What vaccinations are recommended for patients undergoing splenectomy (removal of the spleen) to prevent infections?

Vaccination Guide for Patients Undergoing Splenectomy

All patients undergoing splenectomy must receive pneumococcal, meningococcal (both MenACWY and MenB), Haemophilus influenzae type b, and annual influenza vaccinations to prevent overwhelming post-splenectomy infection (OPSI), which carries a 30-70% mortality rate. 1, 2

Core Required Vaccinations

Pneumococcal Vaccination

• Administer PCV20 (preferred) or PCV15 as the initial pneumococcal vaccine 2
• If PCV15 is used, follow with PPSV23 at least 8 weeks later 2, 3
• For patients previously vaccinated with PCV13 only, give PCV20 at least 1 year later 2
• Revaccinate with PPSV23 every 5 years for life 4, 1, 2
• The 23-valent polysaccharide vaccine is more than 90% effective in healthy adults under age 55 4

Meningococcal Vaccination

• Administer both MenACWY and MenB vaccines—both are required, not optional 2, 3
• Give MenACWY as 2 doses 8 weeks apart 2, 3
• Give MenB as either a 2-dose or 3-dose series depending on formulation 2, 3
• Revaccinate with MenACWY every 5 years for life 2, 3
• Revaccinate with MenB every 2-3 years if risk remains 2, 3
• Meningococcal infection carries 40-70% mortality in asplenic patients 3

Haemophilus influenzae Type B (Hib)

• Administer 1 single dose of Hib vaccine for previously unvaccinated adults 2, 3, 5
• This is particularly important as phenoxymethylpenicillin prophylaxis does not reliably cover H. influenzae 4

Influenza Vaccination

• All post-splenectomy patients must receive annual inactivated or recombinant influenza vaccine for life 4, 1, 2
• This reduces secondary bacterial pneumonia and sepsis risk by 54% 3
• The vaccine is best avoided in pregnancy 4

Critical Timing Considerations

For Elective/Planned Splenectomy

• Administer all vaccines at least 2 weeks (minimum 14 days) before surgery to ensure optimal antibody response 4, 1, 2, 5
• Ideally, vaccinate 4-6 weeks before surgery if possible 2, 3
• Antibody formation generally takes 9 days, making the 2-week minimum critical 3

For Emergency/Trauma Splenectomy

• Wait at least 14 days post-operatively before vaccinating, as antibody response is suboptimal before this timeframe 1, 2, 3, 6, 5
• Vaccinate as soon as the patient's condition stabilizes after the 14-day period 2

Special Timing Consideration

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

Lifelong Risk and Reimmunization Schedule

Duration of Risk

• The risk of OPSI is lifelong and clinically significant, with cases reported more than 20 years after splenectomy 4, 1, 3
• Most infections occur within the first two years, but up to one-third manifest at least five years later 4
• Streptococcus pneumoniae accounts for approximately 50% of OPSI cases 1, 3

Reimmunization Requirements

• Children under 2 years should be reimmunized after 2 years due to inherently reduced antibody response 4
• Antibody levels may decline more rapidly than expected in asplenic patients, requiring reimmunization as early as three years after the first dose, especially in children with sickle cell disease 4

Additional Preventive Measures Beyond Vaccination

Antibiotic Prophylaxis

• Lifelong prophylactic antibiotics should be offered to all patients, with highest priority in the first 2 years post-splenectomy 4, 1, 2
• Prophylactic oral phenoxymethylpenicillin is the standard agent 4, 1, 6
• For penicillin-allergic patients, offer erythromycin 4
• Patients should keep emergency standby antibiotics (amoxicillin) at home for immediate use at first sign of fever, malaise, or chills 4, 1, 2, 3

Patient Education and Documentation

• Provide written information about lifelong infection risk and issue a Medic-Alert disc and post-splenectomy card indicating asplenic status 4, 1, 2
• Primary care providers must be formally notified of the patient's asplenic status to ensure appropriate ongoing care 4, 1
• Educate patients about the need for emergency department evaluation with fever >101°F (38°C) 2, 3

Special Precautions

• After dog or animal bites, asplenic patients require a 5-day course of co-amoxiclav due to susceptibility to Capnocytophaga canimorsus (DF-2 bacillus) 4, 1, 3
• Malaria prophylaxis is strongly recommended for travelers to endemic areas 1

High-Risk Populations Requiring Extra Vigilance

Children

• Children under 5 years—especially infants—have an infection rate exceeding 10%, much higher than adults (<1%) 4, 1
• Children under 2 years have inherently reduced ability to mount an antibody response 4
• Because of reduced vaccine efficacy in young children, rely initially on prophylactic antibiotics and immunize after the second birthday 4

Other High-Risk Groups

• Patients with sickle cell disease (HbSS, HbSC) are at especially high risk of overwhelming infection 4
• Patients with lymphoproliferative disorders, myeloma, or chronic infections from encapsulated organisms require extra attention 4
• Patients with functional hyposplenism (from sickle cell disease, thalassemia major, coeliac disease, inflammatory bowel disease) require identical preventive measures as surgical splenectomy patients 4, 2

Common Pitfalls to Avoid

• Failing to administer both MenACWY and MenB vaccines—both are required 2, 3
• Forgetting lifelong revaccination schedules—protection wanes and infection risk persists for life 2, 3
• Vaccinating too soon after emergency splenectomy—wait at least 14 days for optimal antibody response 1, 2, 3, 5
• Not providing emergency standby antibiotics—patients need immediate access to antibiotics at home 4, 1, 2, 3
• Failing to notify primary care providers—only 8% of appropriate immunizations are completed in some studies due to lack of coordination 3, 7
• Not educating patients about lifelong risk—patient compliance depends on understanding the 30-70% mortality rate of OPSI 1, 3, 6