What vaccinations are recommended for individuals with asplenia (absence of a spleen)?

From the Guidelines

Individuals with asplenia should receive pneumococcal vaccines (both PCV13 and PPSV23), meningococcal vaccines (MenACWY and MenB), Haemophilus influenzae type b (Hib) vaccine, and yearly influenza vaccines to prevent severe infections. The recommended sequence for pneumococcal vaccines is PCV13 first, followed by PPSV23 at least 8 weeks later 1. For meningococcal protection, both the MenACWY vaccine with a booster every 5 years and the MenB series are necessary 1. Additionally, staying current with all routine adult vaccines, including tetanus, diphtheria, and pertussis (Tdap), is crucial 1.

Key Vaccinations

• Pneumococcal vaccines: PCV13 and PPSV23
• Meningococcal vaccines: MenACWY and MenB
• Haemophilus influenzae type b (Hib) vaccine
• Yearly influenza vaccines
• Routine adult vaccines: tetanus, diphtheria, and pertussis (Tdap)

Timing of Vaccinations

• Ideally, vaccinations should be given at least 2 weeks before splenectomy 1
• If splenectomy is planned, PPSV23 should be administered ≥2 weeks prior to surgery or ≥2 weeks following surgery 1
• In patients discharged before 15 days after splenectomy, the first vaccines should be given before discharge 1

Importance of Vaccinations

Without a spleen, the body has difficulty fighting encapsulated bacteria that cause severe infections, making these vaccines crucial for additional protection 1. The spleen normally filters bacteria from the blood and contains immune cells that help fight infections, so without it, these vaccines are necessary to prevent potentially life-threatening infections.

From the Research

Vaccination Recommendations for Individuals with Asplenia

• Individuals with asplenia (absence of a spleen) are at increased risk of infections, particularly those caused by encapsulated bacteria such as Streptococcus pneumoniae 2.
• Vaccination against pneumococcal disease is essential for individuals with asplenia, and the recommended vaccinations include:
  • 13-valent pneumococcal conjugate vaccine (PCV13) 3, 2
  • 23-valent pneumococcal polysaccharide vaccine (PPSV23) 4, 5, 6
• The use of PCV13 as a booster dose in asplenic patients with previous PPSV23 vaccination has been shown to be immunogenic for certain serotypes 2.
• Adherence to vaccination guidelines is crucial, and individuals with asplenia should receive both pneumococcal and meningococcal vaccinations 2.

Immunogenicity and Efficacy of Pneumococcal Vaccines

• Studies have shown that PCV13 elicits a functional immune response and is noninferior to PPSV23 for certain serotypes 3.
• PPSV23 has been shown to be effective against vaccine-type invasive pneumococcal disease and vaccine-type pneumococcal pneumonia 5.
• The use of both conjugate and purified polysaccharide modalities in series has produced greater and lasting immunity 6.

Specific Recommendations for Asplenic Individuals

• Asplenic individuals who have previously received PPSV23 can receive PCV13 as a booster dose, which has been shown to be immunogenic for certain serotypes 2.
• Asplenic individuals should receive meningococcal vaccination, in addition to pneumococcal vaccination, to reduce the risk of overwhelming post-splenectomy infection (OPSI) 2.