What vaccinations are recommended after a splenic rupture to prevent infections?

Vaccinations After Splenic Rupture

All patients who have undergone splenectomy or experienced splenic rupture must receive pneumococcal, meningococcal (both MenACWY and MenB), Haemophilus influenzae type b (Hib), and annual influenza vaccines to prevent overwhelming post-splenectomy infection (OPSI), which carries a mortality rate of 30-70%. 1, 2

Core Vaccination Requirements

Pneumococcal Vaccination

• Administer PCV20 (preferred) or PCV15 as the initial pneumococcal vaccine, followed by PPSV23 at least 8 weeks later if using PCV15 3
• For patients previously vaccinated with PCV13 only, give PCV20 at least 1 year later 3
• Revaccinate with PPSV23 every 5 years for life if that vaccine was part of the series 4, 3
• The 23-valent polysaccharide vaccine demonstrates 65-84% effectiveness in asplenic patients and is more than 90% effective in healthy adults under age 55 4, 5

Meningococcal Vaccination

• Administer 2 doses of MenACWY vaccine at least 8 weeks apart (not a single dose as used in routine young adult vaccination) 1, 3
• Give MenB vaccine as either a 2-dose series (MenB-4C) given ≥1 month apart OR a 3-dose series (MenB-FHbp) at 0,1-2, and 6 months 1, 3
• Revaccinate with MenACWY every 5 years for life 1, 3
• Revaccinate with MenB every 2-3 years if risk remains 1, 3
• This enhanced protocol is mandatory because Neisseria meningitidis is one of the most common causative organisms of OPSI 1

Haemophilus influenzae Type b (Hib)

• Administer 1 single dose of Hib vaccine for unvaccinated adults (≥15 months) and asplenic patients aged >59 months 1, 3

Influenza Vaccination

• All post-splenectomy patients must receive annual inactivated or recombinant influenza vaccine to reduce the risk of secondary bacterial infections 4, 3, 2

Critical Timing Considerations

Elective Splenectomy

• Administer all vaccines at least 2 weeks before elective surgery to ensure optimal antibody response 4, 1, 3, 2
• Ideally, vaccinate 4-6 weeks before surgery if possible 3
• The 2-week pre-surgery timing is particularly important for PPSV23, as this results in higher antibody concentrations compared to vaccination at shorter intervals 3

Emergency/Traumatic Splenectomy

• Wait at least 14 days post-operatively before vaccinating in cases of emergency or trauma splenectomy, as antibody response is suboptimal before this time 1, 3, 2
• Vaccinate as soon as the patient's condition stabilizes after the 14-day window 3

Additional Preventive Measures

Antibiotic Prophylaxis

• Offer lifelong prophylactic antibiotics to all patients, with highest priority in the first 2 years post-splenectomy 4, 3, 2
• Phenoxymethylpenicillin is the standard prophylactic agent 4, 2
• For penicillin-allergic patients, offer erythromycin 4
• Provide emergency standby antibiotics (amoxicillin) for home use at first sign of fever, malaise, or chills 4, 3, 2

Patient Education and Documentation

• Issue a Medic-Alert disc and post-splenectomy card indicating asplenic status 4, 3
• Educate patients about their lifelong infection risk and the need for immediate emergency department evaluation with fever >101°F (38°C) 3
• Formally notify primary care providers of the patient's asplenic status to ensure appropriate ongoing care 2

Special Infection Risks

• After dog or animal bites, administer a 5-day course of co-amoxiclav (erythromycin in allergic patients) due to susceptibility to Capnocytophaga canimorsus 4, 2
• Provide malaria prophylaxis for travelers to endemic areas 2
• Warn patients about tick-borne infections (babesiosis), particularly those in contact with animals 4

Common Pitfalls to Avoid

Critical Errors in Vaccination

• Do not treat asplenic patients like routine young adults with a single dose of MenACWY—they require the enhanced 2-dose series 1
• Do not forget lifelong revaccination, as protection wanes and infection risk persists for life 1, 3
• Do not omit MenB vaccination—it is mandatory for asplenic patients, not permissive as in routine young adult vaccination 1

Special Populations

• Patients who received rituximab in the previous 6 months may have suboptimal vaccine response; vaccination should be reassessed once B-cell recovery has occurred 3
• Children under 2 years have inherently reduced antibody response and should be reimmunized after 2 years 4, 3
• Immunocompromised persons may have diminished immune response to vaccines 5

Clinical Context and Evidence Quality

The risk of OPSI is lifelong and clinically significant, with cases reported more than 20 years after splenectomy 3. Streptococcus pneumoniae accounts for approximately 50% of OPSI cases 3. The most recent CDC and National Comprehensive Cancer Network guidelines (2025) provide the highest quality evidence for these recommendations 1, 3. Vaccination coverage studies demonstrate suboptimal adherence globally (ranging from 18.7% for Hib to 55.1% for pneumococcal vaccines), highlighting the need for systematic implementation of these protocols 6, 7.