Vaccine Smarts
By Dr. Richard Rupp and Bridget Hawkins, Ph.D.

Dear Vaccine Smarts,

After I had my spleen and appendix removed following a car accident, my doctor advised me to get the pneumonia shot each year, then it changed to every two to four years, and now he is advising every 10 years.

I’ve also been told by doctors and pharmacists that I should not have the flu or shingles vaccines since I do not have a spleen. Is this true?

Amy
Galveston

Dear Amy,

We are sorry to hear about your accident. It is great that your doctor is paying special attention to your condition.

The confusion is coming from changes in the recommendations. The good news is that there are more vaccines to help protect you.

The spleen is an important organ involved with both the red blood cells and immune system. The spleen acts as a filter that removes damaged and old red blood cells.

It also releases antibodies into the blood stream and removes antibody-coated bacteria from the blood.

Individuals who have lost their spleen or their spleen doesn’t work are referred to as asplenic (“without spleen”).

They have trouble dealing with certain bacteria that cause problems, such as meningitis and pneumonia.
 

As a result, there are special vaccine recommendations for asplenic people. Asplenic adults should get all of the usual vaccinations for healthy adults along with the pneumonia and meningitis vaccines.

Pneumococcus is one of the more common causes of pneumonia. There are two types of vaccines for this bacterium.

One is recommended for healthy infants and children, and the other is recommended for older adults.

Infants and children with asplenia should receive the regular childhood series.

Once they are older than 2, they should receive two doses of the adult vaccine separated by five years.

The recommendations for asplenic adults are complicated but they boil down to everyone needing a dose of the children’s vaccine and two doses of the adult vaccine separated by five years.

A physician can determine the timing between the adult and child vaccine doses.

A dose of the adult vaccine is recommended after 64 for both healthy and asplenic adults.

This dose should be at least five years after the previous dose for asplenic people.

Asplenic adults are not any more likely to get the flu than normal adults. For reasons that are not entirely clear, having the flu increases the chance a person will develop a pneumococcal infection.

This is particularly dangerous for asplenic people and is the reason why it is especially important that they get their flu vaccine each year.

There are two main types of influenza vaccines, the shot and the nasal spray. Asplenic adults older than 50 should receive the shot while those younger, if otherwise healthy, may receive either.

Meningitis is an infection of the surface of the brain. Meningococcus is a frequent cause of meningitis and is a problem for asplenic people.

Luckily there are vaccines that cover four of the common strains of Meningococcus.

Asplenic individuals should receive two doses of vaccine eight to 12 weeks apart, followed by a booster every 5 years.

We aren’t sure why some physicians and pharmacists told you that you shouldn’t receive the shingles (zoster) vaccine.

The vaccine is recommended for adults older than 59, including those with asplenia.

Asplenic people aren’t any more likely to develop shingles than other adults.

The vaccine doesn’t carry any additional risk for asplenic people, so you should receive it at the appropriate age.

In summary, you should receive all of the routine adult vaccinations, including the annual flu vaccine.

You should have one dose of the child, along with two doses of adult pneumonia vaccine and two doses of the meningitis vaccine.

You should also receive a booster dose of the meningitis vaccine every five years.

Dr. Richard Rupp is a pediatrician and member of UTMB’s Sealy Center for Vaccine Development. Bridget Hawkins, Ph.D. is the assistant director of the SCVD. This column is supported by a UTMB President’s Cabinet Award to provide information about vaccines. Visit www.utmb.edu/scvd/vaccinesmarts or like us on Facebook.