Ideally, vaccination against pneumococcal disease, Hib disease, and meningococcal strains A, C, W, Y, and B should be completed at least 2 weeks before a scheduled splenectomy, if time permits. When preparing a patient for splenectomy, follow the dosing recommendations for a patient who is already asplenic.
Vaccine doses administered within the two-week period before surgery or after surgery are valid; however, administration at least two weeks before surgery ensures the patient is protected from the moment the spleen is removed. Completing all doses preoperatively requires advanced planning based on the age and vaccination history of the patient. If vaccinations cannot be completed, administer as many as feasible at least 2 weeks prior to surgery. Postponing splenectomy to complete vaccination is not recommended.
Because the most likely vaccine-preventable threat to the patient is from invasive pneumococcal disease, CDC subject matter experts consider pneumococcal conjugate vaccine (PCV) the highest priority vaccine to administer before splenectomy. This may be completed most rapidly by administering a single dose of PCV20. If PCV15 is used, a dose of pneumococcal polysaccharide vaccine (PPSV23) must be administered at least 8 weeks after PCV15. Splenectomy patients require a two-dose primary series of MenACWY, given at least 8 weeks apart. PCV may be administered at the same visit with (or any time before or after) Menveo or MenQuadfi brands of MenACWY. Because the Menactra brand of MenACWY may interfere with the immune response to PCV, if Menactra is used, the first dose of Menactra in asplenic patients should be delayed 4 weeks after PCV. The MenB primary vaccination series requires 2 doses (Bexsero, GSK) or 3 doses (Trumenba, Pfizer).
If vaccines are not administered before surgery, they should be administered as soon as the person’s condition stabilizes post-operatively.