Booster Vaccination After Prevnar20 in Post-Splenectomy Patients
A patient who received Prevnar20 (PCV20) after splenectomy does not need additional pneumococcal boosters, as PCV20 provides complete pneumococcal coverage and eliminates the need for PPSV23. 1, 2
Pneumococcal Vaccination Status
- PCV20 is a standalone vaccine that covers all 20 pneumococcal serotypes and requires no additional pneumococcal vaccination in asplenic patients. 1, 2
- The National Comprehensive Cancer Network confirms that patients who received PCV20 have complete pneumococcal coverage without needing PPSV23. 2
- Unlike the older PCV13/PCV15 regimens that required PPSV23 boosters, PCV20 is designed as a comprehensive single-vaccine solution. 1, 2
Critical Non-Pneumococcal Vaccinations Still Required
While pneumococcal vaccination is complete, asplenic patients face lifelong risk of overwhelming infection with 30-70% mortality rates, making additional vaccinations absolutely essential. 1, 3
Meningococcal Vaccination (Urgent Priority)
- Administer both MenACWY and MenB vaccine series immediately if not already given. 1, 2
- MenACWY requires 2 doses separated by 8 weeks, with revaccination every 5 years for life. 1, 2
- MenB requires a 2-dose or 3-dose series (depending on formulation), with boosters every 2-3 years if risk persists. 1, 2
- Meningococcal infection carries 40-70% mortality in asplenic patients, making this vaccination critical. 3
Haemophilus Influenzae Type B (Hib)
- A single dose of Hib vaccine is required for previously unvaccinated adults. 1, 2
- This can be administered simultaneously with meningococcal vaccines at different injection sites. 2
Annual Influenza Vaccination
- Annual inactivated or recombinant influenza vaccine is required for life. 1, 3
- Influenza increases risk of secondary bacterial pneumonia and sepsis in asplenic patients. 4
Additional Protective Measures Beyond Vaccination
Antibiotic Prophylaxis
- Lifelong prophylactic phenoxymethylpenicillin is recommended, especially in the first 2 years post-splenectomy. 4, 1, 2
- Emergency standby antibiotics (amoxicillin) should be kept at home for immediate use with fever >101°F (38°C). 1, 3
Patient Education and Documentation
- Provide medical alert identification and formal notification to primary care providers of asplenic status. 4, 3
- Educate about lifelong infection risk—cases have been reported more than 20 years after splenectomy. 4, 3
- After dog or animal bites, require a 5-day course of co-amoxiclav due to Capnocytophaga canimorsus susceptibility. 4, 3
Common Pitfall to Avoid
The most critical error is forgetting the lifelong revaccination schedules for non-pneumococcal vaccines: MenACWY every 5 years, MenB every 2-3 years, and annual influenza vaccine. 1, 3 Research shows only 4.2% of splenectomized patients receive appropriate meningococcal vaccination, leading to preventable infections. 5