinsJB, AustrianR, LeeCJConsiderations for formulating the second-generation pneumococcal capsular polysaccharide vaccine with emphasis on the cross-reactive types within groups.J Infect Dis1983; 14: 1136–59.
12.
Health and Public Policy Commitee, American College of Physicians.Pneumococcal vaccine.Ann Intern Med1986; 104: 118–20.
BolanG, BroomeCV, FacklamRR, PlikaytisBD, FraserDW, SchlechWFIIIPneumococcal vaccine efficacy in selected populations in the United States.Ann Intern Med1986; 104: 1–6.
15.
ShapiroED, ClemensJD. A controlled evaluation of the protective efficacy of pneumococcal vaccine for the patients at high risk of serious pneumococcal infections.Ann Intern Med1984; 101: 352–30.
16.
WinstonDJ, HoWG, SchiffmanG, ChamplinRE, FeigSA, GaleRP. Pneumococcal vaccination of recipients of bone marrow transplants.Arch Intern Med1983; 143: 1735–7.
17.
AmmanAJ, SchiffmanG, AddiegoJE, WaraWM, WaraDW. Immunization of immunosuppressed patients with pneumococcal polysaccharide vaccine.Rev Infect Dis1981; 3: S160–7.
18.
ForresterHL, JahnigenDW, LaforceFM. Inefficacy of pneumococcal vaccine in a high-risk population.Am J Med1987; 83: 425–30.
19.
Centers for Disease Control.Recommendations of the Immunization Practices Advisory Committee (ACIP): pneumococcal polysaccharide vaccine.MMWR1981; 30: 410–9.
20.
SiskJE, RiegelmanRK. Cost effectiveness of vaccination against pneumococcal pneumonia: an update.Ann Intern Med1986; 104: 79–86.
KingSD, RamlalA, WynterHSafety and immunogenicity of a new Haemophilus influenzae type b vaccine in infants under one year of age.Lancet1981; 2: 705–9.
30.
Committee on Infectious Diseases.Hemophilus type b polysaccharide vaccine.Pediatrics1985; 76: 322–4.
31.
CatesKL. Haemophilus influenzae type b polysaccharide vaccine.Pediatr Ann1986; 15: 461–8.
32.
PochedlyC.New prospects for preventing Haemophilus influenzae type b meningitis through immunization.NY State J Med1987; 87: 195–6.
33.
AndersonPW, PichicheroME, InselRA, BettsR, EbyR, SmithDH. Vaccines consisting of periodate-cleaved oligosaccharides from the capsule of Haemophilus influenzae type b coupled to a protein carrier: structural and temporal requirements for priming in the human infant.J Immunol1986; 137: 1181–6.
34.
PeltolaH, KayhtyH, VirtanenM, MakelaPH. Prevention of Hemophilus influenzae type b bacteremic infections with the capsular polysaccharide vaccine.N Engl J Med1984; 310: 1561–6.
35.
Centers for Disease Control.Recommendations of the Immunization Practices Advisory Committee (ACIP): update: prevention of Haemophilus influenzae type b disease.MMWR1986; 35: 170–80.
36.
FDA workshop on Haemophilus b polysaccharide vaccine—a preliminary report.MMWR1987; 36: 529–31.
37.
EinhornMS, WeinbergGA, AndersonEL, GranoffPD, GranoffDM. Immunogenicity in infants of Haemophilus influenzae type b polysaccharide in a conjugate vaccine with Neisseria meningitidis outer-membrane protein.Lancet1986; 2: 299–302.
38.
PenneyCL. Chemical perspectives in the design of a pediatric meningitis vaccine.NY State J Med1987; 87: 226–9.
39.
InselRA, AndersonPW. Response to oligosaccharide-protein conjugate vaccine against Haemophilus influenzae b in two patients with IgG2 deficiency unresponsive to capsular polysaccharide vaccine.N Engl J Med1986; 315: 499–503.
40.
KayhtyH, EskolaJ, PeltolaH, StoutMG, SamuelsonJS, GordonLK. Immunogenicity in infants of a vaccine composed of Haemophilus influenzae type b capsular polysaccharide mixed with DPT or conjugated to diphtheria toxoid.J Infect Dis1987; 155: 100–6.
41.
GranoffDM, BoiesEG, MunsonRSJr.Immunogenicity of Haemophilus influenzae type b polysaccharide-diphtheria toxoid conjugate vaccine in adults.J Pediatr1984; 105: 22–7.
42.
