What vaccinations are required for a 12-year-old post-splenectomy (surgical removal of the spleen) patient to prevent bacterial infections?

From the Guidelines

A 12-year-old post-splenectomy patient requires vaccination against encapsulated bacteria, specifically Streptococcus pneumoniae (pneumococcal vaccine), Haemophilus influenzae type b (Hib), Neisseria meningitidis (meningococcal vaccine), and annual influenza vaccination. For pneumococcal protection, the child should receive both the 13-valent pneumococcal conjugate vaccine (PCV13) and the 23-valent pneumococcal polysaccharide vaccine (PPSV23), with PPSV23 given at least 8 weeks after PCV13, as recommended by the most recent guidelines 1. The meningococcal vaccination should include both the quadrivalent meningococcal conjugate vaccine (MenACWY) and the meningococcal B vaccine (MenB) 1. Haemophilus influenzae type b vaccine should be administered if not previously given. These vaccinations are crucial because the spleen plays a vital role in filtering blood and removing encapsulated bacteria. Without a spleen, the patient has reduced ability to clear these pathogens from the bloodstream and is at significantly increased risk for overwhelming post-splenectomy infection (OPSI), which can progress rapidly and has high mortality, as highlighted in studies 1. Revaccination schedules should be followed according to age-appropriate guidelines, with pneumococcal revaccination typically recommended every 5 years, and consideration of the patient's immune status and potential need for additional vaccinations or prophylactic antibiotics in certain situations 1.

Key points to consider:

• The patient should receive vaccinations against Streptococcus pneumoniae, Haemophilus influenzae type b, and Neisseria meningitidis.
• Annual influenza vaccination is also recommended.
• The timing of vaccination is important, with pneumococcal vaccination recommended at least 2 weeks before or after splenectomy, if possible.
• The patient and their caregivers should be educated about the risks of OPSI and the importance of seeking medical attention immediately if symptoms occur.
• Antibiotic prophylaxis may be considered in certain situations, such as travel to areas with high risk of infection or in patients with specific underlying conditions.

Overall, the goal of vaccination in post-splenectomy patients is to reduce the risk of OPSI and other infections, and to improve morbidity, mortality, and quality of life outcomes.

From the Research

Vaccinations Required for Post-Splenectomy Patients

To prevent bacterial infections in a 12-year-old post-splenectomy patient, the following vaccinations are recommended:

• Vaccinations against encapsulated bacteria, including:
  • Streptococcus pneumoniae (S. pneumoniae) 2, 3, 4, 5, 6
  • Neisseria meningitidis (N. meningitidis) 2, 3, 4, 5, 6
  • Haemophilus influenzae (H. influenzae) 2, 3, 4, 5, 6
• Specific vaccine types and dosages:
  • 13-valent pneumococcal conjugate vaccine 3
  • Quadrivalent meningococcal conjugate vaccine 3
  • Meningococcal serogroup B vaccine 3
  • Haemophilus influenzae serotype b (Hib) vaccine 3, 4, 5, 6
• Influenza virus vaccination is also recommended to prevent infection 2

Patient Compliance and Vaccination Coverage

Studies have shown that patient compliance with vaccination recommendations varies, with some patients not receiving all recommended vaccinations 2, 5. Vaccination coverage (VC) decreases with age, and efforts are required to increase VC in post-splenectomy patients 5.

Importance of Vaccinations

Vaccinations are crucial in preventing overwhelming post-splenectomy infection (OPSI), which is associated with high morbidity and mortality rates 2, 3. OPSI can be caused by encapsulated bacteria, and vaccinations can help prevent these infections 2, 3, 4, 5, 6.