From the Guidelines
Conjugate pneumococcal vaccine (PCV) and pneumococcal polysaccharide vaccine (PPSV) should be administered at least 2 weeks before splenectomy.
Rationale
- The Advisory Committee on Immunization Practices (ACIP) recommends that pneumococcal vaccine should be administered at least 2 weeks before elective splenectomy 1.
- This timing allows for the development of adequate antibody responses to pneumococcal serotypes, reducing the risk of invasive pneumococcal disease after splenectomy.
- The optimal vaccination schedule for asplenic patients includes PCV13, followed by PPSV23 at least 8 weeks later, or PCV20, which does not require additional PPSV23 1.
- Studies have shown that vaccination with PCV and PPSV after splenectomy can result in lower antibody concentrations and opsonophagocytic titers compared to vaccination before surgery 1.
- The Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology also recommends vaccination at least 2 weeks before planned splenectomy, or 14 days after surgery if preoperative vaccination is not possible 1.
- It is essential to note that vaccination does not guarantee protection against fulminant pneumococcal disease, and asplenic patients should be informed of this risk and receive prompt medical attention if they develop symptoms of sepsis 1.
- Key points to consider when vaccinating asplenic patients include:
- PCV13 or PCV20 should be administered first, followed by PPSV23 at least 8 weeks later, if recommended 1.
- The timing of vaccination is critical, with at least 2 weeks before elective splenectomy being the recommended timeframe 1.
- Asplenic patients should be vaccinated against other encapsulated bacteria, such as Haemophilus influenzae type b (Hib) and Neisseria meningitidis, in addition to pneumococcal vaccination 1.
From the Research
Vaccination Timing for Splenectomy
- The optimal timing for administering conjugate pneumococcal vaccine (PCV) and pneumococcal polysaccharide vaccine (PPSV) in relation to splenectomy is crucial for effective immune response.
- According to 2, pneumococcal, meningococcal, and Haemophilus influenzae (Hib) vaccinations are indicated for patients after splenectomy, and these immunizations should be given at least 14 days before a scheduled splenectomy, or given after the fourteenth postoperative day.
Post-Splenectomy Vaccination Response
- Studies have shown that the immune response to pneumococcal vaccination is affected by the timing of vaccination after splenectomy.
- Research by 3 and 4 suggests that delaying vaccination to 14 days postoperatively may result in better functional antibody responses, although the response may still be lower than that of normal controls.
- Additionally, 5 found that splenectomy negatively influences the levels of PCV-induced lymphoproliferation, TH1 differentiation, and cytokine release, indicating a compromised cellular immune response in asplenic individuals.
Pre-Splenectomy Vaccination
- In cases where splenectomy is scheduled, vaccination with PCV and PPSV at least 14 days before surgery is recommended 2.
- A study by 6 demonstrated that pneumococcal conjugate vaccines can induce good antibody responses even after splenectomy, particularly after a second dose, suggesting the potential benefit of pre-splenectomy vaccination with conjugate vaccines.
Key Considerations
- The choice of vaccine (PCV or PPSV) and the timing of vaccination in relation to splenectomy should be based on individual patient circumstances and current guidelines.
- Further research is needed to fully understand the immune response to pneumococcal vaccination in asplenic individuals and to optimize vaccination strategies for this population, as indicated by studies such as 3, 4, 5, 2, 6.