In this episode, I’ll discuss why vaccines aren’t given in the 14 days after non-elective splenectomy.
This recommendation is based on a small study of 59 splenectomy patients where pneumococcal vaccine response at 1, 7, and 14 days post-splenectomy were compared.
Better functional antibody responses against the serogroup and serotypes studied seemed to occur with delayed (14-day) vaccination. In fact, with one exception, all titers for the 14-day group approached those of the control subjects.
However this is not considered by many clinicians as a hard and fast rule, as the same study did show that post-vaccination immunoglobulin G serum antibody concentrations were not significantly different from normal control subjects regardless of the time of vaccination. This leads some clinicians to consider other factors when deciding post splenectomy vaccine timing. For example, what if the patient is being discharged from the hospital before 14 days and the ability of the patient to follow-up is in question? In this scenario, some trauma centers will give the vaccines immediately prior to hospital discharge, even if it has not been 14 days post splenectomy.
What if a patient was given a vaccine before 14 days post splenectomy and they are not scheduled to be discharged from the hospital? There is no data to assist with decision making in this scenario. Advice given by immunize.org, an organization supported by the CDC is to consider these doses as being valid. However other experts suggest that if the clinician is concerned about the effectiveness of these early vaccine doses, they can consider repeating these vaccinations at a date about 8 weeks in the future.
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