Which vaccinations are indicated after splenectomy?

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Clinical Inquiries

Which vaccinations are indicated after splenectomy?

J Fam Pract. 2006 August;55(8):711-712

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References

1. Shatz DV, Schinsky MF, Pais LB, Romero-Steiner S, Kirton OC, Carlone GM. Immune responses of splenectomized trauma patients to the 23-valent pneumococcal polysaccharide vaccine at 1 versus 7 versus 14 days after Splenectomy. J Trauma 1998;44:765-766.

2. Shatz DV, Romero-Steiner S, Elie CM, Holder PF, Carlone GM. Antibody responses in postsplenectomy trauma patients receiving the 23-valent pneumococcal polysaccharide vaccine at 14 versus 28 days postoperatively. J Trauma 2002;53:1037-1042.

3. Balmer P, Falconer M, McDonald P, et al. Immune response to meningococcal serogroup C conjugate vaccine in asplenic individuals. Infect Immun 2004;72:332-337.

4. Cimaz R, Mensi C, D’Angelo E, et al. Safety and immunogenicity of a conjugate vaccine against haemophilus influenzae type b in splenectomized and nonsplenectomized patients with Cooley anemia. J Infect Disease 2001;183:1819-1821.

5. Konradsen HB, Rasmussen C, Ejstrud P, Hansen JB. Antibody levels against streptococcus pneumoniae and haemophilus influenzae type B in a population of splenectomized individuals with varying vaccination status. Epidemiol Infect 1997;119:167-174.

6. Recommended Adult Immunization Schedule United States October 2004–September 2005. The Advisory Committee on Immunizations Practices. Department of Health and Human Services. Centers for Disease Control and Prevention. Available at: www.cdc.gov/nip/recs/adult-schedule.pdf. Accessed on July 6, 2006.

7. National Guideline Clearinghouse Surgical Treatment of Disease and Injuries of the Spleen. Society for Surgery of the Alimentary Tract (SSAT). 2004 Feb. Available at: www.guideline.gov/summary/summary.aspx?view_id=1& doc_id=5698. Accessed on July 6, 2006.

8. Davies JM, Barnes R, Milligan D. Update of guidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen. Clin Med 2002;2:440-444.

In another study, 130 asplenic individuals were compared with 48 age-matched controls after receiving a meningococcal vaccine.³ The majority (93%) achieved bactericidal immunoglobulin levels following immunization. This study demonstrated the need to have antibody titers drawn to ensure immunization response, as 20% of the subjects required a second dose of vaccine to achieve adequate levels. No clear evidence supports the timing of the meningococcal vaccine post-splenectomy.

Two recent studies look at the immunogenicity of the Hib for asplenic patients. The first study demonstrated increased antibody titers to Hib at 2, 6, 12, 24, and 36 months after immunization.⁴ Fifty of the 57 patients in the study (88%) maintained adequate antibody titers 3 years after immunization. No symptomatic infections were observed during the 3-year study period. In a study of 561 Danes, those vaccinated within 14 days of splenectomy (before or after) had a significantly higher need for revaccination than those who were vaccinated more than 14 days before or after surgery.⁵

FAST TRACK

Those vaccinated with Hib within 14 days (before or after) splenectomy had a significantly higher need for revaccination

Recommendations from others

The most common infections occurring among asplenic patients are due to encapsulated organisms. The incidence is 10 to 50 times higher than in the general population.

The Advisory Committee on Immunization Practices for the Centers for Disease Control and Prevention (CDC) and the Society of Surgery for the Alimentary Tract recommends all patients that undergo splenectomy have the pneumococcal polysaccharide vaccine.^6-7 In addition, this organization also recommends that all asplenic patients receive meningococcal vaccination and be considered for the Hib vaccine. Both groups recommend that these vaccinations occur at the same time as the pneumococcal vaccine.^6-8

The CDC also recommends annual influenza vaccine in addition to the pneumococcal, meningococcal, and Hib vaccines, because secondary bacterial infections can lead to severe disease in this patient population. Boosters are recommended for all the bacterial vaccines every 5 years for asplenic patients.

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Which vaccinations are indicated after splenectomy?

References

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