Table 4 Measures to Improve Care of Asplenic Patients in Healthcare Practice (adapted from [3, 6,7,8, 34, 35])

Vaccinate against commonly encountered encapsulated bacteria and influenza

(guidelines may vary according to each country)

Streptococcus pneumoniae

PCV13 then PPSV23 2 to 12 months later (boosted strategy)

− consider another boosted strategy if PPSV23 has been injected more than one year after PCV13

− consider adding PCV13 if PPSV23 was given first, and do a new boosted vaccination 5 years after the PPSV23 injection

− respect a 5-year minimum interval between two doses of PPSV23

Neisseria meningitidis

Consider two doses of tetravalent ACWY vaccine in a 6-month interval, and a recall every 5 years

Consider two doses of anti-MenB vaccine in a 1-month interval

Haemophilus influenzae type b

Consider one dose of the vaccine in adulthood

Influenzae

Consider an annual dose of vaccine in November

Antibiotic prophylaxis

Oral penicillin V, or erythromycin in case of allergy, for at least two years

- consider lifelong prophylaxis in patients at high risk: age < 16 or > 50, survival to a first OPSI episode, patients with haematological diseases, HIV, or ongoing immunosuppressive therapies, or inadequate response to pneumococcal vaccination

- reconsider this attitude regarding the evolution of local bacterial ecology and patient’s medical history or concomitant medications over time (drug interactions or contra-indications)

Therapeutic education

Educate patients with recurrent information about:

- the function of the spleen

- the infectious risk: encapsulated bacteria, the role of influenza in such infections, alert signs of infection, how to act at signs of infection

- vaccinations to be done over time

- antibiotic prophylaxis

- animal and tick bites

- communication of the asplenic state to other healthcare professionals

- medical ID (splenectomy card or personalized medical ID)

- travel advice