What vaccinations are recommended for asplenic (without a spleen) patients?

Recommended Vaccinations for Asplenic Patients

Asplenic patients should receive pneumococcal, meningococcal (both MenACWY and MenB), Haemophilus influenzae type b, and annual influenza vaccines to prevent potentially fatal infections from encapsulated bacteria. 1

Core Vaccinations Required

1. Pneumococcal Vaccination

• PCV20 (preferred) for pneumococcal vaccine-naïve patients 1
• Alternatively, PCV15 followed by PPSV23 at least 8 weeks later 1
• For patients with previous pneumococcal vaccination history:
  • If previously received PPSV23: Administer PCV20 (preferred) or PCV15 1
  • If previously received PCV13 only: Administer PCV20 at least 1 year later 1
  • If previously received PCV13 and PPSV23: Administer PCV20 at least 5 years later 1
• Revaccination with PPSV23 should be performed every 6 years 1
• Timing: At least 2 weeks before elective splenectomy or 14 days after emergency splenectomy 1, 2

2. Meningococcal Vaccination

• MenACWY: 2 doses given 8 weeks apart 1
  • Revaccination every 5 years 1
• MenB: 2-3 dose series (depending on vaccine formulation) 1
  • Booster dose 1 year after primary series with revaccination every 2-3 years if risk remains 1
• Timing: At least 2 weeks before elective splenectomy 1, 2

3. Haemophilus influenzae type b (Hib) Vaccination

• One dose of conjugated Hib vaccine for unvaccinated persons aged ≥5 years 1
• No revaccination needed if properly immunized 1
• Timing: At least 2 weeks before elective splenectomy 2

4. Influenza Vaccination

• Annual vaccination with inactivated influenza vaccine 1, 2
• Important to prevent secondary bacterial pneumonia and sepsis 1

Timing of Vaccinations

For Elective Splenectomy:

• Administer all vaccines at least 2 weeks before surgery 1, 2
• This timing allows for optimal antibody formation, which generally takes 9 days 1

For Emergency Splenectomy:

• Administer vaccines 14 days after surgery 1, 2
• Earlier administration may result in insufficient antibody response 1
• Longer delay does not yield additional benefit 1

Special Considerations

• All recommended vaccines can be administered simultaneously at different injection sites 1
• Functional asplenia (e.g., sickle cell disease, hemoglobinopathies) requires the same vaccination strategy as anatomic asplenia 1
• Penicillin prophylaxis is advised for asplenic patients to prevent pneumococcal disease 1, 2
• Vaccination compliance is often suboptimal (33-55% depending on vaccine) despite clear guidelines 3

Common Pitfalls to Avoid

1. Delaying vaccination: Vaccination should not be postponed as asplenic patients are at high risk for overwhelming post-splenectomy infection (OPSI) with mortality rates of 40-70% 1, 2

2. Incomplete vaccination series: Ensure all recommended vaccines are administered, not just pneumococcal 3

3. Neglecting booster doses: Regular revaccination is essential, especially for pneumococcal (every 6 years) and meningococcal (every 5 years) vaccines 1

4. Overlooking functional asplenia: Patients with functional asplenia (e.g., sickle cell disease) require the same vaccination protocol as those with anatomical asplenia 1

5. Forgetting annual influenza vaccination: Annual influenza vaccination is critical as influenza increases the risk of secondary bacterial infections 1, 2

The risk of overwhelming post-splenectomy infection is highest in the first 1-2 years after splenectomy but remains elevated for more than 10 years and is likely lifelong 2. Therefore, proper vaccination is essential to reduce morbidity and mortality in this vulnerable population.