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Patients with asplenia have an increased risk of severe infections. When preparing a young adult with asplenia for college dormitory living, understanding how to manage meningococcal vaccination, among other vaccines, is critical.
Read the question and peer recommendations for creating an effective vaccine plan below. Then log in or sign up to see the consensus.
Patient profile:
A 19-year-old college student with asplenia due to prior splenectomy for hereditary spherocytosis presents for routine care before moving into a dormitory. She has no prior history of meningococcal vaccination.
Her primary care provider is considering how to catch her up on both MenACWY and MenB coverage in the most efficient and immunogenic way.
Questions for consult
How would you proceed to treat this patient and why?
Consults
Key takeaways about meningococcal vaccinations in patients with asplenia:
- Prioritize protection against encapsulated bacteria
Prioritize vaccines for pneumococcus, meningococcus (ACWY + B), and Hib. - Catch up and sequence correctly
Use conjugate vaccines first; confirm prior doses and complete any missed. - Go beyond vaccines
Provide emergency antibiotics, a medical ID, and clear fever protocols. Be sure to emphasize the importance of vaccinating before entering college to prevent serious infections.
Family Practice
"I would immediately co-administer the first doses of three critical vaccines: a MenACWY conjugate, the MenB vaccine (specifically the 3-dose Trumenba series for the most robust immune response), and the PCV20 pneumococcal vaccine. This aggressive vaccination strategy is essential to rapidly mitigate her high risk of life-threatening sepsis from encapsulated organisms before she enters the high-transmission college dormitory environment.
Concurrently, I would prescribe emergency stand-by antibiotics, provide documentation for a medical alert ID, deliver explicit education on the 'fever is an emergency' protocol, and schedule all necessary follow-up appointments to ensure completion of her vaccine series."
Family Practice
"A 19-year-old with hereditary spherocytosis and asplenia should receive immunizations against Streptococcus pneumoniae (PCV13 followed by PPSV23), Neisseria meningitidis (MenACWY, two-dose primary series), Haemophilus influenzae type b (if not previously vaccinated), and annual influenza vaccination. The rationale is that asplenic patients are at significantly increased risk for overwhelming postsplenectomy infection, particularly from encapsulated organisms such as S. pneumoniae, N. meningitidis, and H. influenzae type b.
The sequence of PCV13 followed by PPSV23 is recommended because it elicits a higher antibody response than PPSV23 alone, and the conjugate vaccine should precede the polysaccharide vaccine to optimize immunogenicity. Annual influenza vaccination is also recommended, as influenza infection increases susceptibility to secondary bacterial infections, including those caused by S. pneumoniae and S. aureus."
Oncology & Hematology
"She should have undergone vaccination prior to splenectomy. It should be confirmed with her hematologist that immunizations were not performed in anticipation of surgery or after spleen removal. Regardless of her splenectomy status, she should receive all available vaccinations against meningitis. They are not mandatory, but if she is moving into a dormitory setting, she will be at high risk. The patient should undergo catch-up vaccination if she is not fully immunized according to the childhood and adult vaccination schedule.
This includes the immunizations that are of particular importance in asplenic patients— Hib, meningococcus, and pneumococcus vaccination. If the splenectomy was recent, she should start the relevant vaccine series two weeks after the operation, if this is doable. She should also be immunized against influenza and SARS-CoV-2 due to the potential for increased morbidity."
Family Practice
"Stress to the patient how important it is now to be immunologically protected due to the absence of the spleen. This is especially important against encapsulated bacteria. I would recommend the Penbraya shot that converts the prior Men ACWY and the MenB into one shot, and also recommend getting the pneumonia vaccine(s) every 5 years. I would also do a thorough review of prior immunizations, as things have changed. She may (and likely will) need additional vaccines for good protection."
Family Practice
"Each are (2) dose series. Start both in one visit and final dose at next visit within 6 months. Efficient and cost-effective."
To explore more peer insights on meningococcal vaccination for patients with asplenia or contribute your opinion to the conversation, read the full case on Healthcasts.
