What is the recommended frequency of pneumococcal conjugate vaccine (PCV) and pneumococcal polysaccharide vaccine (PPSV) administration post splenectomy?

Pneumococcal Vaccination Schedule Post-Splenectomy

For patients who have undergone splenectomy, PPSV23 should be administered 8 weeks after PCV13/15/20, with revaccination with PPSV23 every 5 years thereafter to maintain protection against pneumococcal disease. 1

Initial Vaccination Series

Timing of Initial Vaccination

• For elective splenectomy: Pneumococcal vaccines should be administered ≥2 weeks before surgery 1
• For emergency/trauma splenectomy: Administer as soon as clinically stable, ideally at day 14 post-splenectomy 2
  • Day 14 vaccination produces better functional antibody responses compared to earlier administration 2

Initial Vaccination Protocol

1. PCV Series First:

   • For pneumococcal vaccine-naïve patients: Administer PCV (preferably PCV20) 1
   • If using PCV15, follow with PPSV23 ≥8 weeks later 1
   • If using PCV20, no additional PPSV23 is needed initially 1

2. For Previously Vaccinated Patients:

   • If previously received PCV13 only: Administer PCV20 at least 1 year later 1
   • If previously received PCV13 and 1-2 doses of PPSV23: Administer PCV20 at least 5 years later 1, 3

Revaccination Schedule

PPSV23 Revaccination

• Frequency: Every 5 years throughout life 1
• This ongoing revaccination is critical as asplenic patients remain at lifelong risk for overwhelming post-splenectomy infection (OPSI) 4

Monitoring Considerations

• Consider antibody level monitoring to guide revaccination timing in high-risk patients 4
• Significant antibody responses have been documented with both primary vaccination and revaccination in splenectomized patients 4

Additional Vaccines for Asplenic Patients

Meningococcal Vaccination

• Administer quadrivalent meningococcal conjugate vaccine (MenACWY) in 2 doses 8 weeks apart 1
• Administer meningococcal serogroup B vaccine series 1
• Revaccination: Every 5 years with MenACWY 1

Haemophilus influenzae Type b

• One dose of Hib vaccine should be administered to unvaccinated persons aged ≥5 years 1

Clinical Considerations

Vaccine Effectiveness

• While splenectomized patients can produce antibodies to pneumococcal vaccination, their functional antibody activity may be reduced compared to individuals with intact spleens 5, 2
• Cellular immune responses are also diminished in asplenic patients, with lower levels of TH1 differentiation and cytokine release 5

Common Pitfalls to Avoid

1. Inadequate timing: Administering vaccines too soon after emergency splenectomy may result in suboptimal functional antibody response 2
2. Missing revaccination: Failure to revaccinate every 5 years leaves patients vulnerable to OPSI 1, 4
3. Incomplete series: Administering only one type of pneumococcal vaccine provides inadequate serotype coverage 1
4. Neglecting other vaccines: Failing to administer meningococcal and Hib vaccines 1

Special Considerations

• Penicillin prophylaxis is advised in addition to vaccination for asplenic patients 1
• Patient education about the risk of OPSI and the importance of seeking immediate medical attention for fever is essential 4

By following this comprehensive vaccination schedule, the risk of overwhelming post-splenectomy infection can be significantly reduced, though never completely eliminated due to the permanent immune deficiency caused by asplenia.