Introduction Patients with liver cirrhosis are immunocompromised and prone to invasive infection where outcomes are usually poor. In particular, cirrhosis is a major risk factor for severe pneumococcal infection which has a mortality rate of up to 20%. Whilst patients awaiting liver transplantation routinely receive the pneumococcal vaccine, it is less clear whether the remainder of patients with cirrhosis do so or not. The present literature suggests that pneumococcal vaccination prophylaxis should be administered in cirrhotic patients and revaccination desirable at 5-yearly intervals.
The aims of this study were to assess whether patients with liver cirrhosis received pneumococcal vaccination in line with current recommendations at a single centre in the UK.
Methods A retrospective analysis of all patients with biopsy-proven liver cirrhosis, irrespective of aetiology, over a 7-year period (2005–2012) at Barnet and Chase Farm Hospitals was performed. We used a database of patients with biopsy-proven cirrhosis created by our histopathology department. Patient’s primary care physicians were contacted in writing to assess whether they had received the pneumococcal vaccine.
Results 37 patients had biopsy-proven liver cirrhosis over the audit period. There was no response from the primary care physicians of 6 patients. Data for 31 patients (17 male, 14 female), median age 50 years were analysed. 14 (45%) patients had received the pneumococcal vaccine. 4 (28.5%) of these patients were vaccinated after their histopathological diagnosis of cirrhosis was proven. The median time interval from diagnosis to vaccination was 24 months in this group of patients. Of the 7 patients vaccinated before 2007, none had received a repeat vaccine after 5 years.
Conclusion More than half of patients with biopsy-proven liver cirrhosis in our study did not receive the pneumococcal vaccine placing these patients at risk of life threatening preventable disease. None of the patients who received the vaccine initially were revaccinated at five yearly intervals as present literature would recommend.
We would recommend an increased awareness of the importance of regular pneumococcal vaccination to all healthcare professionals, primary care physicians and those in secondary care, who come into contact with this important and growing cohort of patients.
Disclosure of Interest None Declared.
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