How many doses of Prevnar (pneumococcal conjugate vaccine) are recommended after splenectomy?

Prevnar Vaccination After Splenectomy

For post-splenectomy patients who are vaccine-naïve, administer 1 dose of PCV13 (or the newer PCV15/PCV20) followed by PPSV23 at least 8 weeks later, then a second dose of PPSV23 five years after the first dose. 1, 2, 3

Pneumococcal Conjugate Vaccine (Prevnar) Dosing

For Previously Unvaccinated Patients

• Administer a single dose of PCV13 (or preferably PCV20 if available) as the initial pneumococcal vaccine. 4, 2, 3
• If using PCV13 or PCV15, follow with PPSV23 at least 8 weeks after the conjugate vaccine. 1, 2, 3
• If PCV20 is used, no additional PPSV23 is needed, as PCV20 provides complete pneumococcal coverage for all 20 serotypes. 4

For Patients With Prior Vaccination History

• If the patient received 1-3 doses of Prevnar previously: Give 1 additional dose of Prevnar, then PPSV23 6-8 weeks after the last Prevnar dose. 1
• If the patient received 4 doses of Prevnar: Give PPSV23 6-8 weeks after the last Prevnar dose (no additional Prevnar needed). 1
• If the patient received only PPSV23 previously: Give 2 doses of Prevnar 6-8 weeks apart. 1
• For patients previously vaccinated with PCV13 only, give PCV20 at least 1 year later. 2

Booster Dosing

• Administer a second dose of PPSV23 five years after the first PPSV23 dose. 1, 2, 3
• Revaccinate with PPSV23 every 5-10 years for lifelong protection. 2, 3

Optimal Timing Considerations

Elective Splenectomy

• Administer all vaccines at least 2 weeks (ideally 2-6 weeks) before elective surgery to ensure optimal antibody response. 1, 2, 3, 5
• The 2-week pre-surgery timing results in higher antibody concentrations compared to shorter intervals. 2

Emergency/Traumatic Splenectomy

• Wait at least 14 days post-operatively before vaccinating once the patient is clinically stable. 2, 5
• Research demonstrates that immediate post-operative vaccination (within 72 hours) produces similar antibody responses to normal controls, though current guidelines recommend waiting 2 weeks. 6

Critical Additional Vaccines Required

Beyond Prevnar, asplenic patients require comprehensive vaccination:

Meningococcal Vaccines (Urgent Priority)

• Administer both MenACWY and MenB vaccine series. 4, 2, 3
• MenACWY: Give 2 doses separated by 8 weeks. 4, 2
• MenB: Administer as 2-dose or 3-dose series depending on formulation. 4, 2
• Revaccinate with MenACWY every 5 years lifelong. 1, 4, 2, 3
• MenB booster needed at 1 year, then every 2-3 years if risk persists. 4, 2

Haemophilus Influenzae Type B (Hib)

• Administer 1 single dose of Hib vaccine for all unvaccinated asplenic adults aged ≥5 years. 1, 2, 3

Annual Influenza Vaccine

• Give annual inactivated or recombinant influenza vaccine. 2, 3
• Never use live attenuated influenza vaccine (nasal spray) in asplenic patients. 3

Common Pitfalls to Avoid

Forgetting Lifelong Revaccination

• Protection wanes over time, and infection risk persists for life. 2, 3
• Overwhelming post-splenectomy infection (OPSI) has been reported more than 20 years after splenectomy, with mortality rates of 30-70%. 2, 3
• Streptococcus pneumoniae accounts for approximately 50% of OPSI cases. 2

Inadequate Meningococcal Coverage

• Meningococcal infections in asplenic patients carry 40-70% mortality rates. 3
• Both MenACWY and MenB are required; one alone is insufficient. 4, 3

Suboptimal Timing in Special Populations

• Patients who received rituximab in the previous 6 months may have suboptimal vaccine response. 2
• Vaccination should be reassessed once B-cell recovery has occurred. 2

Additional Protective Measures

Antibiotic Prophylaxis

• Initiate lifelong penicillin prophylaxis immediately post-splenectomy, regardless of vaccination status. 4, 2, 3
• Highest priority in the first 2 years post-splenectomy. 2, 3

Patient Education

• Educate patients about lifelong infection risk and the need to seek immediate medical attention for fevers >101°F (38°C). 2, 3
• Provide emergency standby antibiotics (amoxicillin) for home use at first sign of fever, malaise, or chills. 2, 3
• Issue Medic-Alert identification indicating asplenic status. 2