Vaccination Schedule for Asplenia
Asplenic patients require a specific multi-vaccine protocol administered ideally 2-6 weeks before elective splenectomy (or at least 14 days after emergency splenectomy), including pneumococcal, meningococcal (both MenACWY and MenB), Haemophilus influenzae type b, and annual influenza vaccines, with mandatory lifelong revaccination to prevent overwhelming post-splenectomy infection that carries 30-70% mortality. 1, 2
Optimal Timing for All Vaccines
Administer all vaccines at least 2 weeks (ideally 2-6 weeks) before elective splenectomy to allow optimal antibody formation before the patient becomes functionally asplenic. 1, 3 This 2-week pre-surgery window produces significantly higher antibody concentrations compared to shorter intervals. 1, 3
If preoperative vaccination is impossible, wait at least 14 days after surgery once the patient's condition stabilizes before administering vaccines. 4, 3 Vaccinating sooner than 14 days post-operatively results in insufficient antibody response. 4
All recommended vaccines can be administered simultaneously at different injection sites. 4
Pneumococcal Vaccination: Sequential Prime-Boost Strategy
Start with PCV13 (or newer PCV15/PCV20) as the initial pneumococcal vaccine. 1, 2, 3 This conjugate vaccine primes the immune system more effectively than polysaccharide vaccines alone. 4
Administer PPSV23 at least 8 weeks (not 6-12 weeks) after PCV13. 1, 2, 3 Never give these vaccines simultaneously—the sequential timing is critical for optimal antibody response. 1
Give a second dose of PPSV23 exactly 5 years after the first dose. 1, 2, 3
Revaccinate with PPSV23 every 5-6 years for lifelong protection. 4, 1 This addresses the fact that Streptococcus pneumoniae causes approximately 50% of overwhelming post-splenectomy infections. 1
Meningococcal Vaccination: Dual Vaccine Requirement
Asplenic patients require BOTH MenACWY and MenB vaccines—this is mandatory, not optional, given that meningococcal infections carry 40-70% mortality in this population. 4, 1
MenACWY Protocol:
Administer 2 doses of MenACWY vaccine given at least 8 weeks apart for patients aged ≥10 years—this is NOT a single-dose regimen like in healthy adults. 1, 2, 3 This is a critical pitfall: asplenic patients need the enhanced 2-dose series. 1
Revaccinate with MenACWY every 5 years for life. 4, 1, 2
Consider measuring immune response 1 month after administration, and if inadequate, give a second dose. 4
MenB Protocol:
Administer MenB vaccine series: Either MenB-FHbp (3 doses at 0,1-2, and 6 months) OR MenB-4C (2 doses at least 1 month apart). 1
Give MenB booster at 1 year after primary series, then every 2-3 years if risk persists. 1, 3 Serogroup B now accounts for 40% of meningococcal cases in high-risk populations. 4
Haemophilus Influenzae Type b (Hib) Vaccination
Administer one dose of conjugated Hib vaccine to all unvaccinated asplenic persons aged ≥5 years. 4, 1, 2
A patient is considered immunized if they completed the childhood Hib primary series (by age 6 months) plus booster (6-8 months later), OR received one dose after age 14 months. 4
No revaccination is needed if the patient completed the childhood series. 4
Annual Influenza Vaccination
Administer annual inactivated influenza vaccine (IIV) to all asplenic patients aged ≥6 months. 4, 1, 2
Never use live attenuated influenza vaccine (LAIV/nasal spray) in asplenic patients. 1, 3
While asplenic patients don't have higher baseline influenza risk, influenza increases the risk of secondary bacterial pneumonia and sepsis, which can be fatal in this population. 4 Influenza vaccination reduces mortality by 54% in asplenic patients compared to unvaccinated controls. 4
Critical Pitfalls to Avoid
Do NOT treat asplenic patients like routine adults—they require the enhanced 2-dose MenACWY series, not a single dose. 1
Do NOT skip MenB vaccination—it is mandatory for asplenic patients, not optional. 1
Do NOT forget lifelong revaccination—protection wanes and infection risk persists for life, with cases reported more than 20 years post-splenectomy. 1, 3
Do NOT use MenACWY-D in children <2 years with asplenia—it reduces pneumococcal vaccine response. 1
Essential Non-Vaccine Preventive Measures
Prescribe lifelong prophylactic antibiotics (phenoxymethylpenicillin), with highest priority in the first 2 years post-splenectomy. 1, 2, 3
Provide emergency standby antibiotics (amoxicillin) for home use at first sign of fever, malaise, or chills. 1, 3
Educate patients about lifelong infection risk and need for immediate medical attention for fever >101°F (38°C). 1, 2, 3
Issue medical alert identification indicating asplenic status. 1, 3
Special Populations
Patients with functional asplenia (sickle cell disease, hemoglobinopathies, certain hematologic malignancies) require identical vaccination protocols as those with anatomic asplenia. 4, 3
Patients who received rituximab in the previous 6 months may have suboptimal vaccine response; reassess vaccination once B-cell recovery occurs. 3