Splenectomy and pneumococcal vaccination

• children and adults requiring splenectomy, or those with splenic dysfunction or commencing immunosuppressive treatment, should be vaccinated according to age-specific clinical risk group schedules (1)
• prophylactic antibiotic cover should be continued indefinitely following splenectomy, regardless of pneumococcal vaccination status

Elective Splenectomy and Treatment Timing

• pre-procedure window: ideally, pneumococcal vaccination should be administered 4 to 6 weeks (and at least 2 weeks) prior to elective splenectomy or initiation of chemotherapy/radiotherapy (1)
• immediate priority: if vaccination beforehand is not possible, splenectomy, chemotherapy, or radiotherapy must never be delayed (1)
• post-procedure delay: if immunisation cannot be given 2 weeks prior to splenectomy, it should be delayed until at least 2 weeks after surgery, as functional antibody responses are improved from this point (1)
• post-treatment delay: if immunisation cannot be given 2 weeks prior to starting chemotherapy or radiotherapy, it should be delayed until at least 3 months after completion of therapy to maximize vaccine response (1)
• pragmatic delivery: immunisation should not be delayed indefinitely if doing so risks a complete failure to vaccinate (1)

Vaccine Regimen Updates

• choice of vaccine: UK guidance has transitioned to PCV20 (Prevenar 20®) for clinical risk groups aged 2 years and over, replacing PPV23
• dosing for asplenia/splenic dysfunction: a single dose of PCV20 is indicated for individuals aged 2 years and over (1)
• 5-year booster policy: individuals with asplenia or splenic dysfunction (including sickle cell disease) require re-immunisation with PCV20 every 5 years due to rapid antibody decline (1)

Reference:

1. UK Health Security Agency (UKHSA). Pneumococcal: guidance and immunisation schedule. UKHSA Guidance. Updated 16 October 2026.