Do any of the bacterial vaccines that are recommended for people with functional or anatomic asplenia need to be given before splenectomy? Do the doses count if they are given during the 2 weeks prior to surgery?

Ideally, vaccination with both types of pneumococcal (conjugate [PCV] and polysaccharide [PPSV]), both types of meningococcal (MenACWY and MenB), and Hib vaccine should all 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 pneumococcal sepsis, CDC subject matter experts consider PCV the highest priority vaccine to administer before splenectomy. PPSV must be administered at least 8 weeks after PCV. Splenectomy patients require a two-dose primary series of MenACWY, given at least 8 weeks apart. Because the Menactra brand of MenACWY may interfere with the immune response to PCV, the first dose of Menactra in asplenic patients should be delayed 4 weeks after PCV. PCV may be administered at the same visit with (or any time before or after) Menveo or MenQuadfi brands of MenACWY. The MenB primary vaccination series requires 2–3 doses, depending upon the brand.

If vaccines are not administered before surgery, they should be administered as soon as the person’s condition stabilizes post-operatively.