Paediatric

Asplenia

Splenectomy is associated with fulminant bacterial infection. The risk is long-term but is highest in the first two years after splenectomy.

  • Vaccination, patient education and antibacterial prophylaxis are indicated.
  • Functional hyposplenia is associated with medical conditions such as sickle cell disease. 
  • Antibiotics must be given promptly if a patient with asplenia or functional hyposplenia presents with signs or symptoms of infection.

Immunisation

All patients with an absent or dysfunctional spleen should be fully vaccinated in accordance to the national schedule found HERE

Vaccination against pneumococcal infection is recommended for all individuals who have/are at high risk of developing splenic dysfunction (including coeliac disease) in the future.

Vaccines should be administered at least 2 weeks before OR if this is not possible 2 weeks after splenectomy/diagnosis (typically given at the GP surgery). Vaccines can be given in hospital if admission lasts longer than 2 weeks.

  • Patients with splenic dysfunction should receive boosters of PPV23 at five-yearly intervals.
  • All patients aged over 6 months should be given influenza vaccine annually via their GP.

Recommended vaccinations for asplenia/functional hyposplenia in paediatrics:

Patient age at first diagnosis

Vaccination

Age less than 1 year

 

 Children should be fully immunised according to the national schedule, and should also receive:
  • Two doses of MenACWY vaccine at least 4 weeks apart during their first year
  • An additional priming dose of PCV13, such as to receive a total of two priming doses of PCV13 with an 8-week interval during their first year
  • One booster dose of MenACWY conjugate vaccine 8 weeks after the vaccinations scheduled at one year of age
  • One booster dose of PCV13 at least 8 weeks after the vaccinations scheduled at one year of age
  • One dose of PPV23* after their second birthday and at least 8 weeks after the last dose of PCV13
  • Annual influenza vaccine each season for patients aged over 6 months

Age between 12-23 months

 

If not yet administered, give the routine vaccines due at 1 year of age (Hib/MenC, PCV13, MMR and MenB vaccines) PLUS:

  • One additional dose of PCV13 AND one dose of MenACWY conjugate vaccine at least 8 weeks after the vaccines scheduled at 1 year of age,
  • One dose of PPV23* after second birthday.
  • Annual influenza vaccine each season

Age between 2 years to 9 years

 

 Ensure children are immunised according to national schedule, and they should also receive:
  • One dose of PPV23* (If they have not received any PCV previously, they should receive a dose of this first followed by the dose of PPV23* at least 8 weeks later)
  • One dose of MenACWY conjugate vaccine
  • If they have not received the routine 2+1 schedule for MenB, ensure they have received two doses of MenB 8 weeks apart since their first birthday.
  • Annual influenza vaccine each season

Age 10 years or more

 

Older children should receive the following (regardless of previous vaccination):

  • One dose of PPV23*, MenB and MenACWY conjugate vaccine
  • An additional dose of MenB vaccine 4 weeks later
  • Annual influenza vaccine each season

*Patients with splenic dysfunction should receive boosters of PPV23 at five-yearly intervals.

Vaccine terminology:

  • MenB Meningococcal B vaccine (Bexsero®)
  • MenACWY Meningococcal ACWY conjugate vaccine (Menveo®)
  • PCV13 Pneumococcal conjugate vaccine (Prevenar 13®)
  • PPV23 Pneumococcal polysaccharide vaccine (Pneumovax II®)

 

Prophylactic antibiotics

Patients are to start prophylactic antibiotics as soon as functional hyposplenia is diagnosed or immediately following splenectomy and should be continued into adulthood. At this point the ongoing need for antibiotic prophylaxis should be reviewed by the adult team.

Preferred prophylactic antibiotic

1 month - 11 months

phenoxymethyl penicillin (penicillin V) 62.5mg po BD

1 year - 4 years

phenoxymethyl penicillin (penicillin V) 125mg po BD

5 years - 17 years

phenoxymethyl penicillin (penicillin V) 250mg po BD

Alternative prophylactic antibiotic (penicillin allergy)

1 month - 23 months

erythromycin 125mg po BD

2 years - 7 years

erythromycin 250mg po BD

8 years - 17 years

erythromycin 500mg po BD

Rescue pack antibiotics

Patients are to be provided with a treatment course of antibiotics (for example 3 days course of amoxicillin or clarithromycin in case of penicillin allergy) to start immediately if they have signs or symptoms of infection. The patient should start this treatment and their GP or hospital team should be informed immediately.

Prophylactic antibiotics should be held while patient is receiving treatment dose of an antibiotic that also provides cover for pneumococcal bacteria (discuss with pharmacy if in doubt).

Patient Education

Parents/carers can be directed to the information leaflet and an alert card. Parents/carers may wish to invest in a pendant or bracelet.

Travel

Individuals travelling abroad should carry a treatment course of antibiotics with them, to commence immediately if they develop any signs of infection. When prescribing antibiotics, it is important to consider pneumococcal resistance in certain countries. Those who are not routinely taking prophylactic antibiotics should do so when travelling.

When travel is to malaria endemic countries, individuals need to be advised about the consequences of developing malaria. They should take antimalarial prophylaxis and avoid mosquito bites (wear long trousers and long sleeves, use insect repellent creams, use mosquito nets or screens).

Animal bites

Individuals should seek prompt medical attention if they sustain an animal bite that has broken the skin and drawn blood (dog and cat bites are of high risk due to the possibility of transmitting C.canimorsus, which can be fatal).

See Bites, animal/human/insects for management.

References

  1. Public Health England. Immunisation of immunocompromised individuals. In: Immunisation Against Infectious Disease (The Green Book). Chapter 7. Available from: https://www.gov.uk/government/publications/immunisation-of-immunocompromised-individuals-the-green-book-chapter-7
  2. British National Formulary for Children. Vaccination – General Principles [Internet]. NICE; [cited 2025 Jul 8]. Available from: https://bnfc.nice.org.uk/treatment-summaries/vaccination-general-principles/

Editorial Information

Last reviewed: 01 Jul 2025