Splenectomy: What Vaccines Should You Avoid?

Vaccinations are an important consideration for patients who have undergone a splenectomy, as the spleen plays a crucial role in the body's immune response to infections. The absence of a spleen, or hyposplenia, can increase an individual's susceptibility to certain bacterial infections and therefore, prophylactic measures with immunizations are often necessary. While there are no specific vaccines that are universally contraindicated for individuals who have had a splenectomy, the decision to administer certain vaccines may depend on various factors such as the patient's age, underlying health conditions, and the timing of the surgery.

Live attenuated vaccines are contraindicated for severely immunocompromised patients

People with asplenia or hyposplenia are at a higher risk of infection from encapsulated bacteria such as S. pneumoniae, H. influenzae, and N. meningitidis. Therefore, immunizations are necessary for this population, and exceptions to the typical dosing schedules for these vaccines are made for individuals with asplenia or hyposplenia.

According to the CDC, about 50% of invasive pneumococcal diseases in immunocompromised adults are due to serotypes contained in the PCV13 vaccination, and about 21% are due to serotypes contained only in PPSV23. Immunocompromised patients may have a reduced response to PPSV23, but the CDC recommends administering this vaccine to reduce the risk of invasive pneumococcal disease. If the pneumococcal vaccination cannot be administered before the splenectomy, it should be delayed until a functional antibody response returns, at least 14 days after the procedure. Pneumococcal, meningococcal, and Hib vaccines are contraindicated if the patient previously experienced a severe allergic reaction, such as anaphylaxis, upon administration of the vaccine or a component.

In asplenic patients, influenza immunization is associated with a 54% reduced risk of death compared to unimmunized asplenic persons. Therefore, international guidelines recommend an annual influenza vaccine for hyposplenic or asplenic patients. The vaccine could be administered before or after splenectomy, preferably in October, to afford seasonal protection.

Live attenuated vaccines are contraindicated in severely immunocompromised patients, while inactivated vaccines are strongly recommended for subjects with primary or secondary immunodeficiency. In general, subjects with lymphocyte deficits should not receive live viral attenuated vaccines, while subjects with neutropenia should not receive live attenuated bacterial vaccines. If a person who is immunocompromised is inadvertently given a live vaccine, they need a prompt review to consider the degree of immunocompromise and the likelihood of experiencing an adverse event. If a person is considered moderately to severely immunocompromised, urgent management may be needed.

Patients with severe B-cell defects (XLA, CVID) and those receiving regular immunoglobulin replacement therapy should not receive measles-mumps-rubella (MMR), measles-mumps-rubella-varicella (MMRV), or varicella vaccines as Ig will interfere with the efficacy of these vaccines. All other live vaccines such as rotavirus, live attenuated influenza, Bacille Calmette-Guérin (BCG), oral polio, smallpox, oral typhoid, and yellow fever vaccines are contraindicated. If travel to an area where yellow fever is being transmitted cannot be avoided, vaccination in consultation with a specialist is advised.

Vaccines with diphtheria toxoid are contraindicated for those with a history of severe reactions

Vaccines are an essential tool to prevent infectious diseases, especially in individuals with asplenia or hyposplenia, as they are more susceptible to infections.

Live attenuated vaccines are generally contraindicated in severely immunocompromised patients, while inactivated vaccines are strongly recommended for those with primary or secondary immunodeficiency.

For individuals with asplenia or hyposplenia, vaccinations against S. pneumoniae, N. meningitidis, H. influenzae type b, and influenza are strongly recommended. The pneumococcal vaccine (PCV13 or PPSV23) can be safely administered with the inactivated influenza vaccine.

Now, regarding vaccines with diphtheria toxoid, these are indeed contraindicated for individuals with a history of severe reactions. Specifically, the MenACWY vaccine is contraindicated for those who have had a reaction to diphtheria toxoid. Additionally, PCV13 is contraindicated for patients with a history of severe reactions to a diphtheria toxoid-containing vaccine.

It is important to note that the terms "severe reaction" and "severe allergic reaction" are often used to refer to anaphylaxis, which is a potentially life-threatening allergic reaction. A history of anaphylaxis to a vaccine component or a previous dose is generally a contraindication to further doses.

The decision to administer a vaccine should be made on a case-by-case basis, considering the patient's medical history and the potential benefits and risks of vaccination.

Pneumococcal vaccines are contraindicated for those with a history of severe allergic reactions

Pneumococcal vaccines are generally safe and recommended for those who have had a splenectomy. However, in rare cases, individuals with a history of severe allergic reactions may need to avoid certain vaccines, including some pneumococcal vaccines.

