Preventing severe infection after splenectomy

Editor—The editorial by Newland et al on preventing severe infection after splenectomy deals with the risks of malarial infection and meningitis in asplenic travellers rather cursorily.¹

Asplenia, from whatever cause, is not uncommon. Worldwide travel to malarial areas is probably increasing. Increased risks of Plasmodium falciparum malaria in asplenic people, although difficult to quantify, are widely recognised. Fatal outcomes, anecdotally, are increased: I have heard of three people who acquired malaria in west Africa and died. Incidence of meningitis in sub-Saharan Africa, India, and Nepal poses substantial potential hazards.

Asplenic travellers should be advised to avoid travel to high risk malarial areas. People who travel should scrupulously adhere to measures to avoid bites and take appropriate antimalarial prophylaxis. Immediate referral for medical advice is essential should a fever develop. People travelling to areas with a high incidence of meningitis must be immunised with meningococcal ACWY vaccine (quadrivalent polysaccharide vaccine that provides a level of protection against meningococcal disease due to groups A, C, W135, and Y).