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Clin Infect Dis. 2019 Jan 1;68(1):51-60. doi: 10.1093/cid/ciy403.

High Risk of Plasmodium vivax Malaria Following Splenectomy in Papua, Indonesia.

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Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia.
Timika Malaria Research Program, Papuan Health and Community Development Foundation, Timika, Papua.
Rumah Sakit Umum Daerah Kabupaten Mimika, Timika, Papua.
Pediatric Research Office, Department of Pediatrics, University of Gadjah Mada, Yogyakarta, Indonesia.
Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia.
Rumah Sakit Mitra Masyarakat, Timika, Papua, Indonesia.
Center for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom.



Splenectomy increases the risk of severe and fatal infections; however, the risk of Plasmodium vivax malaria is unknown. We quantified the Plasmodium species-specific risks of malaria and other outcomes following splenectomy in patients attending a hospital in Papua, Indonesia.


Records of all patients attending Mitra-Masyarakat Hospital 2004-2013 were reviewed, identifying those who underwent splenectomy. Subsequent risks of specific clinical outcomes within 12 months for splenectomized patients were compared to nonsplenectomized patients from their first recorded hospital admission. In addition, patients splenectomized for trauma 2015-2016 were followed prospectively for 14 months.


Of the 10774 patients hospitalized during 2004-2013, 67 underwent splenectomy. Compared to nonsplenectomized inpatients, patients undergoing splenectomy had a 5-fold higher rate of malaria presentation within 12 months (adjusted hazard ratio [AHR] = 5.0 [95% confidence interval (CI): 3.4-7.3], P < .001). The AHR was 7.8 (95% CI: 5.0-12.3) for P. vivax and 3.0 (95% CI: 1.7-5.4) for P. falciparum (both P < .001). Splenectomized patients had greater risk of being hospitalized for any cause (AHR = 1.8 [95% CI: 1.0-3.0], P = .037) and diarrheal (AHR = 3.5 [95% CI: 1.3-9.6], P = .016). In the 14-month prospective cohort, 12 episodes of P. vivax and 6 episodes of P. falciparum were observed in 11 splenectomised patients.


Splenectomy is associated with a high risk of malaria, greater for P. vivax than P. falciparum. Eradication of P. vivax hypnozoites using primaquine (radical cure) and subsequent malaria prophylaxis is warranted following splenectomy in malaria-endemic areas.

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