From the Guidelines
After a traumatic splenectomy, patients should receive vaccines against Streptococcus pneumoniae, Haemophilus influenzae type b, and Neisseria meningitidis, as well as an annual influenza vaccine, to reduce the risk of overwhelming post-splenectomy infection (OPSI). The vaccines recommended include the 13-valent pneumococcal conjugate vaccine (PCV13) followed by the 23-valent pneumococcal polysaccharide vaccine (PPSV23) at least 8 weeks later, the Haemophilus influenzae type b (Hib) vaccine, and the meningococcal conjugate vaccine (MenACWY) along with meningococcal B vaccine (MenB) 1.
Key Considerations
- The risk of OPSI is highest in the first year after splenectomy, but remains elevated for more than 10 years and probably for life 1.
- Patients should be vaccinated at least 14 days after splenectomy, as vaccination before this time may result in a suboptimal antibody response 1.
- In patients discharged before 15 days after splenectomy, vaccination should be given before discharge to minimize the risk of missing vaccination 1.
- Annual influenza vaccination is recommended for all patients over 6 months of age to reduce the risk of secondary bacterial infection, including pneumococcal infection 1.
Vaccination Schedule
- PCV13 followed by PPSV23 at least 8 weeks later
- Hib vaccine
- MenACWY along with MenB vaccine
- Annual influenza vaccine
Education and Prophylaxis
- Patients should be educated about the importance of seeking immediate medical attention for any fever or signs of infection 1.
- Many patients will require prophylactic antibiotics (typically penicillin or amoxicillin) for at least the first few years after splenectomy or lifelong in high-risk patients 1.
From the Research
Vaccines Recommended After Traumatic Splenectomy
The following vaccines are recommended for individuals after a traumatic splenectomy:
- Pneumococcal vaccines, including 13-valent pneumococcal conjugate vaccine (PCV13) followed by the 23-valent pneumococcal polysaccharide vaccine (PPV23) 2, 3, 4
- Meningococcal vaccines, including meningococcal conjugate vaccines for serogroups A, C, Y, and W-135, and serogroup B meningococcal vaccines 2, 5, 3
- Haemophilus influenzae type b (Hib) vaccines 2, 5, 3, 6
- Inactivated influenza vaccines 3
Timing of Vaccination
Vaccinations should be given at least 14 days before a scheduled splenectomy, or after the fourteenth postoperative day 5.
Importance of Vaccination
Vaccination against encapsulated bacterial pathogens decreases the incidence of post-splenectomy sepsis and can prevent overwhelming post-splenectomy infection (OPSI) 2, 5, 3, 4.
Vaccine Response
Studies have shown that asplenic individuals can mount an immune response to vaccines, including PCV13 and Hib-conjugate vaccine 4, 6.
Adherence to Vaccination Guidelines
Adherence to vaccination guidelines is crucial to prevent infections in asplenic individuals, but it is often a challenge 2, 3, 4. Dedicated teams or clinics focused on patient education and monitoring can improve vaccine coverage rates and reduce the risk of infection 3.