Is the RSV (Respiratory Syncytial Virus) vaccine recommended for individuals with a history of splenectomy?

RSV Vaccination for Individuals with History of Splenectomy

Yes, RSV vaccination is strongly recommended for individuals with a history of splenectomy, as they are considered immunocompromised and at significantly increased risk for severe RSV disease.

Rationale for Vaccination in Splenectomized Patients

Splenectomized individuals fall into the high-risk category of immunocompromised patients who should receive RSV vaccination. Adults with anatomic or functional asplenia are explicitly recognized as immunocompromised and at elevated risk for severe RSV-associated outcomes, including hospitalization and death. 1

Immunocompromised Status and RSV Risk

• Immunocompromised patients, including those with asplenia, face substantially higher morbidity and mortality from RSV infection compared to immunocompetent individuals 1
• Studies demonstrate that immunocompromise was significantly more common in RSV patients requiring ICU admission (57.6% vs. 34.4%), with 90-day mortality rates exceeding 50% in immunocompromised individuals 1
• Patients receiving immunosuppressive medications or with underlying conditions affecting immune function are at particularly high risk for RSV-associated hospitalization 1

Specific Vaccination Recommendations

Age-Based Guidelines for Splenectomized Patients

All splenectomized adults aged ≥60 years should receive a single dose of RSV vaccine, with universal vaccination recommended for those ≥75 years regardless of other risk factors. 2, 3

• Adults aged 60-74 years with splenectomy qualify for RSV vaccination based on their immunocompromised status 2, 4
• Adults aged 50-59 years with splenectomy should receive RSVPreF3 (Arexvy), which is the only vaccine currently approved for this younger age group with risk factors 2, 3
• Multiple international guidelines (Austria, Belgium, Germany, Spain, USA) explicitly include immunodeficiency and immunosuppression as indications for RSV vaccination in adults ≥60 years or ≥18 years depending on the country 1

Dosing and Timing

• A single lifetime dose of RSV vaccine is currently recommended, with no booster doses indicated at this time 2, 3, 4
• The vaccine should preferably be administered between September and November, before or early in the RSV season, to maximize protection during peak transmission months 2, 3, 4
• RSV vaccine can be co-administered with seasonal influenza vaccine at different injection sites 2, 3, 4

Clinical Implementation Considerations

Documentation Requirements

• Patient attestation of splenectomy is sufficient evidence for vaccination eligibility; extensive medical documentation should not be required to avoid barriers to vaccination 2, 4
• Healthcare providers should not delay vaccination while waiting for formal medical records if the patient reports a history of splenectomy 2

Integration with Other Post-Splenectomy Vaccinations

Splenectomized patients require multiple vaccinations beyond RSV. The vaccination schedule should include:

• Pneumococcal vaccines (both conjugate and polysaccharide formulations) 1
• Meningococcal vaccines (both MenACWY and MenB series) administered at least 2 weeks before elective splenectomy when possible 1
• Haemophilus influenzae type b (Hib) vaccine, ideally at least 2 weeks before splenectomy 1
• RSV vaccine can be incorporated into this comprehensive vaccination strategy for asplenic patients

Common Pitfalls to Avoid

A critical gap exists in vaccination coverage for splenectomized patients across all recommended vaccines. Studies demonstrate suboptimal immunization rates:

• Only 29-62% of splenectomized patients receive recommended pneumococcal vaccination 5, 6, 7
• Meningococcal vaccination rates are even lower at 4-34% 5, 6
• Many patients are vaccinated at inappropriate times relative to splenectomy 7

To avoid these pitfalls:

• Establish specific prophylaxis protocols in clinical routine to guarantee better immunization compliance 5
• Ensure discharge letters clearly document splenectomy status and vaccination recommendations 7
• Educate healthcare workers about the importance of comprehensive vaccination in asplenic patients 5
• Consider vaccination at disease diagnosis rather than waiting, as disease duration exceeding 3 months is associated with better vaccination compliance 8

Priority Considerations if Vaccine Supply is Limited

If RSV vaccine availability is constrained, splenectomized patients should be prioritized based on:

• Age ≥75 years receives highest priority 2, 3
• Presence of multiple comorbidities in addition to asplenia 2, 4
• Residence in long-term care facilities 2

Evidence Strength and Nuances

While RSV vaccines have not been specifically studied in splenectomized populations, the classification of asplenia as an immunocompromising condition provides strong rationale for vaccination. The American Society of Clinical Oncology recommends RSV vaccination for cancer patients aged ≥60 years, and similar logic applies to other immunocompromised states including asplenia 1. The benefits of vaccination clearly outweigh potential harms in immunocompromised populations, even though vaccine efficacy may be somewhat reduced compared to immunocompetent individuals. 1