Post-Splenectomy Vaccines

Patients who have had splenectomy for trauma should be properly immunized (see algorithm) but should also receive information about overwhelming post-splenectomy infection (OPSI). They should be informed that OPSI is rare (0.2-0.4%/year). The best way to prevent OPSI is to be immunized.  Warning signs of OPSI include symptoms of sepsis (acute illness, fever, lethargy) and these symptoms should prompt immediate medical care, at which time they must inform the doctor or provider that they ‘do not have a spleen’.

Post-splenectomy patients should be:

1.       Immunized according to the guideline

2.       Provided teaching about OPSI

3.       Provided an immunization card to use as their own reminder and an indicator of their asplenic state should they need immediate medical care for symptoms of OPSI

4.       Scheduled for a ‘vaccine-only nurse visit’ in the clinic for follow-up immunization, 8 weeks to 2 months after their initial immunization. This visit is in addition to the postop visit. 

5.       Provided information about ‘vaccine-only nurse visit’ follow-up in their discharge instructions

6. Educated again on OPSI and immunizations in their post-op visit

NOTE IN PATIENTS UNDERGOING ANGIOEMBOLIZATION: EAST conditionally recommends AGAINST routine post-splenectomy vaccinations in adult trauma patients who have undergone angioembolization for splenic injury (Freeman, Injury 2022).

Post-splenectomy/functional asplenia vaccines

Initial (within 14d splenectomy/functional asplenia)	Dose	Route
Pneumococcal conjugate vaccine, 13-valent (PCV13, Prevar-13)	0.5mL	IM
Quadrivalent meningococcal conjugate vaccine (menACWY, Menactra or Menveo)	0.5mL	IM
Meningococcal group B vaccine (MenB, Bexsero)	0.5mL	IM
Haemophilus influenzae type B (Hib) vaccine (ActHIB, Hiberix, PedvaxHIB)	0.5mL	IM

≥8 weeks after initial (clinic follow-up)	Dose	Route
Pneumococcal polysaccharide vaccine, 23-valent (PPSV23, Pneumovax 23)	0.5mL	IM
Quadrivalent meningococcal conjugate vaccine (menACWY, Menactra or Menveo)	0.5mL	IM
Meningococcal group B vaccine (MenB, Bexsero)	0.5mL	IM

Every 5 years thereafter	Dose	Route
Pneumococcal polysaccharide vaccine, 23-valent (PPSV23, Pneumovax 23)	0.5mL	IM
Quadrivalent meningococcal conjugate vaccine (menACWY, Menactra or Menveo)	0.5mL	IM
Meningococcal group B vaccine (MenB, Bexsero)	0.5mL	IM

Exceptions*:

·Age<18

·Previous known vaccine administration with any of the above vaccines prior to splenectomy or functional asplenia

*call PharmD to assist with determining necessary vaccines to administer

The product is in and the orderset “COM – Splenectomy” is updated (see below).
Please note that that there are now 4 vaccines that are given initially with 3 vaccines given at f/u clinic visit.

0. References
   1. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6422a3.htm
   2. http://www.cdc.gov/vaccines/schedules/downloads/adult/adult-schedule-bw.pdf
   3. http://www.surgicalcriticalcare.net/Guidelines/post%20splenectomy%20vaccines%202015.pdf 4. http://www.cdc.gov/mmwr/volumes/65/wr/mm6504a5.htm <Accessed 12 October 2016> 5. http://www.cdc.gov/vaccines/hcp/acip-recs/recs-by-date.html <Accessed 12 October 2016> 
   
1. Jennifer J. Freeman, Brian K. Yorkgitis, Krista Haines, Deepika Koganti, Nimitt Patel, Rebecca Maine, William Chiu, Thai L. Tran, John J. Como, George Kasotakis, Vaccination After Spleen Embolization: A practice management guideline from the Eastern Association for the Surgery of Trauma, Injury, 2022, ISSN 0020-1383, https://doi.org/10.1016/j.injury.2022.08.006.