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

Post-Splenectomy Vaccination Recommendations

Patients who have undergone splenectomy should receive pneumococcal, meningococcal, Haemophilus influenzae type b, and annual influenza vaccines to prevent potentially fatal infections from encapsulated bacteria. 1

Rationale for Vaccination

Asplenic patients face a lifelong risk of overwhelming post-splenectomy infection (OPSI), which carries a case-fatality rate of 50-80%. 1 This risk is 10-50 times higher than in the general population. 2 Vaccination is a critical preventive measure, although it does not guarantee complete protection against fulminant disease.

Recommended Vaccines and Timing

Pneumococcal Vaccines

• PCV13 (conjugate vaccine) followed by PPSV23 (polysaccharide vaccine) with at least 8 weeks interval between doses
• PPSV23 booster dose after 5 years
• Timing: At least 2 weeks before elective splenectomy, or no sooner than 14 days after emergency splenectomy 1, 3

Haemophilus influenzae type B (Hib) Vaccine

• Single dose as part of routine vaccination schedule
• Timing: Same as pneumococcal vaccines 1, 3

Meningococcal Vaccines

• Meningococcal ACYW135 conjugate vaccine (2 doses)
• Meningococcal B vaccine (for patients splenectomized after 2014)
• Timing: Same as pneumococcal vaccines 1, 4, 3

Influenza Vaccine

• Annual vaccination for all asplenic patients over 6 months of age 1

Revaccination Considerations

Research shows significant antibody responses to both primary and repeated pneumococcal vaccinations in splenectomized patients. Frequent revaccination (every 1-5 years) is recommended until more definitive data on protective antibody levels becomes available. 5

Common Pitfalls and Challenges

1. Poor vaccination coverage: Studies show suboptimal vaccination rates globally:

   • Pneumococcal: 55.1%
   • Hib: 48.3%
   • Meningococcal C/ACYW135: 33.7%
   • Meningococcal B: 13.3%
   • Influenza: 53.2% 2

2. Lack of awareness: The infection risk in asplenic patients is often misunderstood by healthcare providers, leading to inadequate preventive measures. 6

3. Age-related differences: Vaccination coverage decreases with patient age, with children under 10 years having better coverage due to inclusion in childhood immunization programs. 4

Additional Preventive Measures

Beyond vaccination, asplenic patients should:

• Take prophylactic antibiotics for at least 2 years post-splenectomy (consider lifelong for high-risk patients)
• Keep a supply of amoxicillin at home for immediate use if infection symptoms develop
• Wear a Medic-Alert bracelet
• Seek immediate medical attention for fever >38°C (101°F)
• Take special precautions for animal/tick bites and travel to endemic areas 1

Special Considerations

• Immunocompromised patients (including those with hematologic malignancies): Require lifelong antibiotic prophylaxis and close monitoring
• Children under 5 years: Need special consideration for antibiotic prophylaxis and vaccination
• Animal bite management: Requires a 5-day course of Amoxicillin/Clavulanic acid (or erythromycin for allergic patients) 1