Vakzinierung vor und nach Splenektomie

Vaccine Schedules and Recommendations for Patients With Splenectomy, According to US Centers for Disease Control and Prevention–Advisory Committee on Immunization Practices (2019) and Infectious Disease Society of America Guidelines (2013)
Pneumococcal Vaccination
  • Provide pneumococcal conjugate vaccine (PCV) 13, plus pneumococcal polysaccharide vaccine (PPSV) 23 8 wk later and a PPSV23 booster 5 y later.
    • To overcome hyporesponsiveness, patients who have already received PPSV23 in the past should be administered PCV13 at least 1 y after the most recent PPSV23 dose and PPSV23 at least 5 y after the most recent PPSV23 dose.
    • If only 1 vaccine can be provided, this should be PPSV23, to achieve the largest serotype protection.
Meningococcal ACWY Vaccination
  • Provide meningococcal ACWY (MenACWY) plus MenACWY 8 wk later, plus MenACWY boosters every 5 y.
    • Avoid MenACWY administration in infants younger than 2 y to prevent weaker antibody response to simultaneous PCV13 vaccination.
Meningococcal B Vaccination
  • Provide meningococcal (Men) B-4C, plus MenB-4C 1 mo later.
  • Alternatively, provide MenB-fHbp, plus MenB-fHbp 1 to 2 mo later and MenB-fHbp 6 mo later.
Haemophilus Type B Vaccination
  • Provide Haemophilus Influenzae type B conjugate vaccine, single dose.
Seasonal Influenza Vaccination
  • Provide seasonal influenza vaccination annually.
    • The recommended month is October.
    • Recommendation is provided, considering the incremented risk of influenza viruses and capsulated bacteria coinfections.
    • Notably, live attenuated vaccines are contraindicated for patients with asplenia.
  • Give immunization 4 to 6 wk before planned splenectomy if possible, but at least 2 wk prior to surgery.
  • In case of urgent or unplanned splenectomy, immunization should be initiated 2 wk after surgery or thereafter.
  • Patients with oncological diseases should be given immunization before starting cytotoxic, immunosuppressive, or radiation therapy. If immunization is not feasible 2 wk before treatment, it should be initiated 3 mo after treatment completion. For patients receiving anti–B-cell antibodies (rituximab and similar agents), vaccination schedule should be postponed up to 6 mo after treatment completion.
  • Pregnant women have no contraindications to conjugated or inactivated vaccines. MenB vaccination needs precaution and might be delayed until after pregnancy.
  • Vaccines can be administered simultaneously either before or after surgery, except for MenACWY, which should be administered at least 4 wk apart from PCV13. Different injection sites should be preferred.
  • Adverse reactions occur with low frequency and are generally mild (fever, redness, and limited arm mobility).

Bei uns hat sich die Einführung eines Aspleniepasses sehr bewährt. Dabei sind alle Impfungen, Vorsichtsmassnahmen, z.B. bei Zahnextraktion etc. angeführt.

Casciani F et al. Perioperative Immunization for Splenectomy and the Surgeon’s Responsibility- A Review JAMA Surg. 2020;155(11):1068-1077