Splenectomy : Immunisation in Adults

·       In order to optimize the immune response to vaccination, we vaccinate patients at least 2 weeks, and ideally 10 to 12 weeks, prior to splenectomy when possible.

·       In addition, routine vaccinations for which the individual would be due should also be provided, as these are more likely to be effective in an individual with an intact spleen.

·       When vaccines cannot be given at least two weeks prior to splenectomy, we vaccinate approximately two weeks after the procedure. Appropriate vaccinations that were not administered before splenectomy should be given. (However, please check if they can be given together)

·       Recommended antibiotic prophylaxis post splenectomy: PO Amoxicillin 250-500 mg orally OD to BD (duration may be 3 years to lifelong, depending on individual circumstances), kindly use alternative such as macrolide (e.g. PO Clarithromycin 250mg BD or PO Erythromycin) in the case of penicillin allergy.

·       If patient developed sudden unexplained fever or any signs of infection, kindly see a Dr immediately.

Vaccine	Timing of First Dose	Booster / Revaccination	Remarks
Penumococcal (Pneumovax-23)	Elective: 2-12 weeks before elective surgery   OR   Non-elective: 14 days post-splenectomy or at the time of hospital discharge, whichever comes first   Vaccination may be considered upon discharge if patient is expected not to return for follow-up	Every 5 years	USA CDC 2021: At age 65 years or older, give 1 dose PPSV23 at least 5 years after most recent PPSV23 ·  P/S: only 1 dose PPSV23 recommended at age 65 years or older ·  P/S: Some references (like Australian) only administer a maximum of 3 doses of Pneumovax-23 during adulthood.   ·  It is recommended to give 1 dose of PCV13 followed by 1 dose of PPSV23 ≥8 weeks later. However, PCV13 is under paediatric budget in HKGU.
Haemophilus influenza type b (Hib)		Not needed
Meningococcal vaccines polysaccharide (Menactra)		2nd dose given at least 8 weeks after 1st dose, then every 5 years if risk remains	Menactra must be given four weeks after PCV13 because Menactra may interfere with the protection conferred by pneumococcal conjugate vaccines.   USA CDC 2021: A quadrivalent meningococcal conjugate vaccine that protects against meningococcal serotypes A, C, W, and Y (e.g. MenACWY; Menactra) and a univalent serogroup B vaccine (MenB-4C [Bexsero] or MenB-FHbp [Trumenba]). Both vaccines are given as a primary series. However only Menactra available in HKGU
Seasonal influenza vaccination		Once yearly	Although live attenuated vaccines can be safely given to patients with impaired splenic function, the inactivated influenza vaccine is preferred over the live formulation because it is equally effective

 

References:

1.     Uptodate: Elective (diagnostic or therapeutic) splenectomy

2.     Uptodate: Vaccinations for adults (age >19 years) with impaired splenic function and adults undergoing splenectomy in the United States*

3.     Uptodate: Prevention of infection in patients with impaired splenic function

4.     Guidelines for Adult Immunisation (Malaysia), 2nd Edition, 2014

5.     USA CDC 2021. Recommended Adult Immunization Schedulefor ages 19 years or older (Last updated on 11/2/2021).

6.     Relihan K. Post-splenectomy Vaccine Prophylaxis – Evidence Based Medicine Guideline (Last revised on 8/4/2021). Available online at: http://www.surgicalcriticalcare.net/Guidelines/Post%20Splenectomy%20vaccines%202021.pdf

7.     Department for Health and Ageing, Government of South Australia. Splenectomy vaccination and Antimicrobial Prophylaxis (Adult asplenic and hyposplenic patients) Clinical Guideline (Approved on 25/07/2019).

8.     https://spleen.org.au/wp-content/uploads/2020/03/RECOMMENDATIONS_Spleen_Registry.pdf

9.     Cork Emergency Medicine. Management Patients Post-Splenectomy & Hyposplenic Patients (Last reviewed 26/05/2021). Available online at: https://emed.ie/Infections/Prophylaxis/Hyposplenic.php

10.   University of Michigan. UMHHC Immunization Committee Vaccination Record for People with a Splenectomy or Splenic Embolization (Last revised on 07/09/2019).

11.   National Antimicrobial Guideline 2019 (Malaysia).

 

All info accessed on 27 May 2021 [J. Ho]