From the Guidelines
Patients with asplenia should receive pneumococcal vaccines including both PCV13 (Prevnar 13) followed by PPSV23 (Pneumovax) at least 8 weeks later, with PPSV23 revaccination every 5 years, as well as Haemophilus influenzae type b (Hib) vaccine, meningococcal vaccines, and annual influenza vaccination. The most recent and highest quality study 1 provides the most up-to-date recommendations for vaccinations in patients with asplenia. According to this study, patients with anatomic or functional asplenia should first be vaccinated against Streptococcus pneumoniae with PCV13, followed by PPSV23 6-12 weeks later, with revaccination every 6 years.
Key Vaccinations for Asplenic Patients
- Pneumococcal vaccines: PCV13 and PPSV23
- Haemophilus influenzae type b (Hib) vaccine
- Meningococcal vaccines: MenACWY and MenB
- Annual influenza vaccination
Timing of Vaccinations
- Ideally, vaccines should be administered at least 2 weeks before elective splenectomy, but if not possible, they should be given as soon as the patient is stable post-surgery 1.
- Vaccination programs should be started no sooner than 14 days after splenectomy or spleen total vascular exclusion 1.
Importance of Vaccinations
- Vaccinations are crucial because the spleen plays a vital role in filtering blood and removing encapsulated bacteria, and its absence significantly increases the risk of overwhelming post-splenectomy infection (OPSI), which carries high mortality rates 1.
- Asplenic patients should receive all age-appropriate routine vaccinations including tetanus, diphtheria, pertussis, hepatitis A and B, and others according to the standard schedule.
From the Research
Recommended Vaccinations for Patients with Asplenia
The following vaccinations are recommended for patients with asplenia:
- Pneumococcal vaccines: 13-valent pneumococcal conjugate vaccine (PCV13) followed by the 23-valent pneumococcal polysaccharide vaccine (PPSV23) 2, 3, 4
- Meningococcal vaccines: meningococcal conjugate vaccines for serogroups A, C, Y and W-135 and serogroup B meningococcal vaccines 4
- H. influenzae type b vaccines 5, 4
- Inactivated influenza vaccines 4
Vaccination Schedule
The vaccination schedule for patients with asplenia may vary depending on their age, health status, and previous vaccination history. However, the general recommendation is to administer PCV13 first, followed by PPSV23 at least 2 months later 2. Booster doses of pneumococcal and meningococcal vaccines may be necessary to maintain protection 4.
Immunogenicity and Efficacy
Studies have shown that patients with asplenia can mount a sufficient immune response to conjugated vaccines, including PCV13 and H. influenzae type b vaccines 5, 3. However, the immune response may be affected by previous vaccination history and the presence of underlying health conditions 3, 6.