Recommended Vaccinations After Splenectomy
Patients who have undergone splenectomy should receive vaccinations against encapsulated bacteria including Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae type B, and annual influenza vaccine to prevent life-threatening overwhelming post-splenectomy infection (OPSI). 1
Core Vaccinations Required
- Pneumococcal vaccines: Both the 13-valent pneumococcal conjugate vaccine (PCV13) and the 23-valent pneumococcal polysaccharide vaccine (PPSV23) are recommended, as the current vaccines don't provide complete coverage against all serotypes 1, 2
- Meningococcal vaccines: Both meningococcal ACWY conjugate vaccine (2 doses) and meningococcal B vaccine (2 doses) are recommended 1, 3
- Haemophilus influenzae type B (Hib): One dose is recommended for all asplenic patients 1, 2
- Annual influenza vaccine: Recommended yearly to reduce the risk of secondary bacterial infections 4, 1
Optimal Timing of Vaccination
- For elective splenectomy: Ideally, vaccinations should be administered at least 2 weeks before surgery to ensure optimal antibody response 4, 1
- For emergency splenectomy: Vaccination should be started no sooner than 14 days after splenectomy, as antibody response is suboptimal before this time 1
- Reimmunization schedule:
Risk of Overwhelming Post-Splenectomy Infection (OPSI)
- OPSI presents as fulminant sepsis, meningitis, or pneumonia primarily caused by encapsulated bacteria, with mortality rates of 30-70% 1
- The risk of serious infection is highest in the first two years after splenectomy, but up to one-third of infections occur at least five years later 4
- Children under 5 years have a greater overall risk of OPSI with increased mortality compared to adults 1
- The risk of dying from serious infection is clinically significant and almost certainly lifelong 4
Additional Preventive Measures
- Antibiotic prophylaxis: Lifelong prophylactic antibiotics (phenoxymethylpenicillin or erythromycin for penicillin-allergic patients) should be offered in all cases, especially in the first two years after splenectomy 4
- Emergency antibiotics: Patients should keep a supply of antibiotics (e.g., amoxicillin) at home to use immediately if symptoms of infection develop 4, 1
- Patient education: Patients should be educated about their lifelong increased risk of infection and the need for immediate medical attention if they develop fever or other signs of infection 1
- Special precautions for travelers: Malaria prophylaxis is strongly recommended for travelers to endemic areas 1
Common Pitfalls and Challenges
- Low vaccination coverage: Studies consistently show suboptimal immunization coverage among splenectomized patients worldwide, with rates ranging from 27-55% for recommended vaccines 3, 5, 6
- Lack of adherence to guidelines: Healthcare providers often fail to follow international guidelines for post-splenectomy care 6
- Animal and tick bites: Asplenic patients are particularly susceptible to infection by Capnocytophaga canimorsus from dog bites and should receive a five-day course of co-amoxiclav (or erythromycin if allergic) 4
- Incomplete protection: Current vaccines do not provide complete coverage against all serotypes, highlighting the need for ongoing vigilance 1
Special Considerations
- Children: Almost all splenectomized children under age 10 receive Hib and PCV vaccines as part of childhood immunization programs, but additional vaccines are needed 3
- Vaccination efficacy: The HIB-conjugate vaccine has been shown to produce significantly higher antibody levels in children undergoing splenectomy compared to the pure polysaccharide vaccine 7
- Primary care coordination: Primary care providers should be informed of the patient's asplenic status to ensure proper ongoing care and management 1