Post-Splenectomy Infection Prevention

Core Vaccinations

The American College of Surgeons recommends administering PCV20 (preferred) or PCV15 as the initial pneumococcal vaccine, followed by PPSV23 at least 8 weeks later if using PCV15 1, 2
For patients previously vaccinated with PCV13 only, the Centers for Disease Control and Prevention suggest giving PCV20 at least 1 year later 1
The World Health Organization recommends revaccinating with PPSV23 every 5 years for life to maintain protection, as antibody levels wane over time 3, 1
The Advisory Committee on Immunization Practices advises administering both MenACWY and MenB vaccines, with MenACWY given as a 2-dose primary series, 8 weeks apart, and MenB as either a 2-dose or 3-dose series depending on formulation 1, 2
The Centers for Disease Control and Prevention recommend revaccinating with MenACWY every 5 years for life, and with MenB every 2-3 years if risk remains 1, 2
The American Academy of Pediatrics suggests administering one single dose of Hib vaccine for previously unvaccinated adults 1, 2
The World Health Organization recommends giving annual inactivated or recombinant influenza vaccine for life to all patients over 6 months of age, reducing the risk of secondary bacterial infections that can be catastrophic in asplenic patients 4, 3, 1

The American College of Surgeons advises administering all vaccines at least 2 weeks before elective surgery (ideally 4-6 weeks if scheduling permits) to ensure optimal antibody response, which typically requires 9 days 1, 2
The World Journal of Emergency Surgery recommends waiting at least 14 days post-operatively before vaccinating once the patient is stable after emergency/trauma splenectomy, as antibody response is suboptimal before this time 4, 1, 2

The Centers for Disease Control and Prevention suggest offering lifelong prophylactic antibiotics (typically phenoxymethylpenicillin), with highest priority in the first 2 years post-splenectomy, and providing emergency standby antibiotics (amoxicillin) for home use at the first sign of fever, malaise, or chills 3, 1, 2
The American Academy of Pediatrics recommends issuing medical alert identification indicating asplenic status, formally notifying primary care providers of the patient's asplenic status, and educating patients about their lifelong increased infection risk and the need for immediate medical attention with fever 4, 3, 1, 2

The World Health Organization states that OPSI presents as fulminant sepsis, meningitis, or pneumonia with a mortality rate of 30-70%, with most deaths occurring within 24-48 hours of symptom onset, and that Streptococcus pneumoniae accounts for approximately 50% of OPSI cases 4, 3, 2
The Centers for Disease Control and Prevention note that the risk of OPSI is highest in the first year after splenectomy but remains elevated for life, with one-third of infections occurring at least 5 years after surgery, and that children under 5 years have a greater overall risk of OPSI with increased mortality compared to adults 4, 3, 2
The American Academy of Pediatrics advises that children under 2 years have inherently reduced antibody response and should be reimmunized after 2 years 1

The World Health Organization recommends malaria prophylaxis for travelers to endemic areas, and a 5-day course of co-amoxiclav after dog or animal bites due to susceptibility to Capnocytophaga canimorsus 4, 3
The Centers for Disease Control and Prevention suggest that patients who received rituximab in the previous 6 months may have suboptimal vaccine response, and vaccination should be reassessed once B-cell recovery has occurred 1, 2

The American College of Surgeons recommends that patients with functional hyposplenism require identical preventive measures as those with surgical splenectomy, including vaccination against pneumococcus, meningococcus, Haemophilus influenzae type b, and annual influenza 5
Annual inactivated or recombinant influenza vaccine should be given for life to all patients over 6 months of age to reduce the risk of secondary bacterial infections that can be catastrophic in asplenic patients 6, 7
No revaccination with Hib vaccine is needed if the patient completed the childhood Hib series 5

The British Medical Association recommends offering lifelong prophylactic antibiotics, such as phenoxymethylpenicillin, to all patients, with the highest priority in the first 2 years post-splenectomy, and using erythromycin for penicillin-allergic patients 7

The British Medical Journal suggests that patients should be educated about their lifelong increased infection risk and the need for immediate medical attention with fever >101°F (38°C), and that written information about OPSI risk should be provided 7
Children under 2 years should be reimmunized after age 2 due to inherently reduced antibody response 7
Patients with functional hyposplenism, such as those with sickle cell disease, celiac disease, or inflammatory bowel disease, require identical preventive measures as those with surgical splenectomy 5