Aspenia means lack of a spleen or a spleen that doesn't work. Although the spleen is an important organ that helps your body fight infections, in addition to other functions, it is certainly possible to live without a spleen. However, kids with asplenia do need to take a few extra precautions.
There are many reasons a child might have asplenia, including:
- congenital asplenia (children born without a spleen), sometimes associated with severe cyanotic congenital heart disease, such as transposition of the great arteries
- surgical removal (splenectomy) secondary to trauma or anatomic defects
- surgical removal to prevent complications of other conditions, such as ITP, hereditary spherocytosis, pyruvate kinase deficiency, Gaucher disease, and hypersplenism, etc.
And some children simply have a spleen that doesn't work (functional asplenia) or doesn't work very well because of sickle-cell disease and some other conditions.
Vaccines for Asplenia
Because the spleen has such an important function in helping fight infections, without a spleen, a child is at increased risk for infections.
Specifically, there is a risk for severe infections from the Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis bacteria.
Fortunately, there are vaccines that protect against many subtypes of these bacteria, including:
- Prevnar 13 - protects against 13 subtypes of Streptococcus pneumoniae and replaced the older Prevnar 7 vaccine
- Pneumovax 23 - protects against 23 subtypes of Streptococcus pneumoniae
- Hib - protects against Haemophilus influenzae type B
- Meningococcal conjugate vaccines - protect against 4 common types of the Neisseria meningitidis bacteria
Although Prevnar 13, Hib, and the meningococcal vaccines (Menactra and Menveo) are part of the routine immunization schedule, there are additional recommendations that can change the timing for when kids get them if they have asplenia.
According to the latest recommendations, children with asplenia should get:
- between one to four doses of Prevnar 13, depending on how old they are when they start and complete the series. Keep in mind that unlike healthy children who do not routinely get Prevnar once they are 5 years old, older children with asplenia can get a single dose of Prevnar 13 up to age 18 years if they have never had it before.
- a dose of Pneumovax 23 once they are at least two years old, with a repeat dose five years later and a maximum of two total doses
- two doses of a meningococcal conjugate vaccine, either Menactra or Menveo, two months apart once a child with asplenia is at least two years old and a booster dose every five years
Also, although not a formal recommendation, beginning with the 2009 immunization schedule, the Advisory Committee on Immunization Practices stated that it is OK to administer one dose of the Hib vaccine to children and adults older than age 5 years with "sickle cell disease, leukemia, or HIV infection, or who have had a splenectomy," if they were not previously vaccinated.
Ideally, children would get these vaccines at least 2 to 3 weeks before they were going to get a planned splenectomy. Of course, that isn't always possible in the case of the emergency removal of a child's spleen, in which case they should get the vaccines as soon as they can.
What You Need To Know About Asplenia
- In addition to these vaccines, preventative antibiotics are typically given once a child's spleen is removed or is no longer working well. Although there are no definitive guidelines for all children who have had a splenectomy, many experts recommend daily antibiotics (usually penicillin or amoxicillin) until a child is at least 5 years old and for at least 1 year after their splenectomy.
- Other less common bacteria that can be a risk for children with asplenia can include Escherichia coli, Staphylococcus aureus, Salmonella species, Klebsiella species, and Pseudomonas aeruginosa. Vaccines aren't available for these bacteria, so you might take other precautions, such as avoiding pet reptiles, which can put kids at risk for Salmonella infections.
- Children with asplenia are at increased risk for severe malaria and babesiosis (a tickborne illness) infections. That makes it important to take malaria preventative medications and avoid mosquitoes if traveling to places that have high rates of malaria and to do daily tick checks when camping, etc.
- A medical alert type bracelet, indicating that your child has had his spleen removed, can be a good idea in case he ends up in the emergency room with a fever and doctors don't know his medical history.
Keep in mind that since there are many different causes of asplenia, the specific treatment plan for your child may be a little different than that described here. Talk to your pediatrician and any pediatric specialists that your child sees.
CDC. Prevention of Pneumococcal Disease Among Infants and Children --- Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine. MMWR. December 10, 2010 / 59(RR11);1-18.
CDC.Updated Recommendations for Use of Meningococcal Conjugate Vaccines --- Advisory Committee on Immunization Practices (ACIP), 2010. MMWR. January 28, 2011 / 60(03);72-76.
Kliegman: Nelson Textbook of Pediatrics, 19th ed.
Long: Principles and Practice of Pediatric Infectious Diseases Revised Reprint, 3rd ed.
Red Book. 2009 Report of the Committee on Infectious Disease. American Academy of Pediatrics. 29th Edition.