Peri-splenectomy vaccination at tertiary-care facilities in Hamilton, Ontario

Objective: The Canadian Immunization Guide recommends vaccinations against Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae type b (Hib) either at least 2 weeks before elective splenectomy or within 2 weeks following emergent splenectomy. This study aimed to assess compliance with these national recommendations. Recommended peri-splenectomy vaccines at the time of the study included the 23-valent pneumococcal polysaccharide vaccine (PPSV23), a quadrivalent meningococcal vaccine, and a Hib vaccine. Methods: Data for all adult elective and emergent splenectomy patients between March 2009 and November 2012 at an academic institution in Hamilton, Canada, were retrospectively reviewed. Data collection included indication for and date of splenectomy, vaccine formulation ordered and administered, and date of vaccine administration. Results: The vaccination rates of 125 patients were 55.2% for pneumococcus, 58.4% for meningococcus, and 59.2% for Hib; 66 patients (52.8%) received vaccinations against all three pathogens. Emergent splenectomy patients were significantly more likely than elective splenectomy patients to have documented vaccination against all three pathogens (62.9% versus 42.9%; p=0.003). Only 6 of 73 patients (8.2%) received a recommended quadrivalent meningococcal vaccine, while 49 of 69 pneumococcal-vaccinated patients (62.3%) received the recommended PPSV23. Conclusions: Peri-splenectomy vaccination patterns did not consistently meet national recommendations. Vaccines against S. pneumoniae, N. meningitidis, and Hib were administered in <60% of patients, which highlights a need for strategies to improve peri-operative vaccination rates in this population. Administration of vaccine formulations inconsistent with national guidelines demonstrates a need to improve awareness of the current vaccination recommendations for asplenic patients.