Pneumococcal vaccines are crucial for individuals who have undergone a splenectomy, as they help protect against infections caused by Streptococcus pneumoniae bacteria. These bacteria can lead to mild illnesses like ear infections and sinusitis, but they can also cause serious infections such as meningitis, sepsis, and pneumonia. Therefore, pneumococcal vaccinations are strongly recommended for asplenic patients to reduce their risk of infection.

However, it is important to consider contraindications for specific vaccines. Pneumococcal vaccines, such as PCV15, PCV20, PCV21, and PPSV23, are generally safe for most people. Nevertheless, individuals with a history of severe allergic reactions, particularly anaphylaxis, to a previous dose of the vaccine or any of its ingredients should refrain from getting these vaccines. This precaution is crucial to prevent the rare but potentially life-threatening allergic reactions that can occur.

Additionally, individuals with a history of severe allergic reactions to diphtheria toxoid-containing vaccines should also avoid pneumococcal vaccines that contain diphtheria toxoid, such as PCV13. This precaution is in place because certain pneumococcal vaccines use diphtheria conjugate as the protein carrier.

It is important to consult with a healthcare provider before receiving any vaccine, especially if there is a history of allergic reactions. A vaccine provider can review an individual's vaccination history and assess the specific ingredients of a vaccine to determine if it is safe to administer.

Influenza vaccines are contraindicated for those with a history of anaphylactic reactions

A splenectomy is the surgical removal of the spleen. People without a spleen are at a higher risk of infection from encapsulated bacteria such as S. pneumoniae, H. influenzae, and N. meningitidis. Therefore, vaccinations are recommended for these patients to prevent infection.

The influenza vaccine is recommended for asplenic and hyposplenic patients. However, it is contraindicated for those with a history of anaphylactic reactions. Influenza vaccines, or flu vaccines, are generally safe and effective for most people. However, those with a history of severe allergic reactions, such as anaphylaxis, to any component of the vaccine, should not receive the vaccine. This includes egg allergies, as most flu vaccines are manufactured using egg-based technology and contain a small amount of egg protein.

Anaphylaxis is a severe and potentially life-threatening allergic reaction that can occur in response to certain allergens. It is characterized by symptoms such as difficulty breathing, swelling of the throat, and a sudden drop in blood pressure. While severe allergic reactions to vaccines are rare, they can occur, and anaphylaxis is a known, albeit uncommon, reaction to influenza vaccines. Therefore, it is recommended that individuals with a history of anaphylaxis to any component of the influenza vaccine refrain from receiving it.

It is important to note that the decision to vaccinate should be made on a case-by-case basis, and individuals with concerns about allergies or other medical conditions should consult their healthcare provider before receiving any vaccine. Additionally, all vaccines should be administered in settings with the appropriate personnel and equipment to rapidly recognize and treat allergic reactions.

MMR vaccines are contraindicated during pregnancy

The MMR vaccine is a combination of live attenuated vaccines against measles, mumps, and rubella. While the MMR vaccine is considered safe and effective, it is not recommended for pregnant women due to potential risks to the fetus.

The MMR vaccine is contraindicated during pregnancy because it is a live vaccine, meaning it contains weakened versions of these viruses. Although the viruses are attenuated, or weakened, there is a theoretical risk of infection to the fetus. The main concern is the risk of congenital rubella syndrome (CRS), which can cause severe birth defects and neurodevelopmental problems in the fetus if a pregnant woman contracts rubella. While the absolute risk of CRS is low, estimated at 0% to 1.6% by the CDC, it is still recommended that the MMR vaccine be given at least one month before pregnancy if a woman did not receive it during childhood.

Additionally, measles infection during pregnancy has been associated with an increased risk of maternal morbidity, abortion, prematurity, and stillbirth. Mumps infection during pregnancy may also increase the risk of spontaneous abortion, although the data is inconsistent.

While there is no evidence of increased risk of congenital malformations or adverse pregnancy outcomes associated with MMR vaccination during pregnancy, there has been at least one documented case of a pregnant woman receiving the MMR vaccine during the first trimester, resulting in her baby being diagnosed with CRS after birth. However, it is important to note that this is an extremely rare occurrence.

To summarize, the MMR vaccine is contraindicated during pregnancy due to the potential risks associated with live attenuated vaccines. Pregnant women or women planning to become pregnant should consult their healthcare providers to assess their individual needs and determine the appropriate timing of the MMR vaccine to ensure their safety and the health of their future children.

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