What vaccinations are recommended for a patient after undergoing a splenectomy?

Post-Splenectomy Vaccination

All patients undergoing splenectomy require vaccination against pneumococcus, meningococcus (both ACWY and B), Haemophilus influenzae type b, and annual influenza to prevent overwhelming post-splenectomy infection (OPSI), which carries a 30-70% mortality rate. 1, 2

Core Vaccination Requirements

Pneumococcal Vaccination

• Administer PCV20 as the preferred initial pneumococcal vaccine 2, 3
• If PCV15 is used instead, follow with PPSV23 at least 8 weeks later 2
• For patients previously vaccinated with PCV13 only, give PCV20 at least 1 year later 2
• Revaccinate with PPSV23 every 5 years for life to maintain protection as antibody levels wane 2, 3

Meningococcal Vaccination

• Administer both MenACWY and MenB vaccines 2, 3
• Give MenACWY as a 2-dose primary series, 8 weeks apart 2
• Give MenB as either a 2-dose or 3-dose series depending on formulation 2
• 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

• Administer one single dose of Hib vaccine for previously unvaccinated adults 2, 3
• No revaccination needed if patient completed childhood Hib series 4

Annual Influenza Vaccination

• Give annual inactivated or recombinant influenza vaccine for life to all patients over 6 months of age 2, 3
• This reduces risk of secondary bacterial infections that can be catastrophic in asplenic patients 4

Critical Timing Considerations

Elective Splenectomy

• Administer all vaccines at least 2 weeks before surgery (ideally 4-6 weeks if scheduling permits) to ensure optimal antibody response 2, 3
• Antibody formation typically requires 9 days, making the 2-week minimum essential 4, 2

Emergency/Trauma Splenectomy

• Wait at least 14 days post-operatively before vaccinating once the patient is stable 1, 2
• Antibody response is suboptimal before this time 1
• If vaccination cannot occur at discharge, schedule it immediately at first follow-up 3

Antibiotic Prophylaxis

• Offer lifelong prophylactic antibiotics (phenoxymethylpenicillin) to all patients, with highest priority in the first 2 years post-splenectomy 2, 3
• For penicillin-allergic patients, use erythromycin 4
• Provide emergency standby antibiotics (amoxicillin) for home use at first sign of fever, malaise, or chills 2, 3
• Children under 5 years should receive prophylactic antibiotics for at least 3 years 5, 6

Patient Education and Documentation

• Issue medical alert identification (card or bracelet) indicating asplenic status 2, 3
• Formally notify primary care providers of the patient's asplenic status to ensure appropriate ongoing care 1, 2
• Educate patients about their lifelong increased infection risk and need for immediate medical attention with fever >101°F (38°C) 2, 3
• Provide written information about OPSI risk, which can occur decades after splenectomy 4, 1

Understanding OPSI Risk

• OPSI presents as fulminant sepsis, meningitis, or pneumonia with most deaths occurring within 24-48 hours of symptom onset 2
• Streptococcus pneumoniae accounts for approximately 50% of OPSI cases 2, 3
• Risk is highest in the first 2 years but remains elevated for life, with one-third of infections occurring at least 5 years after surgery 4, 2
• Children under 5 years have greater overall risk with increased mortality compared to adults 1, 2

Special Situations

Functional Hyposplenism

• Patients with functional hyposplenism (sickle cell disease, celiac disease, inflammatory bowel disease) require identical preventive measures as those with surgical splenectomy 4, 3

Recent Rituximab Use

• Patients who received rituximab in the previous 6 months may have suboptimal vaccine response 2, 3
• Reassess vaccination once B-cell recovery has occurred 2

Travel and Animal Exposure

• Provide malaria prophylaxis for travelers to endemic areas 1, 2
• After dog or animal bites, administer a 5-day course of co-amoxiclav due to susceptibility to Capnocytophaga canimorsus 1, 3

Common Pitfalls to Avoid

• Do not forget lifelong revaccination schedules—protection wanes and infection risk persists for life 3
• Do not delay vaccination in emergency splenectomy cases beyond 14 days post-operatively 2
• Do not assume childhood vaccinations provide adequate coverage—most adults require additional doses 2
• Children under 2 years have inherently reduced antibody response and should be reimmunized after age 2 4, 3