From the Guidelines
Patients undergoing splenectomy should receive pneumococcal vaccines (both PCV13 and PPSV23), Haemophilus influenzae type b (Hib) vaccine, meningococcal vaccines (MenACWY and MenB), and an annual influenza vaccine at least two weeks before surgery when possible, as recommended by the most recent guidelines 1. The timing of vaccination is crucial, as the immune response to vaccines is better with a functioning spleen. If vaccination before surgery isn't possible, it should be administered at least two weeks after splenectomy. Some key points to consider:
- Pneumococcal vaccines (PCV13 and PPSV23) should be given to asplenic patients, with PCV13 administered first, followed by PPSV23 at least 8 weeks later 1.
- Haemophilus influenzae type b (Hib) vaccine should be administered to unvaccinated patients aged ≥5 years who are asplenic or have a sickle cell disease 1.
- Meningococcal vaccines (MenACWY and MenB) should be given to patients aged ≥2 months who are asplenic or have a sickle cell disease, with revaccination every 5 years 1.
- Annual influenza vaccine should be administered to all patients over 6 months of age 1. It's essential to note that these vaccines are not a guarantee against infection, but they can significantly reduce the risk of overwhelming post-splenectomy infection (OPSI), a life-threatening condition with mortality rates of 50-70% 1. Additionally, patients should be educated about their increased infection risk and the importance of seeking immediate medical attention for fevers or signs of infection. In cases where vaccination before surgery is not possible, vaccination should be performed 14 days after surgery, as longer delay does not yield additional benefit, while a shorter wait induces insufficient antibody response 1.
From the Research
Vaccines for Splenectomy
The following vaccines are recommended for patients prior to splenectomy:
- Pneumococcal vaccine
- Meningococcal vaccine
- Haemophilus influenzae type b (Hib) vaccine
- Influenza vaccine
Timing of Vaccination
These vaccines should be administered at least 14 days before a scheduled splenectomy, or given after the fourteenth postoperative day 2. The optimal timing of vaccination in relation to splenectomy depends on the nature of the splenectomy 3.
Importance of Vaccination
Vaccination against encapsulated bacterial pathogens decreases the incidence of post-splenectomy sepsis 2, 3. Patients without a spleen are at risk of developing overwhelming postsplenectomy infections due to encapsulated organisms, mainly pneumococcal, meningococcal, and Haemophilus influenzae type b (Hib) 3, 4.
Adherence to Recommendations
Adherence to recommended post-splenectomy immunizations is crucial to reduce the risk of sepsis 5. However, many patients do not receive all the recommended vaccines, and some receive redundant immunizations not in accordance with guidelines 5.
Co-administration of Vaccines
Co-administration of a novel Haemophilus influenzae type b and Neisseria meningitidis serogroups C and Y-tetanus toxoid conjugate vaccine does not interfere with the immune response to antigens contained in infant vaccines routinely used in the United States 6.