What meningococcal conjugate vaccine is recommended for patients post-splenectomy (removal of the spleen)?

Meningococcal Vaccination for Splenectomy Patients

Splenectomy patients should receive both the quadrivalent meningococcal conjugate vaccine (MenACWY) as a 2-dose series given 8 weeks apart AND the meningococcal serogroup B vaccine (MenB) series, with MenACWY boosters every 5 years and MenB boosters at 1 year then every 2-3 years thereafter. 1

Vaccine Selection and Dosing

MenACWY (Serogroups A, C, W, Y)

• Asplenic patients aged ≥10 years require a 2-dose primary series of MenACWY given at least 8 weeks apart, not the single dose used for routine adolescent vaccination 1, 2
• Available MenACWY products include MenACWY-D (Menactra) and MenACWY-CRM (Menveo), both acceptable for splenectomy patients 1, 3
• Critical distinction: For children with functional or anatomic asplenia under age 2 years, use MenACWY-CRM (not MenACWY-D) to avoid interference with pneumococcal conjugate vaccine (PCV13) immune response 1

MenB (Serogroup B)

• All asplenic patients should receive MenB vaccination in addition to MenACWY 1, 2
• Two non-interchangeable products exist: MenB-FHbp (3-dose series at 0,1-2, and 6 months) OR MenB-4C (2-dose series given ≥1 month apart) 2
• The same MenB product must be used for all doses in the series; if product is unknown, restart the series 1

Timing Considerations

Pre-Operative Vaccination (Preferred)

• Administer meningococcal vaccines at least 2 weeks before elective splenectomy whenever possible 1, 4
• This 2-week window allows adequate antibody formation, which generally takes 9 days 1, 4
• If vaccines are given 2 weeks pre-operatively, they do not need to be repeated post-operatively 4

Post-Operative Vaccination

• If pre-operative vaccination was not possible, administer vaccines 14 days after surgery once the patient's condition is stable 1, 4
• Longer delays beyond 14 days post-operatively provide no additional benefit 1

Booster Schedule

MenACWY Boosters

• Revaccinate with MenACWY every 5 years for life due to persistent infection risk 1, 4, 2
• This differs from routine adolescent vaccination, which does not require ongoing boosters 2

MenB Boosters

• Administer first MenB booster 1 year after completing the primary series 1, 2
• Subsequent MenB boosters every 2-3 years if risk persists 1, 2

Clinical Rationale

Infection Risk

• Asplenic patients face 40-70% mortality from meningococcal infections, making vaccination critical 1, 2
• The risk of overwhelming post-splenectomy infection (OPSI) remains elevated throughout life 2
• Neisseria meningitidis is one of the most common causative organisms in OPSI 2

Vaccine Immunogenicity

• Conjugate vaccines (MenACWY) induce T-lymphocyte-dependent immune responses with immunologic memory, superior to older polysaccharide vaccines 3
• Studies demonstrate that sequential meningococcal vaccination is immunogenic in splenectomized patients, with vaccine response rates of 92.5-100% for rSBA and 55.6-77.1% for hSBA after the first dose 5
• A second MenACWY dose achieves vaccine response rates of 73.0-100% across all serogroups 5

Coordination with Other Vaccines

• All recommended vaccines for asplenic patients (pneumococcal, Haemophilus influenzae type b, and meningococcal) can be administered simultaneously at different injection sites 1, 4
• For children with asplenia, complete all PCV13 doses before administering MenACWY-D, or wait at least 4 weeks after PCV completion 1

Common Pitfalls to Avoid

Treating as Routine Vaccination

• Do not give asplenic patients the single-dose MenACWY regimen used for healthy adolescents; they require the enhanced 2-dose series 2
• Do not omit MenB vaccination—it is mandatory for asplenic patients, not optional as it is for healthy young adults 2

Forgetting Lifelong Boosters

• Failure to schedule and administer MenACWY boosters every 5 years is a critical error, as protection wanes and infection risk persists for life 4, 2
• Document the need for ongoing boosters clearly in the medical record and patient education materials 4

Inadequate Patient Education

• Educate patients about their lifelong increased infection risk and the need to seek immediate medical attention for fevers >101°F (38°C) 4
• Provide written documentation of vaccination status and booster schedule 4

Missing Concurrent Vaccinations

• Asplenic patients also require pneumococcal vaccination (PCV followed by PPSV23) and Haemophilus influenzae type b vaccine—meningococcal vaccination alone is insufficient 1, 4, 2