My 36-year-old patient was diagnosed with idiopathic thrombocytopenic purpura and had a splenectomy three weeks ago. Prior to the splenectomy, he had one dose each of Hib, MenB, PCV13, MenACWY (Menveo), and PPSV23 (separated from the PCV13 by 9 weeks). What vaccines are recommended now?

Since the patient is asplenic, the second dose of the primary series of MenACWY should be given at least 8 weeks after the first dose. He will need a dose of MenACWY every 5 years for the rest of his life. The series of MenB (whether Trumenba or Bexsero) should be completed. The first booster dose of MenB will be due one year after completion of the primary series and subsequent booster doses are recommended every 2–3 years for the rest of his life. The same MenB vaccine should be used for all doses in the series, including booster doses. The patient has already received the one dose of PCV13 recommended for adults, so no further doses are needed. He also has properly received his first dose of PPSV at least 8 weeks after the dose of PCV13. A second PPSV dose will be due at least 5 years after the first dose of PPSV. A third (and final) dose of PPSV should be given after the patient turns age 65. Based on the patient’s age, only one dose of Hib vaccine is recommended, so no further doses are needed. The patient should receive influenza vaccine annually.

Any of these vaccines can be given at the same appointment, except for PCV13 and PPSV23, and PCV13 and the Menactra brand of MenACWY. If Menactra is used for an asplenic person it should be separated from the PCV13 by at least 4 weeks. Menveo and MenQuadfi brands may be given at any time relative to PCV13.