What injections do people need post-splenectomy?

Post-Splenectomy Vaccination Requirements

Patients who have undergone splenectomy require specific vaccinations against encapsulated bacteria including pneumococcal, Haemophilus influenzae type B, and meningococcal vaccines, as well as annual influenza vaccination, to prevent potentially fatal overwhelming post-splenectomy infection (OPSI). 1

Required Vaccinations

Timing of Vaccinations

• For elective splenectomy: Vaccines should be administered at least 2 weeks before surgery to ensure optimal antibody response 2, 1
• For emergency splenectomy: Vaccines should be given no sooner than 14 days after surgery 1

Core Vaccinations Required

1. Pneumococcal vaccine:

   • Polyvalent pneumococcal vaccine (23 serotypes) - more than 90% effective in healthy adults under 55 2
   • 13-valent conjugate pneumococcal vaccine should also be given 1
   • Reimmunization recommended every 5-10 years 2

2. Haemophilus influenzae type B (Hib) vaccine:

   • Single dose as part of routine vaccination schedule 1

3. Meningococcal vaccines:

   • Meningococcal ACYW135 vaccine 1
   • Meningococcal B vaccine 1

4. Influenza vaccine:

   • Annual vaccination recommended for all asplenic patients over 6 months of age 2, 1
   • Helps reduce risk of secondary bacterial infections 2

Antibiotic Prophylaxis

While not an injection, antibiotic prophylaxis is a critical component of post-splenectomy care:

• First-line: Phenoxymethylpenicillin (Penicillin V) 250-500 mg twice daily 1
• For penicillin-allergic patients: Erythromycin 500 mg twice daily 1
• Duration: Minimum of 2 years post-splenectomy, with lifelong prophylaxis recommended for high-risk patients (children under 5 years, those with hematologic malignancies, immunocompromised individuals) 1

Emergency Antibiotics

All splenectomized patients should have an emergency supply of antibiotics:

• For adults: Amoxicillin 3g starting dose followed by 1g every 8 hours 1
• For children: Amoxicillin 50 mg/kg in three divided daily doses 1

Important Considerations

Risk Duration

• Most infections occur within the first two years after splenectomy
• Up to one-third of infections occur at least five years post-splenectomy
• Cases of fulminating infection have been reported more than 20 years after splenectomy 2
• The risk is considered lifelong 2

Vaccination Coverage Issues

Recent studies show suboptimal vaccination coverage among splenectomized patients:

• Pneumococcal: 27-55% 3, 4
• Haemophilus influenzae type B: 30-48% 3, 4
• Meningococcal: 28-34% for ACYW135, 13-31% for MenB 3, 5, 4
• Influenza: 49-53% 3, 4

Patient Education

Patients should:

• Carry a medical alert card/bracelet indicating asplenic status 1
• Seek immediate medical attention for fever >38°C (101°F) 1
• Be educated about infection risk and preventive measures 1
• Take special precautions when traveling to malaria-endemic areas 2, 1

Pitfalls to Avoid

1. Delaying vaccination: Failure to vaccinate in a timely manner significantly increases risk of OPSI 1

2. Incomplete vaccination series: All recommended vaccines must be administered for optimal protection 4

3. Neglecting booster doses: Many patients don't receive recommended booster doses 5 years after initial vaccination 3

4. Overlooking antibiotic prophylaxis: Vaccination alone is insufficient; antibiotic prophylaxis is essential 2, 1

5. Inadequate patient education: Patients must understand the lifelong risk of infection and importance of seeking immediate medical attention for fever 1

6. Failing to provide emergency antibiotics: All patients should have immediate access to antibiotics for use if symptoms of infection develop 2, 1