Do I need to redo any vaccines after a splenectomy (surgical removal of the spleen)?

Vaccination After Splenectomy

Yes, you absolutely need specific vaccinations after splenectomy, and these require periodic revaccination throughout your lifetime to maintain protection against life-threatening infections.

Core Vaccination Requirements

After splenectomy, you face a lifelong risk of overwhelming post-splenectomy infection (OPSI), which carries a mortality rate of 30-70% and can occur even decades after surgery 1, 2. You require three essential vaccines:

Pneumococcal Vaccination

• Start with PCV13, PCV15, or PCV20 (preferred), followed by PPSV23 at least 8 weeks later if you haven't been vaccinated before 2, 3
• Give a second dose of PPSV23 exactly 5 years after the first dose 2, 3
• Revaccinate with PPSV23 every 5-10 years for life 1, 2
• Children under 2 years need reimmunization after 2 years due to reduced antibody response 1

Meningococcal Vaccination

• Administer both MenACWY and MenB vaccines - you need both types 2, 3
• Give MenACWY as 2 doses, 8 weeks apart for patients aged ≥10 years 3
• Revaccinate with MenACWY every 5 years for life 2, 3
• Revaccinate with MenB every 2-3 years if risk remains 2

Haemophilus Influenzae Type B (Hib)

• One single dose is required for all unvaccinated adults 2, 3

Annual Influenza Vaccine

• Receive inactivated influenza vaccine every year to reduce risk of secondary bacterial infections 1, 3
• Never use the nasal spray (live attenuated) version 3

Critical Timing Considerations

For Elective Splenectomy

• Administer all vaccines at least 2 weeks before surgery to ensure optimal antibody response 1, 2
• Ideally, vaccinate 4-6 weeks before surgery if possible 2

For Emergency/Trauma Splenectomy

• Wait at least 14 days after surgery before vaccinating once the patient stabilizes 2, 4
• Antibody response is suboptimal before this time 4

Why Revaccination Is Essential

The need for revaccination stems from several critical factors:

• Antibody levels decline more rapidly in asplenic patients than in the general population 1
• You require higher antibody levels than people with intact spleens to fight infections 1
• The infection risk is lifelong - cases of fulminant infection have been reported more than 20 years after splenectomy 1
• Most infections occur within the first 2 years, but up to one-third manifest at least 5 years later 1, 4

Additional Critical Preventive Measures

Antibiotic Prophylaxis

• Lifelong prophylactic antibiotics should be offered, with highest priority in the first 2 years post-splenectomy 1, 2
• Phenoxymethylpenicillin is the standard prophylactic agent 2, 3
• Keep emergency standby antibiotics (amoxicillin) at home for immediate use at first sign of fever, malaise, or chills 1, 2

Patient Education and Monitoring

• Seek immediate medical attention for any fever >101°F (38°C) 2, 3
• Carry a Medic-Alert card indicating your asplenic status 1, 4
• After dog or animal bites, you require a 5-day course of co-amoxiclav due to susceptibility to Capnocytophaga canimorsus 1, 4

Common Pitfalls to Avoid

• Do not forget lifelong revaccination - this is the most critical error, as protection wanes over time and infection risk persists for life 2
• Do not assume childhood vaccines are sufficient - adults need specific post-splenectomy vaccination regardless of prior immunization history 2, 3
• Do not delay vaccination after emergency splenectomy - vaccinate as soon as the 14-day post-operative window opens 2, 4
• Do not use live vaccines (like nasal flu spray) in asplenic patients 3

Special Considerations

• If you received rituximab in the previous 6 months, vaccine response may be suboptimal and should be reassessed once B-cell recovery occurs 2
• Patients with functional hyposplenism (from conditions like sickle cell disease) require identical preventive measures as surgical splenectomy 2
• Current vaccines don't provide complete coverage against all bacterial serotypes, so vigilance remains essential even with proper vaccination 4