vaccination for immunising individuals with asplenia, splenic dysfunction or complement disorders

Last edited 04/2019

• children under one year of age should be vaccinated according to the UK schedule and should also receive:
  
  
  • two doses of MenACWY vaccine at least one month apart during infancy;
    
    
  • one additional dose of PCV13* and one dose of MenACWY conjugate vaccine two months after the 12-month vaccinations; and
    
    
  • one additional dose of Hib/MenC and one dose of PPV231 after the second birthday.

• First diagnosed at 12-23 months of age
  
  
  • if not yet administered, give the routine 12-month vaccines:
    • Hib/MenC, PCV13, MMR and MenB, plus:
      
      
      • one additional dose of PCV13* and one dose of MenACWY conjugate vaccine two months after the 12-month vaccinations; and
        
        
      • one additional dose of Hib/MenC and one dose of PPV23*,** after the second birthday
        
        
  • if not already received, two primary doses of MenB vaccine should be given two months apart at the same visit as the other vaccinations
    
    
• First diagnosed from two years to under ten years of age
  
  
  • ensure children are immunised according to the national schedule, and they should also receive:
    
    
    • one additional dose of Hib/MenC and one dose of PPV23*; followed by:
      
      
    • one dose of MenACWY conjugate vaccine two months later
      
      
  • if not already received, two primary doses of MenB vaccine should be given two months apart at the same visit as the other vaccinations
    
    
• First diagnosed at age ten years onwards
  
  
  • older children and adults, regardless of previous vaccination, should receive:
    
    
    • one dose of Hib/MenC and one dose of PPV23*; followed by:
      
      
    • one dose of MenACWY conjugate vaccine one month later
      
      
  • If not already received, two primary doses of MenB vaccine should be given one month apart at the same visit as the other vaccinations
    
    
• All patients
  • Annual influenza vaccine each season
    

Where an opportunity arises, and depending on the individual patient's circumstances, children and adults who have never received 4CMenB or MenACWY conjugate vaccine should be offered these vaccines.

* Patients on Eculizumab therapy are not at increased risk of pneumococcal disease and do not require PPV23 or additional doses of PCV13.

** Patients with splenic dysfunction should receive boosters of PPV at five yearly intervals.

Reference:

1. British Committee for Standards in Haematology (2002). Update of guidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen.Clinical Medicine (Journal of the Royal College of Physicians of London;5(5): 440-443.
2. Immunisation Against Infectious Disease - "The Green Book".Chapter 25 Pneumococcal (April 2019)
3. Immunisation Against Infectious Disease - "The Green Book".Chapter 22 Meningococcal (April 2019)