Background

The spleen plays an important role in fighting infections by removing bacteria from the blood stream, in particular, encapsulated bacterial infections. It acts as a filter, breaking down damaged or old red blood cells and also stores red blood cells and platelets which are released in the instance of severe blood loss.

What is Asplenia?

People with no spleen (asplenia) or who have a spleen with decreased or absent function (hyposplenia) are at an increased risk of infection with encapsulated bacteria, most importantly Streptococcus pneumoniae (pneumococcus), the cause of invasive pneumococcal disease (IPD) which includes: meningitis (brain infection); septicaemia (blood infection) and pneumonia (chest infection). Infections with other bacteria, such as Neisseria meningitidis (meningococcus) and Capnocytophaga canimorsus (after dog or cat bite) also occur at an increased rate in people with asplenia.

Children with congenital asplenia, cancer related asplenia and those with sickle cell anaemia are at greater risk of infection than those who have had splenectomy for trauma.

The first two years following splenectomy are considered the highest risk for infection, although several reports indicate that the risk is lifelong.

Immunisation in people with asplenia

Due to the increased risk of infection it is essential that a person without a functioning spleen remain up to date with immunisations. Many of these infections are vaccine preventable, and protection can be optimised by appropriate and timely immunisation.

Individuals without functioning spleens are not at an increased risk of contracting influenza, however, vaccination with the annual seasonal influenza vaccine is recommended as contracting influenza increases the risk of developing a secondary bacterial infection.

Recommended vaccines

It is recommended that people with functional or anatomical asplenia, including sickle cell disease or other haemoglobinopathies receive the following vaccines which are funded under the NIP:

  • Pneumococcal
    • 13-valent pneumococcal conjugate vaccine (Prevenar 13®)
    • 23-valent pneumococcal polysaccharide vaccine (Pneumovax 23®)
  • Meningococcal
    • Meningococcal quadravalent conjugate vaccine 4vMenCV (Nimenrix®)
    • Meningococcal B recombinant multicomponent vaccine MenBV (Bexsero®)
  • Haemophilus influenzae type B
  • Annual influenza vaccine

NB: From 1 July 2020 there have been changes to the National Immunisation Program (NIP) involving recommendations and funding for vaccine schedules for individuals with risk conditions [see ATAGI: Clinical advice on changes to vaccine recommendations and funding for people with risk conditions from 1 July 2020]

MVEC have worked with the Spleen Australia team to develop comprehensive vaccination guidelines [see Resources below].

Resources

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

Reviewed by: Francesca Machingaifa (SAEFVIC Research Nurse, Murdoch Children’s Research Institute) and Georgina Lewis (Clinical Manager SAEFVIC, Murdoch Children’s Research Institute)

Date: July 2020

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.