What vaccines and vaccination schedule are recommended for splenectomy patients? I have found conflicting information regarding the need for measles, mumps, rubella (MMR) boosters. — BRIANNA SEAVER, NP, Brattleboro, Vt.

Persons who have had a splenectomy or who have functional asplenia are at increased risk for infection with encapsulated bacteria. Therefore, age-appropriate pneumococcal, meningococcal, and possibly Haemophilus influenzae (Hib) vaccinations should be given 14 days prior to a scheduled splenectomy or after the 14th postoperative day.

The CDC recommends annual influenza vaccine as well, because secondary bacterial infections can lead to severe disease in this patient population. Boosters are recommended for all bacterial vaccines every five years for asplenic patients.

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MMR contains live viral antigens but is not contraindicated in asplenic patients. Between 2% and 5% of persons do not develop measles immunity after the first dose of the vaccine. The second dose is not a “booster” but another chance to develop immunity. No further administration of MMR is necessary after two doses. — JoAnn Deasy, PA-C, MPH (152-02)