~Teachingcenter的醫學筆記~

脾臟切除和疫苗
Splenectomy and Vaccination

脾臟可以針對侵入人體血內的抗原，激發免疫反應，而沒有脾臟雖然不會因此死亡，在一般情況下也不會有特別的血液功能異常，但是對於感染的威脅，會變得十分脆弱，因為缺少了一個能過濾血液中微生物的大型淋巴器官
= 而在脾臟切除後的全身性嚴重感染，被稱為致死性脾切除後感染(overwhelming post-splenectomy infection, OPSI )或脾臟摘除後敗血症(overwhelming post-splenectomy sepsis, OPSS)

= 其中最具威脅的微生物，為以下三種細菌：
-- 肺炎鏈球菌Streptococcus pneumonia
-- B型流感嗜血桿菌Haemophilus influenzae type B
-- 腦膜炎雙球菌Neisseria meningitides

以下為脾臟切除後，對於疫苗的建議
(證據等級Level 2)
= 創傷性、非選擇性的脾臟切除病人，應於術後14天後開始接種疫苗
Non-elective splenectomy patients should be vaccinated on or after postoperative day 14.
= 無脾臟的病人，應於適當的時間間隔下，再次接種疫苗
Asplenic patients should be revaccinated at the appropriate time interval for each vaccine.
(證據等級Level 3)
= 若是能擇期手術的病人(如因ITP而需切除脾臟的病人)，應於手術前14天前接種疫苗
Elective splenectomy patients should be vaccinated at least 14 days prior to the operation.
= 無脾臟或免疫力缺陷的病人，應於確診後盡早施打疫苗
Asplenic or immunocompromised patients (with an intact, but nonfunctional spleen) should be vaccinated as soon as the diagnosis is made.
= 小於2歲的兒童病患則以建議的時間與疫苗劑量施打(無脾臟一樣可以打減毒活性疫苗，無脾臟”不是”減毒活性疫苗的禁忌症)
Pediatric vaccination should be performed according to the recommended pediatric dosage and vaccine types with special consideration made for children less than 2 years of age.
= 成人切除脾臟或無脾臟病人，建議於診斷後在建議的時間施打以下疫苗
When adult vaccination is indicated, the following vaccinations should be administered:
-- Streptococcus pneumonia
……Polyvalent pneumococcal vaccine (Pneumovax 23)
-- Haemophilus influenzae type B
……Haemophilus influenzae b vaccine (HibTITER)
-- Neisseria meningitides
……Age 16-55: Meningococcal (groups A, C, Y, W-135) polysaccharide diphtheria toxoid conjugate vaccine (Menactra)
……Age >55: Meningococcal polysaccharide vaccine (Menomune-A/C/Y/W-135)

成人脾臟切除病患疫苗接種

EVIDENCE DEFINITIONS

• Class I: Prospective randomized controlled trial.

• Class II: Prospective clinical study or retrospective analysis of reliable data. Includes observational, cohort, prevalence, or case control studies.

• Class III: Retrospective study. Includes database or registry reviews, large series of case reports, expert opinion.

• Technology assessment: A technology study which does not lend itself to classification in the above-mentioned format. Devices are evaluated in terms of their accuracy, reliability, therapeutic potential, or cost effectiveness.

LEVEL OF RECOMMENDATION DEFINITIONS

• Level 1: Convincingly justifiable based on available scientific information alone. Usually based on Class I data or strong Class II evidence if randomized testing is inappropriate. Conversely, low quality or contradictory Class I data may be insufficient to support a Level I recommendation.

• Level 2: Reasonably justifiable based on available scientific evidence and strongly supported by expert opinion. Usually supported by Class II data or a preponderance of Class III evidence.

• Level 3: Supported by available data, but scientific evidence is lacking. Generally supported by Class III data. Useful for educational purposes and in guiding future clinical research.