Specifically, there is a risk for severe infections from the Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis bacteria.
Fortunately, there are vaccines that protect against many subtypes of these bacteria, including:
Hib – protects against Haemophilus influenzae type B
Meningococcal conjugate vaccines – Menactra or Menveo, which protect against 4 common types of the Neisseria meningitidis bacteria – serogroups ACWY
Serogroup B Meningococcal vaccines – Bexsero or Trunemba, which protect against Neisseria meningitidis serogroup B
Prevnar 13 – protects against 13 subtypes of Streptococcus pneumoniae
Pneumovax 23 – protects against 23 subtypes of Streptococcus pneumoniae
Although Prevnar, Hib, and the meningococcal vaccines (Menactra or Menveo and Bexsero or Trunemba) are part of the routine immunization schedule, there are additional recommendations that can change the timing for when kids get them if they have asplenia.
According to the latest recommendations, in addition to all of the other routine immunizations that they should get according to schedule, children with asplenia should get:
one dose of the Hib vaccine if they are older than age 5 years “who are asplenic or who are scheduled for an elective splenectomy” and have not already vaccinated against Hib. Unvaccinated younger kids should get caught up as soon as possible. In general though, Hib is given according to the standard immunization schedule. This recommendation is about kids who are behind on the shot.
two doses of a meningococcal conjugate vaccine, either Menactra or Menveo, two months apart once a child with asplenia is at least two years old and a booster dose every five years. Infants with asplenia can instead get a primary series of Menveo at 2, 4, 6, and 12 months, with a first booster dose after three years, and a second booster after another five years. Older infants can get Menactra at 9 and 12 months, again, with a first booster dose after three years, and a second booster after another five years. While these vaccines are recommended for all kids, those with asplenia get them much earlier than the standard age.
either a two dose series of Bexsero or a three dose series of Trunemba, once they are at least 10 years old. The Men B vaccines are only formally recommended for high risk kids, others can get it if they want to be protected.
between one to four doses of Prevnar, depending on how old they are when they start and complete the series. Keep in mind that unlike healthy children who do not routinely get Prevnar after they are 5 years old, older children with asplenia can get a single dose of Prevnar up to age 65 years if they have never had it before. Like Hib, this recommendation is about kids who are behind on the shot.
a dose of Pneumovax 23 once they are at least two years old, with a repeat dose five years later and a maximum of two total doses. Kids who are not high risk typically don’t get this vaccine.
Ideally, children would get these vaccines at least two to three weeks before they were going to get a planned splenectomy. Of course, that isn’t always possible in the case of the emergency removal of a child’s spleen, in which case they should get the vaccines as soon as they can.
More About Asplenia
In addition to these vaccines, preventative antibiotics are typically given once a child’s spleen is removed or is no longer working well. Although there are no definitive guidelines for all children who have had a splenectomy, many experts recommend daily antibiotics (usually penicillin or amoxicillin) until a child is at least 5 years old and for at least 1 year after their splenectomy.
Other less common bacteria that can be a risk for children with asplenia can include Escherichia coli, Staphylococcus aureus, Salmonella species, Klebsiella species, and Pseudomonas aeruginosa. Vaccines aren’t yet available for these bacteria, so you might take other precautions, such as avoiding pet reptiles, which can put kids at risk for Salmonella infections.
Children with asplenia are at increased risk for severe malaria and babesiosis (a tickborne illness) infections. That makes it important to take malaria preventative medications and avoid mosquitoes if traveling to places that have high rates of malaria and to do daily tick checks when camping, etc.
A medical alert type bracelet, indicating that your child has had his spleen removed, can be a good idea in case he ends up in the emergency room with a fever and doctors don’t know his medical history.
Keep in mind that since there are many different causes of asplenia, the specific treatment plan for your child may be a little different than that described here. Talk to your pediatrician and any pediatric specialists that your child sees.
What to Know about Vaccines for Children with Asplenia
Children with asplenia typically need extra vaccines and protection against pneumococcal disease, Hib, and meningococcal disease.
“Comparisons between rates obtained from immunization records versus the total sample (records and recall) conducted on data collected between 1979 and 1983 showed that the USIS, which accepted parental recall, underestimated the true vaccination rate in preschoolers by as much as 23% for some antigens.”
Simpson et al on Forty years and four surveys: How does our measuring measure up?
The vaccination rates he is citing were based on a phone survey that wasn’t thought to be very accurate, underestimating true vaccination rates. It was last used in 1985.
While vaccination rates weren’t great at the time, they just weren’t as horrible as he makes it seem, but we still had some deaths from vaccine-preventable diseases. Not as bad as the pre-vaccine era though, when hundreds of people died with measles each year.
Unfortunately, it got worse. This was just before the large measles outbreaks from 1989 to 1991, when 123 people died. During those three years, there were also 28 deaths from pertussis, 6 deaths from mumps, 13 deaths from rubella and 77 cases of congenital rubella syndrome!
Deaths from non-Vaccine-Preventable Diseases, 1985
Many of the diseases on J.B. Handley’s chart weren’t yet vaccine-preventable in 1985. They were quite deadly though, which is why vaccines were being developed and were eventually added to the schedule to protect our kids from getting them.
But in 1985 (*or in the years before the vaccine was introduced), tragically, the CDC lists:
80 deaths from hepatitis A
490 deaths from hepatitis B
68 deaths from chicken pox
219 deaths from Hib meningitis in children and about another 45 deaths from Hib epiglotittis
at least 200 deaths from pneumococcal disease in children*
257 deaths from meningococcal infections
20 to 60 deaths each year from rotavirus infections*
Want us to Turn Back the Clock and go back to an immunization plan (the Jenny McCarthy schedule) that didn’t include vaccines against any of these diseases? We would end up back to when kids still died of meningitis, pneumonia, blood infections, severe dehydration, epiglottitis, Hib, pneumococcal disease, rotavirus, hepatitis A, chicken pox, meningococcal disease, and developed cancer from HPV and hepatitis B infections.
And the answer to Mr. Handley’s question becomes even more obvious.
How did we survive the 1980s with vaccination rates well below “herd immunity” thresholds and far fewer vaccines?
Many people didn’t.
What to Know About Deaths and Vaccination Rates
Poor vaccination rates and fewer vaccines led to more deaths from now vaccine preventable diseases in the mid-1980s.
We should know that vaccine-preventable diseases were rarely mild, natural immunity comes at a cost, and that those who died from smallpox, diphtheria, measles, and polio aren’t around to talk about their experiences on Facebook (survivorship bias).
We should never forget that vaccine-preventable diseases were once big killers, and the only reason some folks have grown to fear the side effects of vaccines more than the diseases they prevent, is because we don’t see those diseases very much any more. If more people skip or delay getting vaccinated, we will though.