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Post-Splenectomy Vaccination — FRCA Final MCQ

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ModeratePerioperative MedicinePost-Splenectomy VaccinationFRCA Final

A 25-year-old man with documented completion of the routine UK childhood immunisation schedule undergoes emergency splenectomy after blunt abdominal trauma. Vaccination was not possible before surgery. In addition to annual seasonal influenza vaccination, which set of additional vaccines should be initiated once at least 2 weeks have elapsed after the operation?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — PCV20 or remaining local PPV23, MenACWY and a MenB course

Explanation lettering: E = shown as A · D = shown as B · A = shown as D · B = shown as E

The correct answer is D. Adults with newly acquired asplenia require pneumococcal vaccination, MenACWY and a MenB course; the second MenB dose is given 4 weeks after the first. PCV20 is now used in the at-risk programme, although remaining local PPV23 stock should be used first. Pneumococcal revaccination is required every 5 years, and influenza vaccine is given annually. After emergency splenectomy, vaccination should normally be given at least 2 weeks postoperatively, rather than within the first 2 weeks, because functional antibody responses may be better. PCV13 is not required in this adult before PCV20 or PPV23. Additional Hib vaccination is no longer recommended for asplenic adults who have completed routine immunisation. Options B and C omit part of the required meningococcal protection, while E omits it entirely.

Reference: UK Health Security Agency. Immunisation against infectious disease: the Green Book, chapter 7, section ‘Asplenia’, updated 2020, https://www.gov.uk/government/publications/immunisation-of-individuals-with-underlying-medical-conditions-the-green-book-chapter-7; and chapter 25, sections ‘PPV23 and PCV20’ and ‘Timing of vaccination for those requiring splenectomy’, updated 29 July 2026, https://assets.publishing.service.gov.uk/media/684b1fbc1c8d5c94e201abae/Green_Book__Chapter_25_pneumococcal_12_6_25.pdf