EFFICACY AND SAFETY OF PNEUMOCOCCAL REVACCINATION AFTER SPLENECTOMY FOR TRAUMA

Objective: To assess the outcome of patient education after splenectom y and vaccination and to determine the safety and efficacy of pneumoco ccal revaccination 2 or more years after primary vaccination. Main Out come Measures: Titers to serotype no, 6 and no, 23 pneumococcus and cu taneous and systemic reaction to revaccination. Results: A total of 11 2 consecutive postsplenectomy patients receiving pneumococcal vaccine were identified; 45 were contacted and offered revaccination; 24 patie nts demonstrated a lack of understanding of the postsplenectomy state (unaware of splenectomy n = 2, unaware of splenectomy risk n = 8, unaw are of vaccine n = 23); 3 patients had infections requiring hospitaliz ation (pneumonia, strep throat and tonsillitis, pneumonia and bacterem ia); 40 patients agreed to revaccination, and 33 patients returned for follow-up titers; 16 of 33 (48%) demonstrated at least a two-fold inc rease in at least one titer, Only 15% described the revaccination as w orse than a tetanus shot. Conclusions: (1) Despite physician-patient c onversations, pamphlets, and Medic Alert bracelets, patient retention was poor. (2) All splenectomy patients should be revaccinated and reed ucated between two and six years after splenectomy. (3) Revaccination after two years was well tolerated. (4) There were no fatal episodes o f pneumococcal sepsis in over 200 patient years.