The ideal time to give immunization to patients undergoing elective splenectomy is: (AIIMS Nov 2011)
|A||At least 2 months before surgery|
|B||At least 2 weeks before surgery|
|C||In the holding area just prior to surgery|
|D||On the day of discharge from the hospital after splenectomy.|
(Rosai and Ackermans surgical Pathology, 9th edition page no 592)
a. The splenectomized patient should be vaccinated to decrease the risk of overwhelming postsplenectomy sepsis (OPSS) due to organisms such as Streptococcus pneumoniae, Haemophilus influenzae type B, and Neisseria meningitidis.
b. Elective splenectomy patients should be vaccinated at least 14 days prior to the operation.
c. Asplenic or immunocompromised patients (with an intact, but nonfunctional spleen) should be vaccinated as soon as the diagnosis is made.
d. Pediatric vaccination should be performed according to the recommended pediatric dosage and vaccine types with special consideration made for children less than 2 years of age.
e. When adult vaccination is indicated, the following vaccinations should be administered:
i. Streptococcus pneumoniae
ii. Polyvalent pneumococcal vaccine (Pneumovax 23)
iii. Haemophilus influenzae type B
iv. Haemophilus influenzae b vaccine (HibTITER)
v. Neisseria meningitidis
vi. Age 16-55: Meningococcal (groups A, C, Y, W-135) polysaccharide diphtheria toxoid conjugate vaccine (Menactra)
vii. Age >55: Meningococcal polysaccharide vaccine (Menomune-A/C/Y/W-135)
viii. Vaccine Dose Route Revaccination
Polyvalent pneumococcal 0.5 mL SC* revaccination -Every 6 years
Quadravalent meningococcal/diphtheria conjugate 0.5 mL IM upper deltoid. Revaccination - Every 3-5 years.
Quadravalent meningococcal polysaccharide 0.5 mL SC. Revaccination -Every 3-5 year
Haemophilus b conjugate 0.5 mL IM.
ix. Non-elective splenectomy patients should be vaccinated on or after postoperative day 14.
x. Asplenic patients should be revaccinated at the appropriate time interval for each vaccine.