What is the dose, route, and trade name in India for the polyvalent pneumococcal vaccine (Pneumovax, Pneumo 23), Haemophilus influenzae type b (Hib) vaccine (Hibite), and quadrivalent meningococcal polysaccharide vaccine (Menactra, Mencevax)?

Dose, Route, and Trade Names of Vaccines in India

For asplenic patients in India, the recommended vaccines are Pneumovax 23 (pneumococcal polysaccharide vaccine), Hiberix (Haemophilus influenzae type b vaccine), and Mencevax/Menactra (meningococcal vaccines), administered intramuscularly with specific dosing schedules based on age and risk factors.

Pneumococcal Polysaccharide Vaccine (Pneumovax 23, Pneumo 23)

• Dose: 0.5 mL single dose 1
• Route: Intramuscular injection in the deltoid muscle (preferred) or subcutaneous injection 1
• Trade name in India: Pneumovax 23 or Pneumo 23 2
• Schedule for asplenic patients:
  • For patients ≥2 years: PPSV23 should be administered at least 8 weeks after PCV13 2
  • A second dose of PPSV23 should be administered 5 years after the first dose 2, 3
  • For patients planning splenectomy: PPSV23 should be administered ≥2 weeks prior to surgery (after indicated PCV13 doses) or ≥2 weeks following surgery if pre-surgical vaccination is not possible 2

Haemophilus influenzae type b (Hib) Vaccine

• Dose: 0.5 mL single dose 2
• Route: Intramuscular injection 2
• Trade name in India: Hiberix 2
• Schedule for asplenic patients:
  • One dose of Hib vaccine should be administered to unvaccinated persons aged ≥5 years who are asplenic 2
  • For children under 5 years, follow the routine childhood immunization schedule 2
  • For asplenic patients, a single dose is recommended regardless of prior vaccination history 3

Meningococcal Vaccines

Quadrivalent Meningococcal Polysaccharide Vaccine (MPSV4)

• Dose: 0.5 mL single dose 2
• Route: Subcutaneous injection 2
• Trade names in India: Mencevax ACWY 2

Quadrivalent Meningococcal Conjugate Vaccine (MCV4)

• Dose: 0.5 mL single dose 2
• Route: Intramuscular injection 2
• Trade names in India: Menactra 2
• Schedule for asplenic patients:
  • Meningococcal vaccine should be administered to patients aged ≥2 months who are asplenic 2
  • MCV4-D should not be administered in patients aged <2 years when administered with PCV due to reduced antibody response to some pneumococcal serotypes 2
  • Revaccination with MCV4 (or MPSV4 for those aged >55 years who have not received MCV4) is recommended every 5 years 2, 3

Important Considerations

• Timing of vaccination: Ideally, vaccines should be administered at least 2 weeks before elective splenectomy to ensure optimal immune response 2, 4
• Vaccine interactions: When administering multiple vaccines, be aware of potential interactions. For example, MCV4-D should not be given simultaneously with PCV in children under 2 years 2
• Revaccination requirements: Asplenic patients require booster doses of both pneumococcal and meningococcal vaccines to maintain protection 3
• Vaccination coverage concerns: Studies show that vaccination coverage in asplenic patients is often suboptimal, with rates ranging from 27-42% for recommended vaccines 5, 6

Common Pitfalls to Avoid

• Delaying vaccination: Failure to vaccinate prior to elective splenectomy increases risk of overwhelming post-splenectomy infection 4
• Incomplete vaccination series: Many asplenic patients do not receive all recommended vaccines or booster doses 5, 6
• Neglecting booster doses: The risk of infection in asplenic patients is lifelong, with infections occurring as late as 40 years after splenectomy, making booster doses critical 3
• Improper timing: Administering vaccines too close to each other may affect immune response, particularly with conjugate vaccines containing cross-reacting material 7

Remember that asplenic patients have a 10-50 fold higher risk than the general population of developing overwhelming post-splenectomy infection, making appropriate vaccination crucial for reducing morbidity and mortality 5.