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May 1984

Pneumococcal Vaccine for High-Risk Patients

Author Affiliations

Jamaica, NY

Northport, NY

Arch Intern Med. 1984;144(5):1089. doi:10.1001/archinte.1984.00350170259046

To the Editor.  —In the October Archives, Klein and Adachi1 recommended hospital-based programs to increase pneumococcal immunization rates for patients at risk for serious pneumococcal disease. Yet, their high-risk groups did not include surgically splenectomized patients, who are at substantial risk for pneumococcal pneumonia, meningitis, and sepsis.Although postsplenectomy sepsis is a well-recognized hazard in children, few reports discuss the risk of sepsis in the asplenic adult. We reviewed2 the case reports of 47 adults (31 men and 16 women) with serious infections following splenectomy for trauma or incidental splenectomy during gastric or other surgery. Their ages ranged from 17 to 72 years, with a mean age of 36 years. The interval between the splenectomy and the infectious episode ranged from six months to 31 years, with a mean interval of 7.2 years. The most common organism involved was Streptococcus pneumoniae (29 cases).Diffuse intravascular coagulation was documented