What is the vaccine schedule for an adult patient with asplenia (absence of a spleen)?

From the Guidelines

Asplenic adults should follow a specific vaccination schedule, prioritizing pneumococcal vaccines, including PCV20 as the preferred option, or PCV15 followed by PPSV23, as well as meningococcal vaccines, annual influenza vaccination, and other routine adult vaccines, to minimize the risk of overwhelming post-splenectomy infection (OPSI) and improve quality of life. The vaccination schedule for an adult patient with asplenia should be based on the most recent guidelines, which recommend pneumococcal vaccination with either PCV20 or a combination of PCV15 and PPSV23, depending on the patient's previous vaccination history 1. Key considerations include:

• Pneumococcal vaccination: PCV20 is the preferred option for adults with asplenia, but if not available, PCV15 followed by PPSV23 at least 8 weeks later is recommended 1.
• Meningococcal vaccination: MenACWY and MenB vaccines are essential, with boosters every 5 years for MenACWY and as recommended for MenB 1.
• Annual influenza vaccination: necessary to prevent influenza and its complications.
• Haemophilus influenzae type b (Hib) vaccine: should be administered as a single dose if not previously vaccinated 1.
• Routine adult vaccines: including Tdap/Td, hepatitis A and B, and others, should be administered according to the standard adult schedule. These vaccinations are crucial to prevent infections and improve quality of life in asplenic patients, who face a higher risk of OPSI due to their compromised immune system. Ideally, vaccines should be administered at least 2 weeks before elective splenectomy, but if not possible, they should be given as soon as the patient is stable post-surgery. It is essential to follow the most recent guidelines and consult with a healthcare professional to determine the best vaccination schedule for each individual patient.

From the Research

Vaccine Schedule for Adult Patients with Asplenia

The vaccine schedule for adult patients with asplenia (absence of a spleen) involves a combination of pneumococcal conjugate and polysaccharide vaccines.

• The Advisory Committee on Immunization Practices (ACIP) recommends the use of 13-valent pneumococcal conjugate vaccine (PCV13) for adults aged ≥19 years with immunocompromising conditions, including functional or anatomic asplenia 2.
• Current guidelines suggest a combined schedule of PCV13 and 23-valent pneumococcal polysaccharide vaccine (PPSV23) for asplenic individuals 3.
• Studies have shown that PCV13 induces a T-dependent immune response in asplenic individuals, but previous PPSV23 vaccinations can affect the memory B-cell response in a dose- and time-dependent manner 3, 4.
• The immune response to pneumococcal conjugate vaccination in asplenic individuals has been investigated, and results show that asplenic individuals respond well to PCV7, although protective levels are often demonstrated pre-PCV7 due to prior PPSV23 5.
• Antibody persistence 5 years after PCV13 vaccination in asplenic patients with β-thalassemia has been assessed, and results suggest that antibody levels drop significantly but remain at protective levels 5 years post-PCV13 6.

Key Considerations

• Asplenic individuals are at increased risk of infection with Streptococcus pneumoniae, and vaccination is an important preventive measure.
• The use of PCV13 and PPSV23 in asplenic adults should be guided by current recommendations and individual patient factors, such as immunization history and underlying medical conditions 2.
• Measurement of anti-pneumococcal antibodies before and after vaccination may be useful in optimizing timing of vaccinations and certifying vaccine immunogenicity in asplenic individuals 4, 6.