Can asplenic patients receive the routine flu shot?

Influenza Vaccination in Asplenic Patients

Yes, asplenic patients should receive the routine inactivated influenza vaccine annually. 1

Rationale for Influenza Vaccination in Asplenic Patients

• While asplenic patients do not have a higher risk of influenza virus infection compared to the general population, influenza may increase their risk for secondary bacterial pneumonia and sepsis 1
• Annual influenza vaccination has been shown to be associated with a 54% reduced mortality compared with unvaccinated asplenic patients 1
• The World Society of Emergency Surgery (WSES) guidelines strongly recommend annual immunization against seasonal flu for all asplenic patients over 6 months of age 1

Vaccination Recommendations for Asplenic Patients

Influenza Vaccine

• Annual vaccination with inactivated influenza vaccine is recommended for all asplenic patients 1
• Only the inactivated influenza vaccine should be used, not the live attenuated influenza vaccine (nasal spray) 1, 2
• Influenza vaccination helps reduce the risk of secondary bacterial infections in asplenic patients 1

Other Essential Vaccines for Asplenic Patients

• Pneumococcal vaccines: PCV13 followed by PPSV23 (with an interval of ≥8 weeks between them) 1
• Haemophilus influenzae type b (Hib) vaccine: One dose for unvaccinated persons aged ≥5 years 1
• Meningococcal vaccines: Tetravalent conjugated meningococcal vaccine (MenACWY) with revaccination every 5 years 1
• Meningococcal B vaccine (MenB) is also recommended for asplenic patients 1

Timing of Vaccination

• For elective splenectomy: Vaccines should ideally be administered at least 2 weeks before surgery to ensure optimal antibody response 1
• For emergency splenectomy: Vaccines should be administered at least 14 days after surgery 1
• If there is high risk of missing vaccination, it's better to vaccinate before discharge even if within the 14-day window 1

Special Considerations

• Asplenia itself is not a contraindication to routine immunization 1
• Antibody levels may decline more rapidly in asplenic patients, potentially requiring earlier revaccination than in the general population 1
• Both anatomic asplenia (surgical removal) and functional asplenia (e.g., sickle cell disease) require the same vaccination approach 1
• Vaccination coverage among asplenic patients is often suboptimal worldwide, with influenza vaccination rates around 53.2% 3

Common Pitfalls to Avoid

• Do not administer live attenuated influenza vaccine (nasal spray) to asplenic patients 1, 2
• Do not delay annual influenza vaccination if influenza season has already begun 2
• Do not assume that vaccination alone is sufficient protection; asplenic patients should also be educated about their increased infection risk and the need for prompt medical attention if fever develops 1, 4
• Do not forget that asplenic patients may require antibiotic prophylaxis in addition to vaccination, especially in the first two years after splenectomy 1, 5

By ensuring asplenic patients receive their annual influenza vaccine along with other recommended immunizations, healthcare providers can significantly reduce the risk of serious infections and associated mortality in this vulnerable population.