What vaccines are recommended for post-splenectomy patients?

Recommended Vaccines for Post-Splenectomy Patients

Post-splenectomy patients require vaccination against encapsulated bacteria—specifically pneumococcal, meningococcal (both MenACWY and MenB), Haemophilus influenzae type b (Hib), and annual influenza—to prevent life-threatening overwhelming post-splenectomy infection (OPSI), which carries a 30-70% mortality rate. 1, 2

Core Vaccination Requirements

Pneumococcal Vaccination

• Administer PCV20 (preferred) or PCV15 as the initial pneumococcal vaccine 1
• If PCV15 is used, follow with PPSV23 at least 8 weeks later 1, 3
• If PCV20 is used, no PPSV23 is needed 1
• For patients previously vaccinated with PCV13 only, give PCV20 at least 1 year later 1
• Revaccinate with PPSV23 every 5 years if that vaccine was part of the series 1, 3

Meningococcal Vaccination

• Administer both MenACWY and MenB vaccines—this is mandatory, not optional 1, 4
• MenACWY: Give 2 doses 8 weeks apart (not the single dose used in routine young adult vaccination) 1, 4
• MenB: Give either 2-dose or 3-dose series depending on formulation (MenB-FHbp: 3 doses at 0,1-2, and 6 months; MenB-4C: 2 doses ≥1 month apart) 1, 4
• Revaccinate with MenACWY every 5 years for life 1, 4
• Revaccinate with MenB: 1 booster dose at 1 year, then every 2-3 years if risk remains 1, 4

Haemophilus Influenzae Type b (Hib)

• Administer 1 single dose for unvaccinated adults 1, 4
• This vaccine is considered optional due to limited efficacy data in adults, but good immunogenicity has been demonstrated 1

Annual Influenza Vaccination

• All post-splenectomy patients should receive annual inactivated or recombinant influenza vaccine 1, 2
• This reduces risk of secondary bacterial infections 2, 3

Optimal Vaccination Timing

For Elective Splenectomy

• Administer all vaccines at least 2 weeks before surgery 1, 2, 3, 5
• This timing allows for optimal antibody response before the patient becomes functionally asplenic 3
• The 2-week pre-surgery window is critical for achieving higher antibody concentrations 3

For Emergency/Trauma Splenectomy

• Wait at least 14 days post-operatively before vaccinating 1, 2, 3, 5
• Antibody response is suboptimal if vaccines are given earlier than 14 days after surgery 2, 6
• Functional antibody activity is significantly better when vaccination is delayed to 14 days compared to earlier timepoints 6

Critical Clinical Pitfalls to Avoid

Common Errors

• Do not treat asplenic patients like routine young adults for meningococcal vaccination—they require the enhanced 2-dose MenACWY series plus mandatory MenB vaccination, not the single dose given to healthy adolescents 4
• Do not forget lifelong revaccination—protection wanes and infection risk persists for life, requiring MenACWY boosters every 5 years and MenB boosters every 2-3 years 1, 4
• Do not vaccinate too early after emergency splenectomy—waiting until day 14 post-operatively produces significantly better functional antibody responses 6

Special Populations

• Patients who received rituximab in the previous 6 months may have suboptimal vaccine response—reassess vaccination once B-cell recovery has occurred 3
• Children under 2 years have inherently reduced antibody response—they should be reimmunized after age 2 years 3

Additional Preventive Measures Beyond Vaccination

Antibiotic Prophylaxis

• Offer lifelong prophylactic antibiotics (typically phenoxymethylpenicillin), especially in the first 2 years post-splenectomy 2, 3
• Provide emergency standby antibiotics (amoxicillin) for home use at first sign of fever, malaise, or chills 2, 3

Patient Education

• Educate patients about lifelong infection risk and need for immediate medical attention with fever >101°F (38°C) 2, 3
• Provide written information and consider Medic-Alert identification indicating asplenic status 2, 3
• Inform patients about special risks: dog bites require 5-day course of co-amoxiclav due to Capnocytophaga canimorsus susceptibility 2, 3
• Strongly recommend malaria prophylaxis for travelers to endemic areas 2

Healthcare System Coordination

• Formally notify primary care providers of the patient's asplenic status to ensure appropriate ongoing care 2, 3

Rationale for This Comprehensive Approach

The risk of OPSI is highest in the first 2 years after splenectomy, but up to one-third of infections occur at least 5 years later, making this a lifelong concern 2. Streptococcus pneumoniae accounts for approximately 50% of OPSI cases, with Neisseria meningitidis and Haemophilus influenzae representing other major pathogens 2, 3. Current vaccines do not provide complete coverage against all serotypes, highlighting the need for multiple vaccines plus non-vaccine preventive measures 2.