Effective measures for the primary prevention of infection in asplenic patients include immunizations against Streptococcus pneumoniae, Haemophilus influenzae type b (Hib), and Neisseria meningitidis, antibiotic prophylaxis, and malaria prophylaxis.

• Up to 87% of asplenic patients were found to have been infected with Streptococcus pneumoniae, one of the most common bacterial pathogen leading to infection in patients with asplenia.^[1]
• All patients with asplenia should receive the standard childhood and adolescent immunizations at the recommended age.^[2]
• Immunizations against Streptococcus pneumoniae, Haemophilus influenzae type b (Hib), and Neisseria meningitidis should be ensured and may be administered on an earlier schedule than is routine, due to the risk of fulminant sepsis from encapsulated bacteria.
  • Pneumococcal vaccine: Both the conjugated 13-valent pneumococcal vaccine and the 23-valent polysaccharide vaccine is recommended for the asplenic patient.
  • Meningococcal vaccine: The conjugate quadrivalent meningococcal vaccine (MCV4) should be given.
  • Haemophilus influenzae type b (Hib): Children with asplenia should receive the Hib vaccine, who present with a life-threatening Hib infection because the infection itself does not confer lifelong protection.
  • Influenza vaccine: is recommended yearly, starting at six months of age, to lower the risk of secondary bacterial infections.
  • All asplenic patients may be at risk of Salmonella infection while travelling to less developed areas of the world and should be immunized for Salmonella typhi.
  • All age-appropriate vaccines and the yearly influenzae vaccine should be given to household contacts of asplenic patients.
  • Before splenectomy and after the surgical removal, vaccinations are also recommended.^[3]
  • Patient with functional asplenia or autosplenectomy, it is also advised to continue aggressive vaccination schedules. Recommended vaccinations in these patients are the pneumococcal conjugate vaccine (PCV-13) 8 weeks in advance, as well as the pneumococcal polysaccharide vaccine (PPSV-23), Haemophilus influenzae type B vaccine (Hib), and the quadrivalent meningococcal conjugate vaccine before 14 days of planned surgery for splenectomy.
• Revaccination: In asplenia or splenic dysfunction patients antibody levels are likely to decline rapidly therefore revaccination with 23-valent PPV is recommended every five years. There is no required for testing of antibodies prior to vaccination.

• Only Immunizations do not protect against infections with encapsulated bacteria, antibiotic prophylaxis Should be given. All the patients younger than five years of age should receive antibiotic prophylaxis.^[2]
• For children
  • Birth to three months: Escherichia coli, Klebsiella is of concern in this age group.^[4]
    • Amoxicillin or clavulanate 10 mg/kg/dose PO q12h, with penicillin VK 125 mg per dose PO q12h OR amoxicillin 10 mg/kg/dose q12h, as an alternative, if not tolerated.
  • more than 3 months to five years:
    • Penicillin VK 125 mg per dose PO q12h OR amoxicillin 10 mg/kg/dose PO q12h.
  • more than 5 years:
    • Penicillin V 250 mg or 300 mg per dose q12h OR amoxicillin 250 mg per dose q12h.

• For adult the infectious risk in asplenic patients is highest during the first 2 years following splenectomy and the risk decreases over time. In these patients along with vaccination, antibiotic prophylaxis should be given. Prophylactic oral antibiotic phenoxymethylpenicillin is required for at least 2 years after splenectomy to cover the period during which the infectious risk is highest as a long term therapy.^[5]

• Asplenic and hyposplenic children must be advised to take malaria prophylaxis as appropriate for their age and the type of malaria found in the area to which they are traveling and they should always seek travel advice due to the increased risk of severe malaria in these patients.^[4]

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