People who do not have a functioning spleen or who have had a splenectomy are at increased risk for infection with encapsulated bacteria, especially Pneumococcus, Neisseria meningitidis, and Haemophilus influenzae type b (Hib).
In addition to receiving routine vaccinations, children and adults without a functioning spleen who are age 2 years and older should receive 1 dose of pneumococcal polysaccharide vaccine (PPSV) at least 8 weeks after the last dose of pneumococcal conjugate vaccine (PCV). Adults should receive 1 dose of PCV either 8 weeks before PPSV, or 1 year after PPSV. If younger than 65, a second dose of PPSV should be administered 5 years after the first dose, with a third and final dose at age 65 (or 5 years after the previous dose, whichever comes later). Only one PPSV dose should be given to someone age 65 or older.
All asplenic persons should receive a primary series of at least 2 doses of meningococcal ACWY vaccine (MenACWY) with a booster dose every 5 years. See the MenACWY recommendation table at www.immunize.org/catg.d/p2018.pdf for details. Asplenic people age 10 years and older should also receive a series (either 2 or 3 doses depending on the vaccine brand) of meningococcal serogroup B vaccine (MenB) with an initial booster dose one year after completion of the primary series and subsequent booster doses every 2–3 years thereafter.
Two doses of Hib vaccine should be given to unimmunized children 12–59 months of age (defined as a child who received zero or 1 dose before 12 months of age). A single dose of Hib vaccine should be administered to unimmunized people age 5 years or older (defined as those who have not received at least 1 dose of Hib vaccine after 14 months of age).