From the Guidelines
For patients who have undergone splenectomy, Pneumovax (pneumococcal polysaccharide vaccine), Menactra (meningococcal conjugate vaccine), Bexsero (meningococcal B vaccine), and Haemophilus influenzae type b (Hib) vaccine should be repeated every 5 years, as recommended by the most recent guidelines 1. This recommendation is crucial because asplenic patients have significantly impaired immunity against encapsulated bacteria, putting them at high risk for overwhelming post-splenectomy infection (OPSI), which carries high mortality rates. The spleen plays a vital role in filtering and clearing encapsulated bacteria from the bloodstream, and without it, patients remain vulnerable to these specific pathogens throughout their lives. Regular revaccination ensures continued protective antibody levels against Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae type b. Some key points to consider include:
- Patients should be educated about this lifelong vaccination schedule and carry medical alert identification indicating their asplenic status.
- Many asplenic patients should maintain prophylactic antibiotics and seek immediate medical attention for any febrile illness, as infections can progress rapidly in this population.
- The optimal timing of vaccination is at least 14 days after splenectomy, as this allows for an adequate antibody response 1.
- Annual immunization against seasonal flu is also recommended for asplenic patients over 6 months of age, as it may decrease the risk of secondary bacterial infection, including pneumococcal infection 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Vaccinations Indicated After Splenectomy
- Pneumococcal, meningococcal, and Haemophilus influenzae (Hib) vaccinations are indicated for patients after splenectomy 2
- These immunizations should be given at least 14 days before a scheduled splenectomy, or given after the fourteenth postoperative day 2
Recommended Vaccines
- Pneumovax is a pneumococcal vaccine
- Meningococcal (Menactra) and Meningococcal B vaccines, like Bexsero, are recommended
- Haemophilus influenzae type b (Hib) vaccine is often included in combination vaccines like pentavalent (5-in-1) and hexavalent (6-in-1) vaccines
Booster Shots
- Booster shots for these vaccines are recommended every 3-5 years, but the exact schedule may vary depending on the specific vaccine and patient population 3
Adherence to Immunization Guidelines
- Adherence to recommended post-splenectomy immunizations is crucial to reduce the risk of sepsis 3
- Studies have shown that many patients do not receive all recommended immunizations, highlighting the need for improved adherence to guidelines 3
Combination Vaccines
- Combination vaccines, such as pneumococcal-meningococcal vaccines, are being developed to simplify immunization schedules 4
- However, these combination vaccines may have reduced immunogenicity compared to separate vaccines 4
Safety and Immunogenicity
- Coadministration of multiple vaccines, such as meningococcal serogroup C and Haemophilus influenzae type b conjugate vaccine with pneumococcal conjugate vaccine and measles, mumps, and rubella vaccine, has been shown to be safe and immunogenic 5