title: Mode of splenectomy and immunogenicity of meningococcal vaccination in patients with hereditary spherocytosis.
abstract: 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.
authors.affiliation: Department of Surgery, Georg August University, Goettingen, Germany.
authors.forename: G A
authors.initials: GA
authors.lastname: Stoehr
authors.forename: J
authors.initials: J
authors.lastname: Luecken
authors.forename: S
authors.initials: S
authors.lastname: Zielen
authors.forename: S W
authors.initials: SW
authors.lastname: Eber
authors.forename: R
authors.initials: R
authors.lastname: Borrow
authors.forename: M A
authors.initials: MA
authors.lastname: Rose
mesh_terms: 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*
chemical_list: D000907:Antibodies, Bacterial; D007074:Immunoglobulin G; D022401:Meningococcal Vaccines; C410218:serogroup C meningococcal conjugate vaccine