Influenza Vaccination in Asplenic Patients

Rationale for Influenza Vaccination in Asplenic Patients

The World Society of Emergency Surgery (WSES) guidelines strongly recommend annual immunization against seasonal flu for all asplenic patients over 6 months of age 1
Annual influenza vaccination has been shown to be associated with a 54% reduced mortality compared with unvaccinated asplenic patients 3
Influenza may increase the risk for secondary bacterial pneumonia and sepsis in asplenic patients, who do not have a higher risk of influenza virus infection compared to the general population 2, 3

Annual vaccination with inactivated influenza vaccine is recommended for all asplenic patients, according to the Annals of Oncology 2, 4
Only the inactivated influenza vaccine should be used, not the live attenuated influenza vaccine (nasal spray), as recommended by the Annals of Internal Medicine 4
Influenza vaccination helps reduce the risk of secondary bacterial infections in asplenic patients, as stated by the BMJ and Annals of Oncology 6, 3
Pneumococcal vaccines, including PCV13 followed by PPSV23, are recommended for asplenic patients, with an interval of ≥8 weeks between them, according to Clinical Infectious Diseases and Annals of Oncology 7, 2
Haemophilus influenzae type b (Hib) vaccine is recommended for unvaccinated asplenic persons aged ≥5 years, as stated by Clinical Infectious Diseases 7, 8
Meningococcal vaccines, including tetravalent conjugated meningococcal vaccine (MenACWY) and Meningococcal B vaccine (MenB), are recommended for asplenic patients, with revaccination every 5 years, according to Annals of Oncology 2, 3

Vaccines should ideally be administered at least 2 weeks before elective splenectomy to ensure optimal antibody response, as recommended by the BMJ and Annals of Oncology 6, 2
For emergency splenectomy, vaccines should be administered at least 14 days after surgery, according to the World Journal of Emergency Surgery and Annals of Oncology 1, 2
If there is high risk of missing vaccination, it's better to vaccinate before discharge even if within the 14-day window, as stated by the World Journal of Emergency Surgery 1

Asplenia itself is not a contraindication to routine immunization, as stated by the BMJ 6
Antibody levels may decline more rapidly in asplenic patients, potentially requiring earlier revaccination than in the general population, according to the BMJ 6
Both anatomic asplenia (surgical removal) and functional asplenia (e.g., sickle cell disease) require the same vaccination approach, as recommended by Annals of Oncology 2, 3