What immunizations are recommended after splenectomy (surgical removal of the spleen)?

From the Guidelines

Patients who have undergone splenectomy should receive immunization against encapsulated bacteria, including Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis, at least 14 days after the procedure, or before discharge if the risk of missing vaccination is high 1. The recommended vaccinations include pneumococcal, Haemophilus influenzae type b, and meningococcal vaccines, as well as annual influenza vaccination.

• The pneumococcal vaccine is crucial in preventing infections from Streptococcus pneumoniae, which is responsible for 50% of cases of overwhelming post-splenectomy infection (OPSI) 1.
• The Haemophilus influenzae type b vaccine is also important, as it prevents infections from Haemophilus influenzae type b, another common cause of OPSI 2.
• The meningococcal vaccine prevents infections from Neisseria meningitidis, which can also cause OPSI 1.
• Annual influenza vaccination is recommended to prevent secondary bacterial infections, including pneumococcal infections 1. It is essential to note that vaccination programs should be started no sooner than 14 days after splenectomy or spleen total vascular exclusion, as the antibody response is supposed to be suboptimal before this interval 1. In addition to vaccinations, patients should be educated about their lifelong increased infection risk and the need for prompt medical attention with any fever or signs of infection.
• Patients should be given an antibiotic supply, such as amoxicillin, in the event of any sudden onset of unexplained fever, malaise, chills, or other constitutional symptoms, especially when medical review is not readily accessible 1.
• Community physicians should be aware of the asplenic/hyposplenic condition to provide the most appropriate level of care 1.

From the FDA Drug Label

In a study using a pneumococcal vaccine containing eight (types 1, 3, 6, 7, 14, 18, 19, and 23) capsular polysaccharides, vaccinated children and young adults aged 2 to 25 years who had sickle cell disease, congenital asplenia, or undergone a splenectomy experienced significantly less bacteremic pneumococcal disease than patients who were not vaccinated

Immunizations in Splenectomy:

• The pneumococcal vaccine is effective in reducing the incidence of bacteremic pneumococcal disease in individuals who have undergone a splenectomy.
• Key finding: Vaccinated individuals with a history of splenectomy had significantly less bacteremic pneumococcal disease compared to unvaccinated individuals 3.
• It is recommended that individuals who have undergone a splenectomy receive the pneumococcal vaccine to reduce the risk of pneumococcal disease.

From the Research

Immunizations in Splenectomy

• Immunizations against Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae type b are recommended for patients undergoing splenectomy to decrease the risk of developing overwhelming infections 4, 5, 6.
• The US Centers for Disease Control and Prevention (CDC) provides guidelines for immunization against these bacteria, which include receiving all 7 immunizations against S pneumoniae, N meningitidis, and H influenzae type b 4.
• Studies have shown that many patients do not receive all the recommended immunizations, with one study finding that only 15% of patients received all 7 immunizations 4.
• Another study found that patients were most commonly immunized against Streptococcus pneumoniae (20%), less often against Haemophilus influenzae b (9.4%), and rarely against Neisseria meningitidis C (3.5%) 6.
• Conjugate vaccines exist that offer protection against disease caused by Haemophilus influenzae type b, Neisseria meningitidis, and Streptococcus pneumoniae, and have been shown to provide herd immunity effects 7.
• Patient education and recall regarding postsplenectomy immunizations is important, with one study finding that only 27% of participants recalled receiving education on postsplenectomy vaccination, and 41% of those patients rated their education as poor or minimal 8.

Recommended Immunizations

• Pneumococcal vaccine: 95% of patients received at least 1 pneumococcal vaccine 4.
• Meningococcal vaccine: 26% of patients did not receive MenB-4C vaccine 4.
• Haemophilus influenzae type b vaccine: 68% of patients received this vaccine 8.

Timing of Immunizations

• Immunizations should be given at least 14 days before a scheduled splenectomy, or given after the fourteenth postoperative day 5.