From the Guidelines
The patient should receive a dose of PCV13 (Prevnar 13) pneumococcal vaccine if not already given, followed by PPSV23 (Pneumovax 23) at least 8 weeks later, and a second dose of PPSV23 should be administered 5 years after the first dose, as recommended by the guidelines 1. For meningococcal protection, she should receive MenB vaccine (either Bexsero as a 2-dose series 1 month apart or Trumenba as a 3-dose series at 0,1-2, and 6 months) if not already given, as per the latest recommendations 1. No booster is needed for the Hib vaccine as a single dose provides adequate protection for adults, according to the guidelines 1. Additionally, she should receive an annual influenza vaccine and ensure all routine adult vaccinations are up-to-date, including Tdap and COVID-19 vaccines, to minimize the risk of overwhelming post-splenectomy infection (OPSI) from encapsulated bacteria, which can be rapidly fatal 1. Some key points to consider in the vaccination schedule include:
- The patient should be vaccinated against Streptococcus pneumoniae with PCV13, 6–12 weeks later with PPSV23, and revaccination should be performed every 6 years, as recommended by the guidelines 1.
- The patient should be vaccinated with conjugated HiB vaccine, and a patient is regarded as immunized if they were sequentially vaccinated with the primary series of HiB and a booster, or were vaccinated once with HiB vaccine after the age of 14 months, with no revaccination needed 1.
- The patient should be vaccinated with the tetravalent conjugated meningococcal vaccine, including activity against serogroups A, C, W, Y (MenACWY), with revaccination every 5 years, and vaccination against serogroup B meningococcus (MenB) is recommended for use in risk groups, including persons with asplenia 1. The patient should also be counseled about the importance of seeking immediate medical attention for any fever or signs of infection, and some physicians may recommend prophylactic antibiotics (typically penicillin) for the first few years or lifelong after splenectomy, as the risk of OPSI remains elevated for more than 10 years and probably for life 1.
From the Research
Recommended Vaccination Schedule
The patient in question, a 44-year-old female who recently underwent a splenectomy, has already received initial vaccinations for Pneumococcal, Haemophilus influenzae type b (Hib), and Meningococcal (Menveo) (Meningococcal ACWY) on 4/26/2025. To mitigate the lifelong increased risk of overwhelming post-splenectomy infection (OPSI), the following vaccinations are recommended:
- Pneumococcal vaccination: The patient has already received the initial pneumococcal vaccination, but booster shots may be necessary 2, 3, 4, 5, 6.
- Meningococcal vaccination: In addition to the Meningococcal ACWY vaccine, the patient should also receive the Meningococcal B (MenB) series 2, 3, 4, 5, 6.
- Haemophilus influenzae type b (Hib) vaccination: The patient has already received the initial Hib vaccination, but booster shots may be necessary 2, 3, 4, 5, 6.
- Influenza vaccination: Annual influenza vaccination is recommended for asplenic patients to prevent influenza and its potential complications 2, 3, 5, 6.
Timing of Vaccinations
The optimal timing of vaccination in relation to splenectomy depends on the nature of the splenectomy. Generally, vaccinations should be given at least 14 days before a scheduled splenectomy or after the fourteenth postoperative day 4, 5. However, some studies suggest that immunization might be effective even in the immediate perioperative time, and surgeons may play a primary role in vaccine delivery 5.
Importance of Adherence to Vaccination Guidelines
Adherence to recommended post-splenectomy immunizations is crucial to reduce the risk of sepsis. However, vaccination coverage is often suboptimal, and there is a need for greater efforts to increase adherence to vaccination guidelines 2, 3, 5, 6. Surgeons and healthcare providers have a responsibility to ensure that asplenic patients receive the necessary vaccinations to prevent overwhelming post-splenectomy infections.
Key Considerations
- Asplenic patients are at a higher risk of developing overwhelming post-splenectomy infections, and vaccinations are essential to prevent these infections 2, 3, 4, 5, 6.
- A robust and complete immunization schedule, including specific Meningococcal B (MenB) series and ongoing boosters for all recommended vaccines, is crucial to mitigate the lifelong increased risk of OPSI 2, 3, 4, 5, 6.
- Healthcare providers should be aware of the recommended vaccinations and timing to ensure optimal immunization coverage for asplenic patients 2, 3, 4, 5, 6.