Post Splenectomy Vaccination

Original Date: 06/2011 | Last Review Date: 4/2023
Purpose: To delineate timing of post-splenectomy vaccines

Related links: My Spleen has been removed: What I Need to Know to Protect Myself

Indications:

  • All patients status post-splenectomy
  • All patients status post main splenic embolization or with < 50% perfused spleen

Vaccines:

  1. Pneumococcal vaccine, PCV20 (Prevnar-20) – 0.5mL IM6
  2. Haemophilus influenzae vaccine (HiB) – 0.5mL IM
  3. Meningococcal vaccine, MenACWY (Menquadfi/Menveo) – 0.5mL IM
  4. Serogroup B meningococcal, MenB-4C (Bexsero) – 0.5ml IM

ADMINISTRATION: Vaccinations should be administered the day prior to discharge.1, 2, 3, 4

All patient charts should be labeled with either “Asplenic” or “S/p Splenectomy” to identify patients that require vaccinations. In addition, “Asplenic” or “S/p Splenectomy” will be added to the trauma service patient list for those patients requiring vaccination.

Follow-up Plan

Education: All patients with splenectomy need to be informed of their operation, the risk and signs/symptoms of developing Overwhelming Post-Splenectomy Infection (OPSI) via physician to patient discussion. Eight weeks after doses given prior to discharge, patient will need a second set of vaccinations: one dose of MenACWY (Menquadfi/Menveo) and one dose of serogroup B meningococcal (Bexsero).

Additionally, revaccination of Menquadfi/Menveo is recommended every 5 years. Revaccination of Bexsero is recommended in one year then every 2-3 years. Patients should be instructed to follow-up with their primary care physician for this assessment.

Asplenic Patient Database: to identify those patient’s that underwent splenectomy, when they received their vaccinations, and when they need to follow up for revaccination

Use of Medical Alert Bracelets: for emergency medical providers to identify patients in the community that are asplenic.

References:
1 Shatz DV, Romero-Steiner S, Elie CM, et al. Antibody responses in postsplenectomy trauma patients receiving the 23-valent pneumococcal polysaccharide vaccine at 14 versus 28 days postoperatively. J Trauma 2002; 53(6): 1037-42.
2 Shatz DV. Vaccination practices among North American trauma surgeons in Splenectomy after trauma. J Trauma 2002;53: 950-956.
3 Taylor MD, Genuit T, Napolitano LM. Overwhelming postsplenectomy sepsis and trauma: Time to consider revaccination? J Trauma 2005: 59: 1482-1485
4 Shatz DV, Schinsky M, Pais L, et al. Immune responses of splenectomized trauma patients to the 23-valent pneumococcal polysaccharide vaccine at 1 versus 7 versus 14 days after Splenectomy (RCT). J Trauma 1998; 44: 760-765.
5 Epidemiology and prevention of vaccine-preventable diseases. The Pink Book, 14th ed. Chapters 14 and 17, US Department of Health and Human Services Center for Disease Control and Prevention; August 2021.
6 Kobayashi M, Farrar JL, Gierke R, Britton A, Childs L, Leidner AJ, et al. Use of 15-Valent Pneumococcal Conjugate Vaccine and 20-Valent Pneumococcal Conjugate Vaccine Among U.S. Adults: Updated Recommendations of the Advisory Committee on Immunization Practices — United States, 2022. MMWR. 2022;71(4);109–117.