How should I manage a patient with hyposplenism and what vaccinations are necessary to prevent infections?

Management and vaccination strategy for patients with hyposplenism to prevent infections involves a comprehensive approach focused on immunisation, antibiotic prophylaxis, and patient education to reduce the risk of overwhelming infections, particularly from encapsulated bacteria.

Patients with hyposplenism should receive pneumococcal vaccination, including the 13-valent pneumococcal conjugate vaccine (PCV13) followed by the 23-valent pneumococcal polysaccharide vaccine (PPSV23) at least 8 weeks later to ensure broad protection against Streptococcus pneumoniae ¹. Additionally, vaccination against Haemophilus influenzae type b (Hib) and meningococcal groups ACWY and B is recommended to protect against other encapsulated organisms ¹.

Annual influenza vaccination is also advised, as viral infections can predispose to secondary bacterial infections in these patients ¹.

Long-term antibiotic prophylaxis, typically with penicillin or an appropriate alternative in case of allergy, is recommended especially in children and may be considered in adults with additional risk factors or previous severe infections ¹. Patients should be educated about the importance of seeking immediate medical attention if febrile illness develops, as rapid progression of infection is a risk due to impaired splenic function (Brigden and Pattullo, 1999).

Furthermore, patients should be advised to carry a medical alert card or bracelet indicating their hyposplenic status and the need for urgent antibiotic treatment if unwell ¹.

This integrated strategy combining vaccination, prophylactic antibiotics, and patient education aligns with UK guidelines and is supported by literature emphasizing the critical role of preventing overwhelming post-splenectomy infection (OPSI) through early immunisation and vigilance (Brigden and Pattullo, 1999).