What vaccine is recommended for a child with asplenia (absence of a spleen)?

From the Guidelines

For an asplenic child, I strongly recommend all routine childhood vaccines plus additional specific vaccines to protect against encapsulated bacteria, prioritizing pneumococcal vaccines (both PCV13 and PPSV23), meningococcal vaccines (MenACWY and MenB series), Haemophilus influenzae type b (Hib) vaccine, and annual influenza vaccines to minimize the risk of overwhelming post-splenectomy infection (OPSI) and improve quality of life. The most recent and highest quality study 1 provides the basis for these recommendations, emphasizing the importance of vaccination in preventing invasive meningococcal disease in asplenic individuals.

Key Vaccines for Asplenic Children

• Pneumococcal vaccines: PCV13 followed by PPSV23 at least 8 weeks later, with a PPSV23 booster 5 years after the first dose, as supported by 1 and 1.
• Meningococcal vaccines: MenACWY with boosters every 5 years, and the complete MenB series, as recommended by 1.
• Haemophilus influenzae type b (Hib) vaccine: especially for unvaccinated children, as noted in 1.
• Annual influenza vaccines: crucial for preventing influenza, which can be particularly severe in asplenic children.

Rationale for Recommendations

The absence of splenic function in asplenic children makes them highly susceptible to infections by encapsulated bacteria, which can rapidly progress to sepsis and death. Vaccination against these pathogens is critical for preventing such outcomes. The recommended vaccines and schedules are designed to provide optimal protection, considering the child's age, health status, and the risk of vaccine-preventable diseases.

Additional Considerations

• Prophylactic antibiotics, typically penicillin, should be considered for asplenic children to further reduce the risk of infections.
• Immediate medical attention is required for any fever, as infections can become life-threatening within hours in this population.
• The timing of vaccination, ideally at least 2 weeks before elective splenectomy if applicable, is important for maximizing protection, as discussed in 1.

By following these recommendations, asplenic children can receive the best possible protection against serious infections, significantly improving their morbidity, mortality, and quality of life outcomes.

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 A retrospective cohort analysis study based on the U. S. Centers for Disease Control and Prevention (CDC) pneumococcal surveillance system, showed 57% (95%CI: 45% to 66%) overall protective effectiveness against invasive infections caused by serotypes included in PNEUMOVAX 23 in persons ≥6 years of age, 65 to 84% effectiveness among specific patient groups (e.g., persons with diabetes mellitus, coronary vascular disease, congestive heart failure, chronic pulmonary disease, and anatomic asplenia)

Recommended vaccine for asplenic child:

• Pneumococcal polysaccharide vaccine (IM) is recommended for asplenic children, as it has been shown to be effective in reducing the incidence of bacteremic pneumococcal disease in this population 2.
• The vaccine should be administered according to the recommended schedule and dosing guidelines.
• It is essential to note that the effectiveness of the vaccine may vary depending on the individual's age, health status, and other factors.

From the Research

Vaccine Recommendations for Asplenic Children

The following vaccines are recommended for asplenic children to prevent infections with encapsulated organisms:

• Pneumococcal vaccines: 13-valent pneumococcal conjugate vaccine followed by the 23-valent pneumococcal polysaccharide vaccine 3
• Meningococcal vaccines: meningococcal conjugate vaccines for serogroups A, C, Y and W-135 and serogroup B meningococcal vaccines 3
• H. influenzae type b vaccines 3
• Inactivated influenza vaccines 3

Immunogenicity and Safety of Vaccines

Studies have shown that these vaccines are immunogenic and safe for asplenic individuals:

• A study found that the 13-valent pneumococcal conjugate vaccine is immunogenic for serotypes 1,3,4,5, 7F, 18C, 19A, 19F, and 23F when used as a booster dose in asplenic patients with previous PPV23 vaccination 4
• Another study demonstrated that coadministering a combined meningococcal serogroup C and Haemophilus influenzae type b conjugate vaccine with 7-valent pneumococcal conjugate vaccine and measles, mumps, and rubella vaccine at 12 months of age is safe and immunogenic 5

Reduction of Infection Risk

Registration with a registry for asplenic/hyposplenic patients and adherence to preventative measures, including vaccination, can reduce the risk of infection with encapsulated organisms:

• A study found that registration with Spleen Australia was associated with a 69% reduction in the risk of infection with encapsulated organisms among asplenic/hyposplenic patients 6
• Another study estimated that systematic, long-term approaches to post-splenectomy care can prevent 5-6 invasive infections with encapsulated organisms annually among registrants 6