Table 2.

Suggested schedule for immunisation in adults with asplenia/splenic hypofunction and splenectomy

Vaccination history	Month 0	Month 1	Month 2	After month 2
Unvaccinated	Hib/MenACWY First dose PCV Seasonal influenzaa	MenB	MenACWY	PPV at least 2 months after PCV Seasonal influenzaa
PPV	Hib/MenACWY/MenB PCV (at least 1 year after PPV) Seasonal influenzaa	MenB	MenACWY	MenACWY every 5 years PPV 5 years after PPV Seasonal influenzaa
MenACWY/MenB vaccination (> 5 years)	Hib/MenACWY PCV13 (at least 1 year after PPV) Seasonal influenzaa	MenB	MenACWY	MenACWY every 5 years PPV 5 years after PPV Seasonal influenzaa
Completed MenACWY/MenC; Hib and PCV vaccination more than 5 years before	Hib/MenACWY PCV Seasonal influenzaa	MenB	PPV	MenACWY every 5 years PPV 5 years after PPV Seasonal influenza∞

Timing: Functional asplenia—as soon as possible. Surgical asplenia (elective)—complete the vaccination schedule 4–6 weeks before surgery; if not possible, complete at least 2 weeks before surgery. Surgical asplenia (emergency)—start the vaccination schedule at least 2 weeks after the operation or as soon as the clinical conditions permit

PCV pneumococcal conjugate vaccine, PPV pneumococcal polysaccharide vaccine, Hib H. influenzae type b vaccine, MenACWY N. menigitidis serotypes A, C, W, Y vaccine, MenC N. meningitidis C vaccine

^aOtherwise healthy asplenic patients 2–49 years of age may be vaccinated with live attenuated influenza vaccine, except patients with sickle cell disease, who should receive inactivated influenza vaccine