title: Vaccination as primary prevention? The effect of anti-pneumococcal vaccination on the outcome of patients suffering traumatic skull base fractures.
abstract: BACKGROUND
  As many as 360,000 people suffer yearly from skull base fractures (SBF). These may be associated with a dural tear, hemosinus, otorrhea or rhinorrhea. The most common causative agent of post-traumatic meningitis is Streptococcus Pneumonia (Pneumococcus). PNEUMOVAX 23 is a potent vaccine against Pneumococcus, but head trauma involving any skull fractures are not defined indications for its use. Our aim was to identify the effect of PNEUMOVAX on the natural course and incidence of infections and infectious prognosis following SBF.
  
  
  METHODS
  A retrospective review of patients suffering a traumatic SBF who were admitted to the Department of Neurosurgery at a single tertiary hospital referred from the entire north of Israel during 2002-2009 were characterized. Six hundred and two patients patients were included in the study; 99 patients received the PNEUMOVAX in the first few days of hospitalization, while 503 patients did not. Demographic data, presenting symptoms, chronic illnesses and radiologic features were logged. Treatment regimens were logged as well, including the use of PNEUMOVAX vaccine. Outcome parameters including infectious complications and functional state were logged at different set time points after admission.
  
  
  RESULTS
  The group receiving the vaccine had a significantly older mean age, higher incidence of obesity, higher rate of headache or confusion on presentation, and a significantly higher incidence of additional cranial injuries. All these factors, known to worsen the outcome of SBF patients did not manifest in the vaccinated group. There was no statistically significant differences between the groups in the outcome parameters measured (fever, meningitis, mortality or length of hospitalization).
  
  
  CONCLUSIONS
  We suggest that patients with a more severe status upon admission may benefit from a prophylactic treatment with the PNEUMOVAX vaccine.
authors.affiliation: Department of Neurosurgery, Rambam Maimonides Health Care Campus, Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel - orcoheni@tx.technion.ac.il.
authors.forename: Or
authors.initials: O
authors.lastname: Cohen-Inbar
authors.affiliation: Department of Neurosurgery, Rambam Maimonides Health Care Campus, Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel.
authors.forename: Alon
authors.initials: A
authors.lastname: Kachel
authors.affiliation: Department of Neurosurgery, Rambam Maimonides Health Care Campus, Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel.
authors.forename: Leon
authors.initials: L
authors.lastname: Levi
authors.affiliation: Department of Neurosurgery, Rambam Maimonides Health Care Campus, Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel.
authors.forename: Menashe
authors.initials: M
authors.lastname: Zaaroor
mesh_terms: D000293:Adolescent; D000328:Adult; D006259:Craniocerebral Trauma / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D016920:Meningitis, Bacterial / Q000209:etiology / Q000517:prevention & control*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011008:Pneumococcal Infections / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000627:therapeutic use*; D011322:Primary Prevention / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D019291:Skull Base / Q000293:injuries*; D014611:Vaccination / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: C414006:23-valent pneumococcal capsular polysaccharide vaccine; D022242:Pneumococcal Vaccines