The prevention and treatment of bacterial infections in children with asplenia or hyposplenia: practice considerations at the Hospital for Sick Children, Toronto.
Children born without a spleen or who have impaired splenic function, due to disease or splenectomy, are at significantly increased risk of life-threatening bacterial sepsis. The mainstays of prevention are education, immunization, and prophylactic antibiotics. The availability of conjugate 7-valent pneumococcal vaccines for use in children to age 9 years at least, as well as conjugate meningococcal C vaccine in some countries, for use beginning in infancy, appear to represent beneficial additions, but not substitutions, to previous recommendations for the use of polysaccharide 23-valent pneumococcal and quadrivalent A, C, Y, W-135 vaccines. Routine immunization against H. influenzae type b should continue with non-immunized children older than age 5 years receiving two doses 2 months apart, similar to children who have not previously received conjugate pneumococcal vaccine in infancy. Annual influenza immunization, which reduces the risk of secondary bacterial infection, is also recommended for asplenic children and their household contacts. Many experts continue prophylaxis indefinitely although prophylaxis of the penicillin allergic child remains suboptimal.
Price
Victoria E
VE
Department of Pediatrics, Division of Hematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Dutta
Sanjeev
S
Blanchette
Victor S
VS
Butchart
Sheila
S
Kirby
Melanie
M
Langer
Jacob C
JC
Ford-Jones
E Lee
EL
D019072:Antibiotic Prophylaxis; D001424:Bacterial Infections / Q000209:etiology / Q000517:prevention & control*; D001428:Bacterial Vaccines / Q000008:administration & dosage; D002648:Child; D002673:Child, Hospitalized; D006776:Hospitals, Pediatric; D006801:Humans; D009864:Ontario; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D013154:Spleen / Q000002:abnormalities*; D013156:Splenectomy; D013158:Splenic Diseases / Q000150:complications*; D014611:Vaccination
D001428:Bacterial Vaccines