A 2-year-old child has received all recommended vaccinations. He is now diagnosed with asplenia due to hereditary spherocytosis requiring splenectomy. Which vaccines are MOST critically required before elective splenectomy to prevent overwhelming post-splenectomy infection (OPSI)?

• A Pneumococcal conjugate vaccine (PCV13) + Meningococcal conjugate vaccine + Hib vaccine ✓
• B Pneumococcal polysaccharide vaccine (PPV23) alone
• C Influenza vaccine only; encapsulated organism vaccines are not indicated in vaccinated children
• D Meningococcal B vaccine + Salmonella typhi Vi vaccine

Explanation

Asplenic and functionally asplenic patients are at highest risk for OPSI caused by encapsulated bacteria: Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae type b. These organisms are normally cleared by splenic macrophages via complement-opsonized phagocytosis. Pre-splenectomy vaccination (ideally ≥2 weeks before elective surgery) should include: (1) PCV13 (or PCV15/PCV20 if available) for pneumococcal disease, (2) meningococcal conjugate vaccine (MenACWY, and MenB if available), and (3) Hib vaccine (if not already up to date or if immunological response may be waning). Annual influenza vaccination is also recommended. PPV23 alone is less immunogenic in young children but may be given as a booster after PCV13.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.