Individuals with an absent or dysfunctional spleen are at increased risk of fulminant bacteraemia, most notably pneumococcal, for the rest of their lives.41

All splenectomised adult individuals should receive the pneumococcal polysaccharide vaccine. There are limited data on the value of revaccination but it is appropriate to administer a further dose 5 years after the first dose. Haemophilus influenzae type b (Hib) vaccination is recommended for splenectomised adults who have close contact with children less than 5 years of age

In elective splenectomy the vaccination should be given 2 weeks before the operation; in unplanned splenectomy, vaccination should be given when the patient has recovered from surgery.42

Children <5 years of age with splenic dysfunction, most frequently due to sickle cell disease, should be vaccinated with pneumococcal conjugate vaccine (see Part 3.18, ‘Pneumococcal infections’). To further reduce the risk of pneumococcal disease, they should also be treated with daily prophylactic doses of penicillin V, commencing before the age of 4 months (penicillin V 125 mg twice daily, rising to 250 mg twice daily when they reach 4 years of age, until 5 years of age).

All splenectomised individuals should be vaccinated first with a single dose of meningococcal C conjugate vaccine, followed 2 or more weeks later by a single dose of the tetravalent meningococcal polysaccharide vaccine (see also Part 3.14, 'Meningococcal infections').