From the Guidelines
Post-splenectomy patients should receive vaccinations against encapsulated bacteria, including pneumococcal, meningococcal, and Haemophilus influenzae type b (Hib) vaccines, at least 14 days after splenectomy, as recommended by the most recent guidelines 1. The vaccines recommended for post-splenectomy patients include:
- Pneumococcal vaccines, such as Prevnar 13 (PCV13) followed by Pneumovax 23 (PPSV23) 8 weeks later
- Meningococcal vaccines, including both MenACWY (Menactra or Menveo) and MenB (Bexsero or Trumenba) series
- Haemophilus influenzae type b (Hib) vaccine, administered as a single dose Annual influenza vaccination is also strongly recommended for post-splenectomy patients 1, 2. Ideally, these vaccines should be given at least 2 weeks before elective splenectomy, but if not possible, they should be administered at least 2 weeks after the procedure when the patient can mount an adequate immune response 2, 3. Patients should also carry medical alert identification indicating their asplenic status and should receive education about their increased infection risk 1. Many guidelines recommend prophylactic antibiotics (typically penicillin V 250-500 mg twice daily or amoxicillin 500 mg daily) for at least 2 years post-splenectomy, and lifelong in high-risk patients 1, 2. Patients should seek immediate medical attention for any fever or signs of infection, as infections can progress rapidly in asplenic individuals due to their impaired ability to clear encapsulated bacteria from the bloodstream 1, 2, 3.
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
Post-splenectomy care guidelines for vaccines include the administration of pneumococcal vaccines to prevent bacteremic pneumococcal disease.
- The vaccine is recommended for individuals who have undergone a splenectomy, as they are at increased risk of pneumococcal disease.
- Key points: + Pneumococcal vaccines can help prevent bacteremic pneumococcal disease in individuals with asplenia or those who have undergone a splenectomy. + The vaccine contains multiple capsular polysaccharides from different pneumococcal serotypes. + Studies have shown that vaccinated individuals have significantly less bacteremic pneumococcal disease than unvaccinated individuals 4
From the Research
Post-Splenectomy Care Guidelines for Vaccines
The following vaccines are recommended for patients after splenectomy:
- Pneumococcal vaccine to prevent Streptococcus pneumoniae infections 5, 6, 7, 8
- Meningococcal vaccine to prevent Neisseria meningitidis infections 5, 6, 7, 8
- Haemophilus influenzae type b (Hib) vaccine to prevent Hib infections 5, 6, 7, 8
- Influenza vaccine to prevent influenza infections 5, 9
Timing of Vaccination
The optimal timing of vaccination in relation to splenectomy depends on the nature of the splenectomy 5. Vaccinations should be given at least 14 days before a scheduled splenectomy, or given after the fourteenth postoperative day 6.
Adherence to Vaccination Guidelines
Adherence to vaccination guidelines is suboptimal, with studies showing that many patients do not receive all recommended vaccines 9, 7, 8. Strategies to improve adherence include educating healthcare workers and introducing specific prophylaxis protocols in clinical routine 9.
Immune Response to Vaccines
Studies have shown that asplenic patients can mount an immune response to vaccines, including pneumococcal conjugate vaccine 7. The use of PCV13 as a booster dose in asplenic patients with previous PPV23 vaccination can induce high levels of pneumococcal serotype-specific antibodies 7.