Standard Post-Splenectomy Vaccine Regimens
The Human Papilloma Virus (HPV) vaccine is not considered a standard post-splenectomy vaccine regimen for patients with intraabdominal bleeding from the spleen secondary to blunt abdominal trauma. 1, 2
Standard Post-Splenectomy Vaccines
Post-splenectomy patients require specific vaccinations to prevent overwhelming post-splenectomy infection (OPSI), which carries a mortality rate of 30-70%. The standard vaccines include:
- Pneumococcal vaccines: Both Prevnar 13 (PCV13) and PPSV23 are recommended as standard post-splenectomy vaccines to protect against Streptococcus pneumoniae 3, 1
- Haemophilus influenzae type b vaccine: One dose is recommended for unvaccinated asplenic patients to prevent infections from this encapsulated bacteria 3
- Meningococcal vaccines: Both quadrivalent meningococcal conjugate vaccine (MenACWY) and meningococcal serogroup B vaccine are standard recommendations 1, 2
- Annual influenza vaccine: Recommended for all patients over 6 months of age who have undergone splenectomy 1
Timing of Vaccination
The optimal timing for vaccination depends on whether the splenectomy was planned or emergent:
- For elective splenectomy: Vaccines should ideally be administered at least 2 weeks before surgery to ensure optimal antibody response 4
- For emergency splenectomy (as in trauma cases): Vaccination should be started no sooner than 14 days after splenectomy, as antibody response is suboptimal before this time 3, 1
- If patients are discharged before 15 days after splenectomy, vaccination before discharge is recommended when the risk of missing vaccination is high 3
Revaccination Schedule
Asplenic patients require booster doses to maintain protection:
- Pneumococcal vaccine (PPSV23): Revaccination every 5 years 4
- Meningococcal vaccine (MenACWY): Revaccination every 5 years 2
- Meningococcal B vaccine: Booster dose 1 year after primary series with revaccination every 2-3 years if risk remains 2
Common Pitfalls and Considerations
- Poor compliance with vaccination guidelines is common among splenectomized patients, with studies showing suboptimal coverage rates ranging from 13.3% to 55.1% 5, 6
- Many healthcare providers fail to administer the complete set of recommended vaccines or follow-up booster doses 7
- Patients may not receive proper education about their lifelong increased risk of infection and the importance of vaccination 8
- For patients undergoing splenic embolization, if 50% or more of the splenic mass is lost, they should receive the same vaccination regimen as splenectomized patients 7
Additional Preventive Measures
- Antibiotic prophylaxis should be considered, especially in the first two years post-splenectomy 4
- Patients should be educated about their increased infection risk and the need to seek immediate medical attention for fevers over 101°F (38°C) 4
- Primary care providers should be informed of the patient's asplenic status to ensure proper ongoing care 1