Impact of a spleen registry on optimal post-splenectomy vaccination and care

ABSTRACT

Objective: To evaluate quality of patient knowledge and rates of adherence to guidelines amongst splenectomised patients registered to the Spleen Australia registry.

Method: Registrants recruited for assessment of residual splenic function post-splenectomy also underwent an assessment of quality of knowledge and a review of their long-term management. Eligible patients were ≥ 18 years of age, registered to the Spleen Australia clinical registry and had been splenectomised at least 1 year prior to their visit. Quality of knowledge was assessed using a validated questionnaire used in similar studies. Receipt of immunisations was validated by record review. Chemoprophylaxis use was self-reported by patients. Adherence was evaluated using Australian guidelines.

Results: 77 patients were evaluated for education and adherence. 58% were female, mean age was 58 years, and median duration since splenectomy was 14 years. Most common indications for splenectomy were trauma and haematological conditions. 77% had good knowledge of key educational points to reduce chances of infection. Adherence to immunisations varied with poor adherence to vaccines introduced after 2010. Only 6 patients were adherent to all recommended immunisations. Increasing duration since registration was associated with poorer 13vPCV (p = 0.008) and 4vMenCV adherence (p = 0.001). Over 70% either currently or had previously used daily chemoprophylaxis and 66% had a supply of emergency antibiotics.

Conclusions: Although registrants are receiving initial and booster vaccinations, they do not receive newly recommended vaccines. In order to maintain long-term adherence, we recommend streamlining health information systems, improving awareness strategies and improving financial access to vaccinations in the community with additional awareness of the activities of the registry.

Keywords:

• Spleen
• registry
• asplenia
• splenectomy
• education
• adherence
• vaccine
• immunisation

Acknowledgments

We would like to thank Yvona Rajchlova and Angie Byrnes from the Clinical Trials Centre at Monash Health Translation Precinct for clinical support, and A/Prof. Denis Spelman for reviewing our manuscript.

Additional information

Funding

This work was supported by the Royal College of Pathologists of Australasia under “RCPA Scholarship in Pathology for Medical Schools”, Senior Medical Staff Association under “Southern Health Senior Medical Staff Research Award” and through an “Australian Government Research Training Program (RTP) Scholarship”.