Mode of splenectomy and immunogenicity of meningococcal vaccination in patients with hereditary spherocytosis.
BACKGROUND
Splenectomy predisposes patients to invasive disease from pneumococci, meningococci, and Haemophilus influenzae; immunization is mandatory. However, data on the impact of the splenectomy on vaccine immunogenicity are scarce.


METHODS
A total of 41 children with hereditary spherocytosis (aged 5.8-14.4 years) had complete (16) or near-total (25) splenectomy. All received one dose of monovalent meningococcal C conjugate vaccine (MCV-C) and, 2 months later, a tetravalent meningococcal polysaccharide vaccine (MPV-ACWY). Serum bactericidal activity and antibodies against serogroups A and C were determined before and after they received MCV-C, and 4 weeks after they received MPV-ACWY.


RESULTS
Before vaccination, only four of the 16 children who had a complete splenectomy were protected against serogroup A, compared with 15 of the 25 who had near-total splenectomy (P < 0.050), with the latter responding to immunization with significantly higher serogroup A serum bactericidal activity: geometric mean (95 per cent confidence interval) 1625.5 (49.9 to 3201.1) versus 980.6 (2.00 to 6204.1) (P < 0.050). All patients achieved putative protective serum bactericidal activity titres (at least 8) against serogroup C.


CONCLUSIONS
Near-total splenectomy provides a favourable immunological basis for natural and vaccine-induced protection against meningococcal serogroup A and C infections. Sequential meningococcal vaccination is immunogenic in patients splenectomized for hereditary spherocytosis.
Stoehr
G A
GA
Department of Surgery, Georg August University, Goettingen, Germany.
Luecken
J
J
Zielen
S
S
Eber
S W
SW
Borrow
R
R
Rose
M A
MA
D000293:Adolescent; D000907:Antibodies, Bacterial / Q000378:metabolism*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000378:metabolism; D008297:Male; D008589:Meningococcal Infections / Q000276:immunology / Q000517:prevention & control*; D022401:Meningococcal Vaccines / Q000276:immunology*; D011183:Postoperative Complications / Q000276:immunology / Q000517:prevention & control*; D011446:Prospective Studies; D013103:Spherocytosis, Hereditary / Q000276:immunology*; D013156:Splenectomy / Q000379:methods*
D000907:Antibodies, Bacterial; D007074:Immunoglobulin G; D022401:Meningococcal Vaccines; C410218:serogroup C meningococcal conjugate vaccine