Background

The spleen plays an important role in preventing infection by removing bacteria (particularly encapsulated bacteria) from the blood stream. Individuals with anatomical asplenia (absent spleen) or functional asplenia/hyposplenia (no function or decreased function) are therefore at an increased risk of infection. In addition to being up to date with National Immunisation Program (NIP) and COVID-19 vaccines, individuals with asplenia or hyposplenia are recommended and funded to receive extra vaccines (outlined below).

The reason for asplenia or hyposplenia may be congenital or due to surgical removal (eg. in the case of trauma). Children with congenital asplenia, cancer related asplenia and those with sickle cell anaemia have a higher risk of infection than those who have had splenectomy for trauma.

Scheduling additional vaccines can be complicated by the cause of asplenia or hyposplenia. Where possible people having a planned splenectomy should ideally receive all additional vaccines at least 2 weeks prior to surgery. This is to ensure optimal protection prior to spleen removal. Those who undergo an unplanned or emergency splenectomy should defer vaccines for at least 7 days following surgery to allow time for recovery.

Individuals with asplenia/hyposplenia have a lifelong risk of infection. In addition to vaccination, patients are also recommended to receive prophylactic antibiotics.

Additional vaccine recommendations for children (< 18 years)

  • Pneumococcal

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    ¥ doses as per NIP at 6 weeks, 4 months, 6 months (additional dose for those with a special risk condition) and routinely at 12 months of age.
    β booster doses are given at ≥ 12 months of age/8 weeks since previous dose (whichever is later).
    §
    if not up to date with NIP recommendations refer to the Australian Immunisation Handbook for catch up advice.
    ^ ideally Prevenar 13® is administered first, followed by Pneumovax 23® at ≥ 4 years of age/minimum of 8 weeks later (whichever is later). If Pneumovax 23® is inadvertently administered first, a minimum of 12 months should elapse before administering Prevenar 13®.
    to be given a minimum of 8 weeks following any previous doses.
    maximum of 2 doses of Pneumovax 23® in a lifetime.
    N/A- not recommended.

  • Meningococcal

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    ^ booster doses are given at ≥ 12 months of age/8 weeks since the previous dose (whichever is later).
    # a single dose of Nimenrix® is funded on the NIP at 12 months and for year 10 students and adolescents aged 15-19 years who missed receiving the vaccine at school.
    ¥ administration of prophylactic paracetamol is recommended for those < 4 years of age (15mg/kg per dose) 30 minutes prior to vaccination (or as soon as possible after), as well as 2 subsequent doses (4-6 hours apart) to reduce the likelihood and severity of fever.
    Menveo® may be used interchangeably as an alternate brand to Nimenrix®. Where possible completing a course with the same brand is preferred.
    § Bexsero® is registered for use from 6 weeks of age. Trumenba® is an alternate meningococcal B vaccine available as a 3 dose course for individuals asplenia/hyposplenia aged 10 years or older. Meningococcal B vaccines are not interchangeable.

  • Haemophilus influenzae type B (HIB)

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    ^ if < 5 years of age and not up to date with NIP refer to the Australian Immunisation Handbook for catch up recommendations.
    § a single dose is recommended for those aged 5 years or over who have not previously completed a primary course.

  • Influenza

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    N/A- not recommended in this age group.
    £  immunisation of family members recommended.
    € 
    2 doses, given 4 weeks apart is recommended for those < 9 years of age in the 1st year of receiving the vaccine.

Additional vaccine recommendations for adults (≥ 18 years)

  • Pneumococcal

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    β please note that pneumococcal vaccination for adults is recommended and funded under the NIP. In instances where doses have already been given they do not need to be repeated following a new diagnosis of asplenia/hyposplenia.
    § dose only required if patient has never received a dose of Prevenar 13® before.
    ¥ ideally Prevenar 13® is administered first, followed by Pneumovax 23® a minimum of 8 weeks later. If Pneumovax 23® is inadvertently administered first, a minimum of 12 months should elapse before administering Prevenar 13®.
    ^ individuals who previously received Synflorix® or Prevenar 7® are recommended to receive a single dose of Prevenar 13® at diagnosis.
    maximum of 2 doses only of Pneumovax 23® in a lifetime.
    N/A- not recommended.

  • Meningococcal

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    ß in instances where a primary course has previously been given there is no need to repeat the course.
    Menveo® may be used interchangeably as an alternate brand to Nimenrix®. Where possible completing a course with the same brand is preferred.
    ^ individuals who previously received meningococcal C only vaccines (eg NeisVac-C®, Menjugate® or Meningitec®) should be re-immunised with meningococcal ACWY as recommended in these guidelines. There should be a minimum interval of at least 8 weeks between meningococcal vaccine doses.
    § individuals who previously received polysaccharide meningococcal ACWY vaccines (Menomume®or Mencevax®) should be re-immunised with conjugate meningococcal ACWY as recommended in these guidelines. There should be a minimum of 6 months elapse before administering a conjugate meningococcal ACWY vaccine.
    ¥ there is no maximum number or doses in a lifetime.
    Ω Trumenba® is an alternate meningococcal vaccine available as a 3 dose course for individuals asplenia/hyposplenia aged 10 years or older. Meningococcal B vaccines are not interchangeable for primary courses or booster doses.

  • Haemophilus influenzae type B (HIB)

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    ^ dose only required if patient did not previously complete their primary course.

  • Influenza

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    § immunisation of family members is recommended.
    ^ people who have received a solid organ transplant/HSCT should be given 2 doses of influenza vaccine, 4 weeks apart in the first year of being vaccinated following their transplant.

Vaccine funding

Some of the recommendations in these guidelines are outside the scope of the National Immunisation Program (NIP). Different jurisdictions and individual hospitals have varying approaches to non-NIP vaccines, which should be clarified with the local health service.

Authors: Rachael McGuire (MVEC Education Nurse Coordinator) and Nigel Crawford (Director SAEFVIC, Murdoch Children’s Research Institute)

Reviewed by: Rachael McGuire (MVEC Education Nurse Coordinator) and Nigel Crawford (Director SAEFVIC, Murdoch Children’s Research Institute)

Date: March 28, 2023

Materials in this section are updated as new information and vaccines become available. The Melbourne Vaccine Education Centre (MVEC) staff regularly reviews materials for accuracy.

You should not consider the information in this site to be specific, professional medical advice for your personal health or for your family’s personal health. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult a healthcare professional.