What vaccines are required prior to splenectomy?

Vaccines Required Prior to Splenectomy

All patients undergoing splenectomy require three essential vaccines—pneumococcal, meningococcal, and Haemophilus influenzae type b (Hib)—administered at least 2 weeks before elective surgery or at least 2 weeks after emergency splenectomy. 1, 2

Optimal Timing for Vaccination

• Administer all vaccines at least 2 weeks (ideally 2-6 weeks) before elective splenectomy to allow optimal antibody response before the patient becomes functionally asplenic 1, 3
• If preoperative vaccination is not possible, administer vaccines at least 2 weeks after surgery once the patient's condition is stable 1, 2
• The 2-week pre-surgery timing results in significantly higher antibody concentrations compared to vaccination at shorter intervals before or after surgery 1, 2

Pneumococcal Vaccination Protocol

For vaccine-naïve patients aged ≥2 years:

• First, administer PCV13 (or newer PCV15/PCV20) 1, 2, 4
• Then administer PPSV23 at least 8 weeks after PCV13 (not simultaneously) 1, 2, 4
• This sequential "prime-boost" strategy produces superior antibody responses compared to PPSV23 alone 1
• Administer a second dose of PPSV23 five years after the first dose 2, 4
• Revaccinate with PPSV23 every 5-10 years for lifelong protection 2, 4

Meningococcal Vaccination Protocol

Asplenic patients require both MenACWY and MenB vaccines due to 40-70% mortality rates from meningococcal infections: 5, 4

• For patients aged ≥10 years: Administer 2 doses of MenACWY vaccine given at least 8 weeks apart (not a single dose) 1, 5, 4
• Revaccinate with MenACWY every 5 years for life 1, 5, 4
• Administer MenB vaccine series: Either MenB-FHbp (3 doses at 0,1-2, and 6 months) OR MenB-4C (2 doses at least 1 month apart) 5, 4
• MenB booster: Single dose at 1 year after primary series, then every 2-3 years 5

Critical timing consideration for children <2 years with functional asplenia:

• Do NOT use MenACWY-D (Menactra) before age 2 years or within 4 weeks of PCV13, as it interferes with pneumococcal vaccine response 1
• Use MenACWY-CRM (Menveo) instead for this population 1

Haemophilus Influenzae Type b (Hib) Vaccination

• Administer one dose of Hib vaccine to all unvaccinated asplenic persons aged ≥5 years 1, 5, 4
• No revaccination needed if patient completed childhood Hib series 1
• Timing should follow the same 2-week pre-surgery guideline, though specific data on timing effects are limited 1

Additional Recommended Vaccines

• Annual inactivated influenza vaccine (IIV) for all asplenic patients aged ≥6 months 1, 4
• Never use live attenuated influenza vaccine (LAIV/nasal spray) in asplenic patients 1, 4

Common Pitfalls and Critical Considerations

Avoid these errors:

• Do NOT treat asplenic patients like routine young adults—they require the enhanced 2-dose MenACWY series, not a single dose 5
• Do NOT skip MenB vaccination—it is mandatory for asplenic patients, not optional 5, 4
• Do NOT forget lifelong revaccination—protection wanes and infection risk persists for life 2, 5, 4
• Do NOT use MenACWY-D in children <2 years with asplenia—it reduces pneumococcal vaccine response 1

Special populations requiring attention:

• Patients who received rituximab in the previous 6 months may have suboptimal vaccine response; reassess vaccination once B-cell recovery occurs 2
• Patients with functional hyposplenism (sickle cell disease, hemoglobinopathies) require identical vaccination as surgical splenectomy patients 1, 2

Essential Non-Vaccine Preventive Measures

• Prescribe lifelong prophylactic antibiotics (phenoxymethylpenicillin), with highest priority in the first 2 years post-splenectomy 2, 4, 3
• Provide emergency standby antibiotics (amoxicillin) for home use at first sign of fever, malaise, or chills 2, 4
• Educate patients about lifelong infection risk and need for immediate medical attention for fever >101°F (38°C) 2, 4
• Issue medical alert identification indicating asplenic status 2

Risk Magnitude Justifying These Measures

• The lifelong risk of overwhelming post-splenectomy infection (OPSI) carries mortality rates of 30-70% 2, 5, 4
• Streptococcus pneumoniae accounts for approximately 50% of OPSI cases 2
• Cases of OPSI have been reported more than 20 years after splenectomy, confirming lifelong risk 2
• Proper vaccination and prophylaxis can prevent at least 28% of post-splenectomy invasive bacterial infections 6