Asplenia Prophylaxis Guideline

Asplenia Guidelines•Vaccinations(>2 weeks pre-op, or post-op if emergent): Haemophilusinfluenzae type b (Hib), Meningococcal, Pneumococcal•See next slide for specific vaccine recommendations•Prophylaxis: •Daily antibiotic prophylaxis to age 5 or for 1 year following splenectomy if > 4 years old•Lifelong antibiotic prophylaxis if patient is immunocompromised •Initiation of prophlyaxisby 2 months old if congenitally asplenic•Antibiotic Dosing: •Amoxicillin: 20 mg/kg BID (max 250 mg/dose) OR•Pen V K: <3 yo125 mg BID, ≥3 yo250 mg BID Source:•American Academy of Pediatrics, Committee on Infectious Diseases. Policy statement: recommendations for the prevention of pneumococcal infections, including the use of pneumococcal conjugate vaccine (Prevnar), pneumococcal polysaccridevaccine, and antibiotic prophylaxis. Pediatrics2000;106:362-6. Updated 3/2019 v3 HaemophilusInfluenza B (HIB)•Anatomic or functional asplenia (including sickle cell disease) •12-59 months: •If unvaccinated or only 1 dose before 12 months: give 2 doses, 8 weeks apart•2 or more doses before 12 months: give 1 dose, at least 8 weeks after previous dose. •Unimmunized* persons 5 years or older:•Give 1 dose•Elective splenectomy•Unimmunized* persons 5 years or older:•Give 1 dose (preferably ≥14 days before procedure) *unimmunized = less than routine series (through 14 months) OR no doses (14 months or older) Detailed Asplenia Vaccination RecommendationsInitiate vaccination at least 2 weeks prior to splenectomy. If emergent splenectomy, start antibiotic prophylaxis immediately and initiate vaccination post-operatively (typically ≥14 days). Pneumococcus•Pneumococcal conjugate vaccine (PCV13 or Prevnar 13®) if not previously received•Teens vaccinated before 2010 will need the booster•Complete Prevnar13 at least 4 weeks prior to Meningococcal (Menactra) as Prevnar13 decrease immunogenicity of Menactra•Pneumococcal polysaccharide vaccine (PPSV23 or Pneumovax®) (minimum age 2 years)•At least 8 weeks after Prevnar13•Can be given with Meningococcal (Menactra) without any interactions•Pneumovax/PPSV23 boosters suggested every 5 years Pneumococcal Vaccination Schedule Previous DoseRecommendations[25]2-5 Years Old: Unvaccinated or any incomplete schedule (< 3 doses)2 doses PCV13First dose >8 weeks after most recent doseSecond dose >8 weeks later2-5 Years Old: Any incomplete schedule of 3 doses1 dose of PCV13>8 weeks after most recent dose6+ Years Old: No history of PCV13 (PCV13 available only after 2010) 1 dose of PCV13>8 weeks after most recent dose*Once PCV13 administration is completed, PPSV23 should be administered beginning 8 weeks after the final dose of PCV13. A second PPSV23 should be administered 5 years later. Meningococcus•Meningococcal ACYW: Meningococcal conjugate vaccines (Menactra®, Menveo®)•Guidelines for patients 24 months and older (patients <24 months of age: refer to the CDC immunization schedule; Menveorecommended <24 months as not affected by PCV13)•Everyone receives 2 doses 8-12 weeks apart•Boosters:•If primary series <7 years of age: first booster after 3 years, then every 5 years•If primary series ≥7 years of age: booster every 5 years •Can be given with Pneumovax®•Meningococcal B: Meningococcal B sesies(MenB; Trumenbaor Bexsero) •The CDC/ACIP currently recommends MenBfor patients 10 years of age or older with anatomic or functional asplenia.•ID recommends MenBvaccination to individuals that will likely undergo surgery within 12 months of evaluation.•Trumenba–3 vaccine series (0.1-2, and 6 months); Bexsero–2 vaccine series (0 and ≥1 month). Bexseroand Trumenbaare not interchangeable, therefore it is preferable to receive the vaccine from same provider/location.•Trumenbaon formulary at CCHMCUpdated 3/2019 v3