LepowM, RandolphM, CimmaR.Persistence of antibody and response to booster dose of Haemophilus influenzae type b polysaccharide diphtheria toxoid conjugate vaccine in infants immunized at 9 to 15 months of age.J Pediatr1986; 108: 882–6.
43.
BerkowitzCD, WardJI, MeierKSafety and immunogenicity of Haemophilus influenzae type b polysaccharide and polysaccharide diphtheria toxoid conjugate vaccine in children 15 to 24 months of age.J Pediatr1987; 110: 509–14.
44.
EskolaJ, PeltolaH, TakalaAKEfficacy of Haemophilus influenzae type b polysaccharide-diphtheria toxoid conjugate vaccine in infancy.N Engl J Med1987; 317: 717–22.
45.
LepowML, BarkinRM, BerkowitzCDSafety and immunogenicity of Haemophilus influenzae type b polysaccharide-diphtheria toxoid conjugate vaccine (PRP-D) in infants.J Infect Dis1987; 156: L591–6.
46.
LepowML, SamuelsonJS, GordonLK. Safety and immunogenicity of Haemophilus influenzae type b-polysaccharide diphtheria toxoid conjugate vaccine in infants 9 to 15 months of age.J Pediatr1985; 106: 185–9.
47.
Centers for Disease Control,. Update: prevention of Haemophilus influenzae type b disease. (Recommendations of the Immunization Practices Advisory Committee [ACIP]).MMWR1988; 37: 13–6.
48.
GranoffDM, ShackelfordPG, SuarezBKHemophilus influenzae type b disease in children vaccinated with type b polysaccharide vaccine.N Engl J Med1986; 315: 1584–90.
49.
Haemophilus influenzae type b vaccine.Med Lett Drugs Ther1985; 27: 61–2.
50.
FraschCE. Status of a group b Neisseria meningitidis vaccine.Eur J Clin Microbiol1985; 4: 533–6.
51.
SaxenaSN, RawalIJ, TripathiKK, GuptaP.Meningococcal vaccines: prevention and control of meningitis.Indian Pediatr1985; 22: 453–65.
52.
Centers for Disease Control,. Meningococcal vaccine: recommendations of the Immunization Practices Advisory Committee.MMWR1978; 27: 327–9.
53.
RossSC, DensenP.Complement deficiency states and infection: epidemiology, pathogenesis and consequences of neisserial and other infections in an immune deficiency.Medicine1984; 63: 243–73.
54.
LoggieBW, HincheyEJ. Does splenectomy predispose to meningococcal sepsis? An experimental study and clinical review.J Pediatr Surg1986; 21: 326–30.
55.
BalfanzJR, NesbitMEJr., JarvisC, KrivitW,. Overwhelming sepsis following splenectomy for trauma.J Pediatr1976; 88: 458–60.
FeldmanHA. The meningococcus: a twenty-year perspective.Rev Infect Dis1986; 8: 288–94.
58.
MohammedI, ObinecheEN, OnyemelukweGC, ZarubaK.Control of epidemic meningococcal meningitis by mass vaccination. Further epidemiological evaluation of groups A and C vaccines in northern Nigeria.J Infect1984; 9: 190–6.
59.
MohammedI, OnyemelukweGC, ObinecheEN, GuptaN, OyeyinkaGO. Control of epidemic meningococcal meningitis by mass vaccination. Persistence of antibody four years after vaccination.J Infect1984; 9: 197–202.
60.
NarainJP, MukherjeeD.Vaccine against meningococcal disease.Indian Pediatr1985; 22: 405–7.
61.
GoldR, LepowML, GoldschneiderIImmune response of human infants to polysaccharide vaccines of groups A and C Neisseria meningitidis.J Infect Dis1977; 136: S31–5.
62.
LepowML, BeelerJ, RandolphM, SamuelsonJS, HankinsWA. Reactogenicity and immunogenicity of a quadrivalent combined meningococcal polysaccharide vaccine in children.J Infect Dis1986; 154: 1003–6.
63.
Package insert. Menomune A/C/Y/W-135 (meningococcal polysaccharide vaccine, groups A, C, Y, and W-135 combined).Swiftwater, PA: Connaught Laboratories, 1983.
64.
RubenFL, HankinsWA, ZeiglerZAntibody responses to meningococcal polysaccharide vaccine in adults without a spleen.Am J Med1984; 76: 115–21.
65.
AmbrosinoDM, SiberGR. Simultaneous administration of vaccines for Haemophilus influenzae type b, Pneumococci, and Meningococci.J Infect Dis1986; 154: 893–6.
