The Australian Immunisation Handbook 10th Edition 2013

Persons with functional or anatomical asplenia
Persons with an absent or dysfunctional spleen are at a life-long increased risk
of fulminant bacterial infection, most notably invasive pneumococcal disease
(IPD). 89,141 Pneumococcal, meningococcal, Hib and influenza vaccination are
particularly recommended for all persons with asplenia, whether functional
or anatomical (such as splenectomy). Other vaccinations should be up to
date. Vaccines should be provided according to the person’s age and previous
immunisation history, and immunisation status should be reviewed regularly. 142
Specific vaccine recommendations for persons with asplenia are discussed below
and shown in Table 3.3.5.
In persons undergoing an elective splenectomy, vaccination should be completed,
where possible, 2 weeks before the scheduled operation date. In an unplanned
splenectomy, vaccination should commence approximately 1 week after the
splenectomy has occurred. 143
Children with splenic dysfunction should also be given antibiotic prophylaxis to
prevent bacterial infection, until at least 5 years of age. 144,145 All asplenic persons
and/or their parents/carers should also be educated about the importance
of early investigation and treatment of febrile illnesses, including the use of
emergency antibiotics. Asplenic persons are recommended to wear a medical
alert. Vaccination cannot provide protection against all bacterial infections,
or even all pneumococcal serotypes that cause IPD, hence it is particularly
important that persons with asplenia are informed of the life-long increased risk
of severe bacterial infection, even if they have been appropriately vaccinated.
Pneumococcal vaccination
Additional doses of pneumococcal vaccine are recommended for persons with
asplenia, depending on their age and previous immunisation history, as shown
in Table 3.3.5. Detailed information is provided in 4.13 Pneumococcal disease and
in Table 2.1.11 Catch-up schedule for 13vPCV (Prevenar 13) and 23vPPV (Pneumovax
23) in children with a medical condition(s) associated with an increased risk of IPD,
presenting at age