What vaccines are indicated for someone who does not have a functioning spleen?

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 need additional pneumococcal vaccinations, with specific recommendations dependent on an individual’s age and specific pneumococcal vaccination history. Refer to current immunization schedules, Immunize.org’s standing orders templates for pneumococcal vaccination, or CDC’s PneumoRecs VaxAdvisor Mobile App.

All asplenic people 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. A pentavalent MenABCWY vaccine (Penbraya, Pfizer) is also an option in certain circumstances.

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).