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  • Vaccination as Primary Prevention? The Effect of Anti-Pneumococcal Vaccination on the Outcome of Patients Suffering Traumatic Skull Base Fractures

    Final Number:
    1447

    Authors:
    Or Cohen-Inbar MD PhD; Alon Kachel MD; Leon Levi MD, MPH; Menashe Zaaroor MD, DSc

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2015 Annual Meeting

    Introduction: Approximately 1.5 million people suffer yearly from skull base fractures (SBF). These may be associated with a dural tear, hemosinus, otorrhea or rhinorrhea. The most common causative agent of post-traumatic meningitis is Streptococcus Pneumonia (Pneumococcus). PNEUMOVAX 23 is a potent vaccine against Pneumococcus, but head trauma involving any skull fractures are not defined indications for its use. Our aim was to identify the effect of PNEUMOVAX on the natural course and incidence of infections and infectious prognosis following SBF

    Methods: Trial registration: A retrospective chart review, approved by the institutional IRB (Helsinki) committee. Setting: a retrospective review of patients suffering a traumatic SBF who were admitted to the Department of Neurosurgery at a single tertiary hospital referred from the entire north of Israel during 2002-2009 were characterized. Participants: 602 patients included in the study. Interventions: 99 patients received the PNEUMOVAX in the first few days of hospitalization, while 503 patients did not.

    Results: Primary and secondary outcome measures: Demographic data, presenting symptoms, chronic illnesses and radiologic features were logged. Treatment regimens were logged as well, including the use of PNEUMOVAX vaccine. Outcome parameters including infectious complications and functional state were logged at different set time points after admission. Results: The group receiving the vaccine had a significantly older mean age, higher incidence of obesity, higher rate of headache or confusion on presentation, and a significantly higher incidence of additional cranial injuries. All these factors, known to worsen the outcome of SBF patients did not manifest in the vaccinated group. There was no statistically significant differences between the groups in the outcome parameters measured (fever, meningitis, mortality or length of hospitalization).

    Conclusions: Conclusion: We suggest that patients with a more severe status upon admission may benefit from a prophylactic treatment with the PNEUMOVAX vaccine.

    Patient Care: A first report on using vaccination as a primary prevention for traumatic brain injury.

    Learning Objectives: A retrospective chart review based on the medical records at Rambam Health Care Campus was conducted. The research hypothesis to demonstrate the preventive effect the Pneumovax vaccine has after the traumatic formation of a tract for nasal / otic flora to penetrate to the CSF as an isolated factor, while ruling out the influence caused by other factors (infectious or otherwise). The population reviewed included 1068 patients logged to suffer from any SBF, with or without CSF leakage or other findings during 2002-2009.

    References: 1. Villalobos T, Arango C, Kubilis P, Rathore M. (1998) Antibiotic prophylaxis after basilar skull fractures: a meta-analysis. Clin Infect Dis. Aug;27(2):364-9. 2. Plaisier BR, Yowler CJ, Fallon WF, Likavec MJ, Anderson JS, Malangoni MA. (2005) Post traumatic meningitis: risk factors, clinical features, bacteriology and outcome. The Internet Journal of Neurosurgery. ISSN: 1528-8285. 3. Dalgic A, Okay HO, Gezici AR, Daglioglu E, Akdag R, Ergungor MF. (2008) An effective and less invasive treatment of post-traumatic cerebrospinal fluid fistula: closed lumbar drainage system. Minim Invasive Neurosurg.;51(3):154-7. doi: 10.1055/s-2008-1042437. 4. Friedman JA, Ebersold MJ, Quast LM. (2001) Post-traumatic cerebrospinal fluid leakage. World J. Surg. 25(8). 5. Center for Disease Control and Prevention. (2010) Updated recommendations for prevention of invasive pneumococcal disease among adults using the 23-valent pneumococcal polysaccharide vaccine (PPSV23). MMWR. 59(34). http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5934a3.htm 6. Yilmazlar S, Arslan E, Kocaeli H, Dogan S, Aksoy K, Korfali E, Doygun M. (2006) Cerebrospinal fluid leakage complicating skull base fractures: analysis of 81 cases. Neurosurg. Rev. Jan;29(1):64-71. 7. Clemenza JW, Kaltman SI, Diamond DL. (1995) Craniofacial trauma and cerebrospinal fluid leakage: a retrospective clinical study. J. Oral Maxillofac. Surg. Sep;53(9):1004-7. 8. Center for Disease Control and Prevention. (1991) Update on adult immunization. Recommendations of the Immunization Practices Advisory Committee (ACIP). MMWR. 40(RR-12). http://www.cdc.gov/mmwr/preview/mmwrhtml/00025228.htm. 9. Center for Disease Control and Prevention. (1997) Prevention of pneumococcal disease: Recommendations of the Advisory committee on Immunization Practices (ACIP). MMWR. 46(RR-8). http://www.cdc.gov/mmwr/PDF/rr/rr4608.pdf. 10. MERCK & CO. (2011) Inc.Pneumovax 23 (Pneumococcal Vaccine Polyvalent). http://www.physicians-academy.com/Upload/e3bb10bf-ccc5-49e0-a6cd-5327309c3f45 11. Jones NS, Becker DG. (2001) Advances in the management of CSF leaks. BMJ. Jan 20;322(7279):122-3.

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