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Post-splenectomy vaccines

WikiSysop — Sat, 12 May 2012 14:05:34 GMT

←Older revision		Revision as of 14:05, 12 May 2012
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-	~~LPG conversion~~-~~Modern fuel~~ with a ~~green cause~~	+	=='''Background'''==
		+	An overwhelming post-splenectomy infection (OPSI) is a rare but rapidly fatal infection occurring in individuals following removal of the spleen. The infections are typically characterized by either meningitis or sepsis, and are caused by encapsulated organisms including Streptococcus pneumoniae. The risk of OPSI is 0.23–0.42 percent per year, with a lifetime risk of 5 percent. Most infections occur in the first few years following splenectomy, but the risk of OPSI is lifelong. OPSI is nearly uniformly fatal without treatment, and modern treatment has decreased the mortality to approximately 40–70 percent. Individuals with OPSI are most commonly treated with antibiotics and supportive care. Measures to prevent OPSI include vaccination and prophylactic antibiotics.

		+	The spleen contains many macrophages (part of the reticuloendothelial system), which are immune cells that phagocytose (eat) and destroy bacteria. In particular, these macrophages are activated when bacteria are bound by IgG antibodies (IgG1 or IgG3) or the complement component C3b. These types of antibodies and complements are immune substances called opsonizers, molecules that bind to the surface of bacteria to facilitate phagocytosis. When the spleen is no longer present (asplenia), IgG and C3b are still bound to bacteria, but they cannot be removed from the blood circulation due to the loss of the splenic macrophages. Hence the bacteria are free to cause infection.

		+	Patients without spleens often need immunizations against pathogens that normally require opsonization and phagocytosis by macrophages in the spleen. These include common human pathogens with bacterial capsules (Streptococcus pneumoniae, Salmonella typhi, Neisseria meningitidis, E. coli, Hemophilus influenzae, Streptococcus agalactiae, Klebsiella pneumoniae). Capsules made of polysaccharides (sugars) are an evolutionary development by bacteria to evade phagocytosis by macrophages alone, since only proteins are directly recognized by macrophages in phagocytosis. So humoral immunity in forms of IgG and complement proteins is the human immune system's response against bacterial capsules.

-	~~Involve vehicles has seen the humans innovate and much more comfortable and easy to use vehicles~~. ~~These are~~ the ~~results~~ of ~~the various experiments that had been done in the process. The vehicles~~ have played very important part within the different events starting from wars towards the common ambulance. In this scenario it is only normal to plan different new techniques to result in the vehicles more useful and cut down the costs associated with ~~it. From the different methods used [http~~:~~//www.Londonlpgconversions.com/ LPG Conversion] is among the modern and affordable methods that have changed a number of things and~~ has ~~provided us with a great deal to consider~~.	+	=='''Risk factors'''==
		+	All post splenectomy patients have an increased risk of overwhelming bacterial infection. Certain factors however do influence the degree of risk: (a) Age: Younger patients have greater risk; (b) Underlying disease: Risk with underlying immunodeficiency > thalassemia > sickle cell anemia > traumatic splenectomy; (c) Time since splenectomy: Recent splenectomy has greater risk than many years post-operatively.

-	~~LPG~~ is ~~one of the natural by products from the refining of crude oil~~. ~~Almost 40 % from the LPG is obtained from refining as the rest is obtained by separating the different components~~ of ~~crude petroleum. The LPG when used in~~ the ~~vehicles gives several reasons to allow it to~~ be ~~the prime fuel. Observations and calculations have drawn inference that almost Forty percent~~ of ~~the price of fuel is cut by the use of LPG~~. ~~This really is among the fuels which have low carbon dioxide emission too~~. ~~It is then among the safer fuels to be used by the humans who have the responsibility to contribute towards a greener earth~~. ~~LPG proves to be the perfect partner for your~~. ~~The Cars have to be fitted having a special device enabling these to operate on LPG~~. ~~These are the LPG converters and the [http://www~~.~~Londonlpgconversions~~.~~com/ LPG Conversion] kits are to be fitted in authorized dealers for safety~~. ~~The gas tank is equipped near~~ the ~~petroleum gas tank. The dashboard includes~~ a ~~switch that can help to swap between~~ the ~~LPG and petroleum according to involve you~~.	+	=='''Pathogens involved'''==
		+	The most common cause of overwhelming post-splenectomy sepsis is S. pneumoniae, however all of the pathogens listed below can be a source of serious infection in these patients: (a) Encapsulated bacteria: S. pneumoniae, H. influenza, N. meningitidis; (b) S. aureus; (c) Numerous gram negatives including E. coli, K. pneumoniae, Salmonella sp. and Capnotcytophagia sp. (the latter usually acquired from a dog bite); (d) Malaria; (e) Babesia (acquired from ticks in the Eastern seaboard particularly Cape Cod, Martha’s Vineyard, Nantucket, Block Island).

-	~~The LPG conversion kits have~~ been in ~~great demand because~~ of the ~~affordability combined with~~ the ~~environment friendly nature~~. ~~With~~ more ~~people relying on~~ this ~~method a greener earth is becoming~~ more ~~possible~~.	+	=='''Specific vaccinations'''==
		+	Individuals undergoing splenectomy should receive the age appropriate (see below) pneumococcal vaccine, H. influenza and quadrivalent meningococcal vaccine (the latter for those > 2 years of age) if possible up to three weeks prior to removal of the spleen to optimize the immune response. When this is not feasible and for emergency splenectomy, vaccination should be initiated as soon as possible after the patient’s recuperation.
		+
		+	There are currently 2 licensed pneumococcal vaccines: (a) 23-valent Pnemococcal Polysaccharide Vaccine, PPV-23 (Pneumovax®). This vaccine is immunogenic only in those > 2 years of age and provides protection against the greatest number of clinically relevant seroptypes; (b) 7-valent Protein-Conjugated Vaccine, PCV-7 (Prevnar®), which is immunogenic and safe beginning at 6 weeks of age. It has not been well studied in older patients and provides protection against only 7 serotypes.
		+
		+	=='''Vaccination guidelines'''==
		+	[NOTE: These guidelines may change and reader should consult most recent sources]
		+	Current recommendations for this use of these vaccines post splenectomy are as follows: (a) Children less than 2 years of age should receive PCV-7 at the usual ages recommended for children their age: 2, 4, 6 and 12-15 months of age. These children should be given PPV-23 at 2 years of age; (b) Children 2 to 5 years of age should receive two doses of PCV-7 given 2 months apart, followed > 2 months later by a dose of PPV-23; (c) Older children and adults should receive the PPV23. (These recommendations may change as more safety and efficacy data becomes available in older patients.)
		+
		+	A booster PPV23 should be given approximately 5 years after the initial vaccine/series; Quadrivalent conjugated meningococcal vaccine should be given to all asplenic individuals > 2 years of age. (Also subject to change as new vaccines become available); Hemophilus influenza vaccine should be given once to all individuals > 2 years of age and at the time of routine vaccination for younger children.
		+
		+	=='''Notes & References'''==
		+	[1] Post-splenectomy guidelines. Available at http://clinicalpharmacy.ucsf.edu/idmp/ucsf_specific/postsplenectomy.htm.
		+
		+	=='''Credits & Notices'''==
		+
		+	'''''Authors-contributors''''' to this page (listed alphabetically, last name, first & middle initial only, no institutional affiliations, no scientific titles):
		+	Stawicki SP
		+
		+	Please make sure you look at the existing references before editing to avoid listing the same citation more than once. The order of references is not important as long as the appropriate reference number in the text points to the correct reference number in the references section.