Posttherapy management

Clinicians should consider and encourage the administration of inactivated vaccines (e.g., influenza) and vaccines made of purified antigens (e.g., pneumococcus), bacterial components (e.g., diphtheria-tetanus-pertussis), or genetically engineered recombinant antigens (e.g., hepatitis B) in all cancer and transplant survivors according to recommended doses and schedules.[10-12]

Two primary doses of quadrivalent meningococcal conjugate vaccine should be administered 2 months apart to children with asplenia, from age 2 years through adolescence, and a booster dose should be administered every 5 years. For more information, see Meningococcal Vaccination: Recommendations of the Advisory Committee on Immunization Practices, United States, 2020.[13]

Two primary doses of quadrivalent meningococcal conjugate vaccine should be administered 2 months apart to children with asplenia, from age 2 years through adolescence, and a booster dose should be administered every 5 years. For more information, see Meningococcal Vaccination: Recommendations of the Advisory Committee on Immunization Practices, United States, 2020.[13]

The efficacy of meningococcal vaccines in children with asplenia has not been established.

Two primary doses of quadrivalent meningococcal conjugate vaccine should be administered 2 months apart to children with asplenia, from age 2 years through adolescence, and a booster dose should be administered every 5 years. For more information, see Meningococcal Vaccination: Recommendations of the Advisory Committee on Immunization Practices, United States, 2020.[13]

No known contraindication exists to giving these vaccines at the same time as other required vaccines, in separate syringes, and at different sites.

Pneumococcal conjugate vaccine (PCV) and pneumococcal polysaccharide vaccine (PPSV) are indicated at the recommended age for all children with asplenia.[14,15]

Pneumococcal conjugate vaccine (PCV) and pneumococcal polysaccharide vaccine (PPSV) are indicated at the recommended age for all children with asplenia.[14,15]

Following the administration of the appropriate number of doses of PCV13, PPSV23 should be administered starting at age 24 months.

Pneumococcal conjugate vaccine (PCV) and pneumococcal polysaccharide vaccine (PPSV) are indicated at the recommended age for all children with asplenia.[14,15]

A second dose should be administered 5 years later.

Pneumococcal conjugate vaccine (PCV) and pneumococcal polysaccharide vaccine (PPSV) are indicated at the recommended age for all children with asplenia.[14,15]

For children aged 2 to 5 years with a complete PCV7 series who have not received PCV13, a supplemental dose of PCV13 should be administered.

Pneumococcal conjugate vaccine (PCV) and pneumococcal polysaccharide vaccine (PPSV) are indicated at the recommended age for all children with asplenia.[14,15]

For asplenic individuals aged 6 to 18 years who have not received a dose of PCV13, a supplemental dose of PCV13 should be considered.

Hib immunization should be initiated at age 2 months, as recommended for otherwise healthy young children and for previously unimmunized children with asplenia.[15] For more information, see Immunization Schedules.[15]

Although the efficacy of daily antimicrobial prophylaxis has been proven only in patients with sickle cell anemia, this experience has been extended to other high-risk children, including asplenic children with a history of malignant neoplasms or thalassemia.

In general, antimicrobial prophylaxis (in addition to immunization) should be considered for all children with asplenia younger than 5 years and for at least 1 year after splenectomy.

The age at which antimicrobial prophylaxis is discontinued is an empiric decision.

The age at which antimicrobial prophylaxis is discontinued is an empiric decision.

On the basis of a multicenter study in sickle cell disease, prophylactic penicillin can be discontinued at age 5 years among those who are receiving regular medical attention and who have not had a severe pneumococcal infection or surgical splenectomy.

The age at which antimicrobial prophylaxis is discontinued is an empiric decision.

The appropriate duration of prophylaxis is unknown for children with asplenia attributable to other causes.

The age at which antimicrobial prophylaxis is discontinued is an empiric decision.

Some experts continue prophylaxis throughout childhood and into adulthood for particularly high-risk patients with asplenia.