January 2007
Patients who have conditions
resulting in an absent / dysfunctional spleen (e.g. receiving
chemotherapy) are at increased risk of infection and should receive
prophylactic vaccinations and antibiotics.
Patients are advised to carry a
card or wear an identifying bracelet at all times.
For advice relating to children
refer to the full policy on the Trust intranet.
Vaccine schedule for adults
|
Vaccine |
Dosing schedule |
Booster |
|
23-valent
polysaccharide pneumococcal vaccine |
1 dose |
Re-vaccinate every 5 years.
|
|
Haemophilus
influenzae type B (HiB) |
1 dose Menitorix |
1 dose of Menitorix 2 months after initial vaccination
|
|
Meningococcal group C conjugate vaccine (Menitorix ) |
||
|
Influenza vaccine |
1 dose annually in October |
The vaccines can be administered at
the same time. They should be given at separate sites, preferably a
separate limb. If given in the same limb, they should be given at
least 2.5 cm apart. In patients with an acute infective episode
vaccination should be delayed until the patient recovers.
Adults who have been fully
immunised with HiB and or MenC as part of the routine programme who
then develop splenic dysfunction, should be offered an additional
dose of combined HiB/MenC vaccine.
Antibiotic Prophylaxis
Lifelong prophylactic antibiotics
are recommended.
Amoxicillin 500 mgs daily
For penicillin
allergic patients
Erythromycin 500 mgs daily
Early Treatment Packs
Patients should keep a supply of
suitable antibiotics at home to take immediately if they develop
raised temperature, malaise or shivering. Suitable antibiotics
include co-amoxiclav and for penicillin allergic patients levofloxacin.
Advise patients to seek immediate medical attention if unwell
Advice to patients
All patients should receive advice covering:
Their lifelong
increased risk of infection
Recommended
vaccines and antibiotic prophylaxis
Importance of
seeking help immediately should infection occur
Recommendations
for travel abroad i.e. malaria risk
Patients should
be advised to keep a therapeutic course of antibiotics (early
treatment packs)
Advice about insect, cat and dog bites. Patients should receive a five-day course of co-amoxiclav (levofloxacin is a suitable choice in penicillin allergic patients, or refer to Trust guidelines) to prevent infection.
DoH information leaflet and The
Splenectomy Trust Fact sheet can be found in the complete policy on
the Trust intranet (appendix 1 & 2).
Travel vaccines
Meningococcal ACWY Vax should be
offered to those travelling to areas with an increased risk of
meningococcal infection e.g. sub-Saharan Africa. A booster should be
given every 2 years if the risk of exposure is ongoing. A gap of six
months should be left between administration of this vaccine and the
Men C conjugate vaccine.
It is the responsibility of the
Consultant Physician in charge of the patient to ensure that all
patients are vaccinated, given antibiotic prophylaxis and counselled
on the risk of infection. A checklist to record this information
should be inserted in the patient's notes and a copy sent to the
General Practitioner. Please refer to complete policy on the Trust intranet.
This policy advises administration
of vaccines in an unlicensed manner. However, the recommendations
follow National guidance from the Department of Health.
Adapted with permission from Salford/Trafford PCTs based on the recommendations of national experts, the Working Party of the British Committee for Standards in Haematology Clinical Haematology Task Force.
Date for Revision: January 2009