From the Guidelines
After a splenectomy, patients should receive several important vaccines to protect against encapsulated bacteria, including pneumococcal vaccines (PCV13 and PPSV23), Haemophilus influenzae type b (Hib) vaccine, meningococcal vaccines (MenACWY and MenB), and annual influenza vaccines, as recommended by the most recent guidelines 1. The recommended vaccination schedule typically involves receiving PCV13 first, followed by PPSV23 at least 8 weeks later, with Hib vaccine given as a single dose, and meningococcal protection provided by both the MenACWY vaccine (with a booster every 5 years) and the MenB vaccine series. These vaccines should ideally be administered at least 2 weeks before an elective splenectomy, but if not possible, they should be given as soon as possible after surgery, typically 2 weeks post-operation when the patient has recovered, as supported by recent studies 1. Key points to consider include:
- The importance of vaccinating against encapsulated bacteria to prevent overwhelming post-splenectomy infection (OPSI) 1
- The need for annual influenza vaccination to reduce the risk of secondary bacterial infections 1
- The recommendation for meningococcal vaccination with both MenACWY and MenB vaccines, with boosters as indicated 1
- The consideration of antibiotic prophylaxis in certain cases, especially when medical review is not readily accessible 1. Overall, the goal is to minimize the risk of OPSI and ensure the best possible outcomes for patients after splenectomy, prioritizing their morbidity, mortality, and quality of life.
From the Research
Recommended Vaccines after Splenectomy
The following vaccines are recommended for individuals after splenectomy:
- Pneumococcal conjugate vaccine (PCV) 2, 3, 4, 5
- Pneumococcal polysaccharide vaccine (PPV) 2, 3, 4
- Meningococcal conjugate vaccine (MCV) 2, 3, 6
- Haemophilus influenzae type b (Hib) vaccine 2, 3
Timing of Vaccination
Vaccinations should be given at least 14 days before a scheduled splenectomy, or after the fourteenth postoperative day 3.
Importance of Vaccination
Vaccination against encapsulated bacterial pathogens decreases the incidence of post-splenectomy sepsis 3. Vaccination according to national recommendations could have prevented at least 28% of invasive bacterial infections in splenectomized individuals 2.
Vaccine Response
Near-total splenectomy provides a favourable immunological basis for natural and vaccine-induced protection against meningococcal serogroup A and C infections 6. Pneumococcal conjugate vaccines can induce good antibody responses even after splenectomy, particularly after a second dose 5.