From the Guidelines
After a splenectomy, patients should receive several important vaccinations to protect against encapsulated bacteria, including pneumococcal vaccines, 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 vaccines and their schedules are as follows:
- Pneumococcal vaccines: PCV20 or PCV15, followed by PPSV23 at least 8 weeks later, with a booster every 5 years 1
- Hib vaccine: one dose if previously not received 1
- Meningococcal vaccines: two-dose series MenACWY-D, with a booster every 5 years, and two-dose primary series MenB-4C at least 1 month apart, with a booster every 2-3 years if risk remains 1
- Annual influenza vaccines: recommended for all patients over 6 months of age 1 These vaccinations are essential because without a spleen, patients are at significantly increased risk of overwhelming post-splenectomy infection (OPSI), which can progress rapidly and has high mortality rates. In addition to vaccinations, many physicians recommend that post-splenectomy patients keep a supply of emergency antibiotics (often amoxicillin-clavulanate or levofloxacin) at home to take immediately if they develop fever or signs of infection, before seeking medical attention 1.
From the FDA Drug Label
In a study using a pneumococcal vaccine containing eight (types 1,3,6,7,14,18,19, and 23) capsular polysaccharides, vaccinated children and young adults aged 2 to 25 years who had sickle cell disease, congenital asplenia, or undergone a splenectomy experienced significantly less bacteremic pneumococcal disease than patients who were not vaccinated
The recommended vaccines after splenectomy include:
- Pneumococcal polysaccharide vaccine, as it has been shown to reduce the incidence of bacteremic pneumococcal disease in individuals with splenectomy 2 2.
- Other vaccines may be recommended, but the provided drug labels only directly support the use of pneumococcal polysaccharide vaccine in this context. Key points:
- Individuals with splenectomy are at increased risk of infections, particularly those caused by encapsulated bacteria like Streptococcus pneumoniae.
- Vaccination is an essential part of preventing these infections.
From the Research
Vaccines Recommended After Splenectomy
The following vaccines are recommended for individuals after splenectomy:
- Pneumococcal conjugate vaccine (PCV) 3, 4, 5, 6
- Pneumococcal polysaccharide vaccine 3, 4, 5, 6
- Meningococcal ACWY conjugate vaccine 3, 4, 5, 7
- Serogroup B meningococcal vaccine 3
- Haemophilus influenzae type b (Hib) vaccine 3, 4, 5
- Influenza vaccine 5
Timing of Vaccination
The optimal timing of vaccination in relation to splenectomy depends on the nature of the splenectomy 5. Vaccinations should be given at least 14 days before a scheduled splenectomy, or given after the fourteenth postoperative day 4.
Importance of Vaccination
Vaccination against encapsulated bacterial pathogens decreases the incidence of post-splenectomy sepsis 4. Vaccinations are recommended as a preventive measure to prevent potentially life-threatening infections in asplenic individuals 5.
Vaccine Coverage
Vaccine coverage (VC) for splenectomized individuals is often low, with VC decreasing with age 3. Efforts are required to increase VC of splenectomised individuals 3.