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

Recommended Vaccinations After Splenectomy

Patients who have undergone splenectomy should receive immunization against encapsulated bacteria (Streptococcus pneumoniae, Haemophilus influenzae type B, and Neisseria meningitidis) to prevent life-threatening overwhelming post-splenectomy infection (OPSI). 1

Core Vaccinations Required

• Streptococcus pneumoniae vaccine 1
• Haemophilus influenzae type B (Hib) vaccine 1
• Neisseria meningitidis vaccine (including serogroups ACYW135 and B) 1
• Annual influenza vaccine for all patients over 6 months of age 1

Optimal Timing of Vaccination

• Ideally, vaccinations should be administered at least 2 weeks before splenectomy if the procedure is planned 1
• For emergency splenectomy or trauma cases, vaccination should be started no sooner than 14 days after splenectomy, as antibody response is suboptimal before this time 1
• If patients are discharged before 15 days post-splenectomy and there is high risk of missing vaccination, vaccines should be administered before discharge 1

Risk of Overwhelming Post-Splenectomy Infection (OPSI)

• OPSI presents as fulminant sepsis, meningitis, or pneumonia primarily caused by encapsulated bacteria 1
• Mortality rate ranges from 30-70%, with most deaths occurring within the first 24 hours 1
• Risk is highest in the first year after splenectomy but remains elevated for life 1
• Children under 5 years have greater overall risk of OPSI with increased mortality compared to adults 1

Vaccination Coverage Issues

• Studies show suboptimal vaccination coverage among splenectomized patients globally:
  • Pneumococcal vaccine: 55.1% coverage 2
  • Hib vaccine: 48.3% coverage 2
  • Meningococcal C/ACYW135: 33.7% coverage 2
  • Meningococcal B: 13.3% coverage 2
  • Influenza: 53.2% coverage 2

Additional Preventive Measures

• Malaria prophylaxis is strongly recommended for travelers to endemic areas 1
• Patients should be provided with emergency antibiotics for use in case of sudden onset of fever, malaise, chills, or other constitutional symptoms 1
• Recommended emergency antibiotics for adults:
  • Amoxicillin, 3g starting dose followed by 1g every 8 hours 1
  • For beta-lactam allergic patients: Levofloxacin 500mg daily or Moxifloxacin 400mg daily 1
• Primary care providers should be informed of the patient's asplenic status 1

Common Pitfalls to Avoid

• Timing of vaccination is critical - antibody response is suboptimal if vaccines are given less than 14 days after splenectomy 3
• Failure to provide booster doses - studies show many patients receive initial vaccination but not the recommended boosters 4
• Patients should be informed that vaccination reduces but does not eliminate the risk of OPSI 1
• Patients with splenic embolization (where ≥50% of splenic mass is lost) should be treated as asplenic and receive the same vaccinations 4

Special Considerations

• Children under age 5 have higher risk of OPSI and require careful attention to vaccination status 1
• Patients should be educated about their lifelong increased risk of infection 1
• Current vaccines do not provide complete coverage against all serotypes (e.g., pneumococcal vaccines cover only 23 of 90 serotypes) 1