From the Guidelines
Post-splenectomy patients should receive specific vaccines, including the 13-valent pneumococcal conjugate vaccine (PCV13), Haemophilus influenzae type b (Hib) vaccine, and meningococcal vaccines (MenACWY and MenB), at least 14 days after an emergency splenectomy or before discharge if the patient is at high risk of missing vaccination, as recommended by the most recent guidelines 1. The vaccines should be administered as follows:
- PCV13, followed by PPSV23 8 weeks later
- Hib vaccine as a single dose
- MenACWY with revaccination every 5 years
- MenB with appropriate boosters Patients should also receive an annual influenza vaccine to reduce the risk of secondary bacterial infections, including pneumococcal infection 1. It is essential to note that vaccination can only reduce the incidence of OPSI, and patients should be educated about their increased infection risk and the importance of seeking immediate medical attention for fevers 1. In cases where preoperative vaccination is not possible, vaccination should be performed 14 days after surgery, as a shorter wait induces insufficient antibody response 1. Additionally, patients with anatomic or functional asplenia should be regarded as high-risk individuals and should be vaccinated accordingly 1.
From the Research
Post-Splenectomy Vaccines
The following vaccines are recommended for patients after splenectomy:
- Pneumococcal vaccines (13-valent pneumococcal conjugate vaccine followed by the 23-valent pneumococcal polysaccharide vaccine) 2
- Meningococcal vaccines (meningococcal conjugate vaccines for serogroups A, C, Y and W-135 and serogroup B meningococcal vaccines) 2
- H. influenzae type b vaccines 2
- Inactivated influenza vaccines 2
Vaccination Coverage
Studies have shown that vaccination coverage among asplenic patients is suboptimal:
- Anti-pneumococcal vaccination coverage: 55.1% (95%CI = 41.0-69.2%) 3
- Anti-Hib vaccination coverage: 48.3% (95%CI = 34.3-52.3%) 3
- Anti-meningococcal C/ACYW135 vaccination coverage: 33.7% (95%CI = 23.6-43.9%) 3
- Anti-meningococcal B vaccination coverage: 13.3% (95%CI = 7.0-19.5%) 3
- Anti-influenza vaccination coverage: 53.2% (95%CI = 22.0-84.4%) 3
Importance of Vaccination
Vaccination is crucial to prevent overwhelming post-splenectomy infection (OPSI) in asplenic patients:
- Asplenic patients have a higher risk (ranging from 10 to 50-fold) of developing OPSI compared to the general population 3
- Vaccines can provide protection against asymptomatic carriage and prevent serious disease 4
- Conjugate vaccines have been shown to provide herd immunity effects and have played an important role in the public health success of conjugate vaccination programmes 4
Strategies to Improve Vaccination Compliance
Several strategies have been recommended to improve vaccination compliance among asplenic patients:
- Introducing specific prophylaxis protocols in the clinical routine 3
- Developing state and national immunization registries and systems to improve adherence with post-splenectomy immunization guidelines 5
- Dedicated teams or clinics focused on patient education and monitoring have demonstrated substantial improvements in vaccine coverage rates for individuals with asplenia and reduced risk of infection 2