From the Guidelines
Asplenic adults should receive immunization against encapsulated bacteria, including Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis, as well as annual influenza vaccination, to reduce the risk of overwhelming post-splenectomy infection (OPSI) 1. The recommended vaccinations include pneumococcal vaccines, Haemophilus influenzae type b (Hib) vaccine, and meningococcal vaccines (MenACWY and MenB) 1.
- Vaccination programs should be started no sooner than 14 days after splenectomy or spleen total vascular exclusion 1.
- In patients discharged before 15 days after splenectomy or angioembolization, where the risk to miss vaccination is deemed high, the best choice is to vaccinate before discharge 1.
- Annual immunization against seasonal flu is recommended for all patients over 6 months of age 1. Antibiotic prophylaxis should be strongly considered in the event of any sudden onset of unexplained fever, malaise, chills, or other constitutional symptoms, especially when medical review is not readily accessible 1.
- The recommended options for emergency standby in adults include amoxicillin, levofloxacin, or moxifloxacin 1. Asplenic patients should be educated about the increased risk of severe infections and the importance of seeking immediate medical attention in case of fever or serious infection 1. Patient education is crucial, including wearing a medical alert bracelet and understanding the increased risk of severe infections 1. These measures are essential because the spleen plays a vital role in filtering blood and removing encapsulated bacteria, and its absence significantly increases the risk of OPSI, which carries high mortality rates 1.
From the Research
Prophylaxis for Asplenic Adults
The prophylaxis for asplenic adults involves vaccination against certain bacteria to prevent overwhelming postsplenectomy infections. The recommended vaccinations include:
- Pneumococcal vaccine, to prevent infection with Streptococcus pneumoniae 2, 3, 4, 5
- Meningococcal vaccine, to prevent infection with Neisseria meningitidis 2, 3, 4
- Haemophilus influenzae type b (Hib) vaccine, to prevent infection with Haemophilus influenzae type b 2, 3, 4
- Influenza vaccine, to prevent infection with the influenza virus 2, 3
Vaccination Schedule
The optimal timing of vaccination in relation to splenectomy depends on the nature of the splenectomy. In general, vaccinations should be administered:
- At least 2 weeks before surgery in elective cases 3
- At least 2 weeks after the surgical intervention in emergency cases 3
- According to the individual's immunization history, with consideration of possible interactions and timing to achieve the most robust immune response 2, 4
Additional Recommendations
Additional recommendations for asplenic adults include:
- Administration of 2 doses of live attenuated vaccines against measles-mumps-rubella and varicella, 4-8 weeks apart, in subjects without evidence of immunity 3
- Administration of a booster dose of tetanus, diphtheria, and pertussis vaccine, even in subjects fully vaccinated 3
- A 3-dose primary vaccination series is recommended in asplenic subjects with unknown or incomplete vaccination series 3