From the Guidelines
Patients who have undergone a splenectomy should receive vaccinations against encapsulated bacteria, including pneumococcal vaccines (PCV13 and PPSV23), Haemophilus influenzae type b (Hib) vaccine, and meningococcal vaccines (MenACWY and MenB), with the optimal timing of PPSV23 vaccination being ≥2 weeks prior to splenectomy or ≥2 weeks following splenectomy 1. The recommended vaccine schedule includes PCV13 given first, followed by PPSV23 at least 8 weeks later, as well as a single dose of Hib vaccine and meningococcal vaccines with appropriate boosters every 5 years for MenACWY. Additionally, patients should receive an annual influenza vaccine.
- The vaccinations against S. pneumoniae, H. influenzae type B, and N. meningitidis should be given at least 2 weeks before splenectomy, if possible, to ensure optimal immune response 1.
- In cases where vaccination cannot be completed before splenectomy, it should be performed ≥2 weeks following splenectomy, as this timing results in higher antibody concentrations or opsonophagocytic titers compared with vaccination at a shorter interval before or after surgery 1.
- It is essential to note that vaccination can only reduce the incidence of OPSI, and patients should be informed that vaccines do not provide exhaustive coverage against all serotypes of S. pneumoniae and N. meningitidis 1.
- Community physicians should be aware of the asplenic/hyposplenic condition to provide the most appropriate level of care, and patients should be given an antibiotic supply in the event of any sudden onset of unexplained fever, malaise, chills, or other constitutional symptoms, especially when medical review is not readily accessible 1.
From the Research
Vaccine Schedule for Splenectomy
- The vaccine schedule for patients after splenectomy includes immunization against encapsulated bacterial pathogens to decrease the incidence of post-splenectomy sepsis 2.
- Recommended vaccinations include:
- Pneumococcal vaccine
- Meningococcal vaccine
- Haemophilus influenzae (Hib) vaccine
- These immunizations should be given at least 14 days before a scheduled splenectomy, or given after the fourteenth postoperative day 2.
Timing and Administration
- The timing of vaccine administration is crucial, with a recommended interval of at least 14 days before or after splenectomy 2.
- Patients who have undergone splenectomy and have invasive disease despite receiving 23-valent pneumococcal polysaccharide vaccine may benefit from administration of protein-conjugate pneumococcal vaccine 3.
Adherence to Recommendations
- Adherence to recommended post-splenectomy immunizations is crucial to reduce the risk of sepsis, with studies showing varying levels of compliance with guidelines 4.
- Regional immunization records analysis showed that among patients who underwent splenectomy, 15% received all recommended immunizations, while 95% received at least one pneumococcal vaccine 4.