What vaccinations are recommended after splenectomy (removal of the spleen)?

Post-Splenectomy Vaccination Recommendations

Patients who have undergone splenectomy should receive pneumococcal, meningococcal, Haemophilus influenzae type b (Hib), and annual influenza vaccines to prevent overwhelming post-splenectomy infection (OPSI). These vaccinations are critical as splenectomized patients have a 10-50 fold higher risk of developing serious infections compared to the general population 1.

Core Vaccinations Required

Pneumococcal Vaccination

• Primary recommendation: PCV20 for pneumococcal vaccine-naïve adults 2
• Alternative regimen: PCV15 followed by PPSV23 at least 8 weeks later 2
• Timing: Ideally at least 2 weeks before elective splenectomy or 14 days after emergency splenectomy 3
• Revaccination: Every 5 years 2

Meningococcal Vaccination

• MenACWY vaccine: 2 doses given 8 weeks apart 4
• Revaccination: Every 5 years with MenACWY 4
• Meningococcal B vaccine: 2-3 dose series (depending on vaccine formulation) 4
• Revaccination: One booster dose 1 year after primary series, then every 2-3 years if risk remains 4

Haemophilus Influenzae Type b (Hib) Vaccination

• One dose recommended for all splenectomized patients 4, 2
• Timing: Ideally at least 2 weeks before elective splenectomy or after 14 days post-splenectomy 3

Influenza Vaccination

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

Timing of Vaccination

• Elective splenectomy: Vaccinate at least 2 weeks before surgery for optimal antibody response 2, 3
• Emergency splenectomy: Vaccinate no sooner than 14 days after surgery 2, 3
• Important: Avoid starting chemotherapy less than 10 days after vaccination, as this may impair antibody response 5

Special Considerations

Patients with Poor Response to Standard Vaccines

• For patients who develop pneumococcal disease despite previous vaccination with polysaccharide vaccines, consider protein-conjugate pneumococcal vaccines which may induce better immune response 6

Antibiotic Prophylaxis

• While not a vaccination, antibiotic prophylaxis is a critical complementary strategy
• Phenoxymethylpenicillin (Penicillin V) 250-500 mg twice daily is recommended 4, 2
• For penicillin-allergic patients: Erythromycin 500 mg twice daily 4, 2
• Patients should keep a supply of emergency antibiotics (amoxicillin) at home 2

Patient Education

• Provide patients with a Medic-Alert bracelet/card indicating their asplenic status 4, 2
• Educate patients to recognize signs of infection and seek immediate medical attention for fever >38°C (101°F) 2
• Any feverish illness should be treated as a medical emergency 2

Vaccination Coverage Challenges

• Studies show poor vaccination coverage among splenectomized patients, with rates ranging from 27-42% for pneumococcal vaccines 1, 7
• Vaccination rates decrease with patient age 7
• Proper vaccination could prevent approximately 28% of post-splenectomy invasive bacterial infections 7

Animal and Tick Bite Precautions

• Animal bites require a 5-day course of co-amoxiclav (erythromycin for allergic patients) due to risk of Capnocytophaga canimorsus infection 4
• Tick bites pose risk of babesiosis; patients should be educated about this risk 4

Proper vaccination is the cornerstone of preventing life-threatening infections in splenectomized patients. Despite clear guidelines, vaccination coverage remains suboptimal, highlighting the need for improved patient education and healthcare provider awareness.