Are there precautions to give MCV4 (Meningococcal Conjugate Vaccine) and PCV (Pneumococcal Conjugate Vaccine) post splenectomy?

From the Guidelines

Both MCV4 (Meningococcal Conjugate Vaccine) and PCV (Pneumococcal Conjugate Vaccine) should be administered to patients who have undergone splenectomy, ideally at least 14 days after the procedure if it's an emergency splenectomy, as stated in the guidelines 1. For planned splenectomies, these vaccines should be given at least 2 weeks before the procedure. The standard dosing schedule should be followed: for adults, a single dose of MCV4 with a booster every 5 years, and for PCV, typically PCV13 followed by PPSV23 (pneumococcal polysaccharide vaccine) 8 weeks later. Some key points to consider:

• Precautions include avoiding administration during acute febrile illness, though mild illness is not a contraindication 1.
• Patients with previous severe allergic reactions to any component of these vaccines should not receive them.
• These vaccines are crucial for post-splenectomy patients because the spleen plays a vital role in clearing encapsulated bacteria from the bloodstream.
• Without a spleen, patients are at significantly increased risk for overwhelming infections from Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae type b, which can be rapidly fatal, as highlighted in the guidelines 1.
• Vaccination helps provide protection against these potentially life-threatening infections. The most recent and highest quality study, from 2018 1, supports the administration of MCV4 and PCV to asplenic patients, with specific recommendations for dosing and timing. It's essential to note that asplenic patients should also receive annual influenza vaccination, as well as be aware of the risks of OPSI and the importance of prompt medical attention in case of symptoms, as stated in the guidelines 1.

From the Research

Precautions for MCV4 and PCV Administration Post-Splenectomy

• Patients who have undergone splenectomy are at increased risk of infections caused by encapsulated bacteria, including Streptococcus pneumoniae and Neisseria meningitidis 2, 3, 4, 5.
• Vaccination against these pathogens, including MCV4 (Meningococcal Conjugate Vaccine) and PCV (Pneumococcal Conjugate Vaccine), is recommended to prevent infections in asplenic patients 2, 3, 4, 5.
• The timing of vaccination is important, with recommendations to vaccinate at least 15 days before surgery, if possible, or within 30 days after surgery in emergency cases 4.
• Vaccination guidelines may vary depending on the patient's age, with children under 10 years old often receiving Hib and PCV as part of their childhood immunization program 3.
• Studies have shown that vaccination can reduce the risk of pneumococcal infections in asplenic patients, but the immune response to vaccination may be impaired in these individuals 6.

Key Considerations for Vaccination Post-Splenectomy

• Asplenic patients should receive vaccination against Streptococcus pneumoniae, Haemophilus influenzae type b, and Neisseria meningitidis to prevent infections 2, 3, 4, 5.
• The choice of vaccine and vaccination schedule should be based on national guidelines and individual patient factors, such as age and underlying medical conditions 3, 4.
• Patients who have undergone splenectomy should be aware of their increased risk of infection and seek medical attention promptly if they develop symptoms of infection 2, 5.
• Healthcare providers should ensure that asplenic patients receive recommended vaccinations and provide education on infection prevention and recognition of symptoms 2, 3, 4, 5.