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No spleen, yellow fever vaccine

265 Posts

Posted:  14-Sep-2013 09:11
Hi, had a TR last night for yellow fever vaccine. In remission for non Hodgkin's lymphoma , last treatment over 12m ago. But did have her spleen remover 12yrs ago. On Amoxycillin.  Gut initial feeling was cant give because of no spleen. But re read the NathNac YF advise and though mentions immunocompromised doesn't mention no spleen. Colleague found info in the yellow book, but still unclear. NathNac closed and so was Sanofi Pasteur. Pt retuning on Monday with Hubbie but such a full on day will try and make phone calls to confirm I can give. Feel I should know this as a YF centre but none of us - 6 of us- have come across this before. Help from the Gurus would be fantastic please.


4276 Posts

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Posted:  14-Sep-2013 09:17 Log in to like this post
There is no issue with vaccinating a healthy asplenic against yellow fever. However, there are other considerations regarding travel and the asplenic.

From Travax:

Function of the Spleen

The spleen is responsible for the breakdown of abnormal or dying red blood cells and for the production of lymphocytes. The spleen is of great importance against bacterial infections in the body but it is not absolutely essential since many of its functions can be assumed by the liver and other lymphoid tissues.

back to topStructure and Purpose of the Spleen

The organ is enclosed in a capsule of fibrous tissues and fibrous strands that make a supporting meshwork throughout the spleen. The spaces of the meshwork are filled with pulp like material called the splenic pulp. Splenic pulp can be categorised as red and white pulp. These differing types of pulp do not separate into specific regions but they intermingle and are distributed throughout the spleen.

The red pulp is a network of channels (sinuses) filled with blood, and it is in the red pulp that most of the filtration occurs. The red pulp is also the major site of destruction of abnormal or dying red blood cells.

The white pulp of the spleen contains lymphoid elements such as plasma cells, lymphocytes, and lymphatic nodules, called follicles in the spleen. Like the lymph nodes, white pulp reacts to micro-organisms and other antigens that reach the bloodstream.

Phagocytic cells in both red and white pulp serve to remove foreign bodies from the blood and initiate an immune reaction that results in the production of antibodies. Germinal centres in the white pulp are sites of lymphocyte production.

back to topVaccination in Asplenic Adult Travellers

Splenectomy may have been carried out for the following reasons because the spleen:

  • Has been damaged in a serious accident.
  • Is diseased.
  • Contains a growth or a tumour.
  • Has become overactive.

Some people are however born without a spleen (asplenia) or have a spleen that does not work correctly (splenic dysfunction). These individuals will have the same problem as those who have had their spleen removed by elective surgery.

Splenectomy is not a contraindication to any vaccination. However, if an individual's spleen is to be removed electively then vaccines required in the foreseeable future should be given prior to surgery. This is because the response to vaccination is likely to be reduced following splenectomy, particularly to polysaccharide vaccines.

Whether pre or post splenectomy, essential vaccinations to consider are shown in the table below.





Pneumococcal (polysaccharide vaccine)

Administer at least two weeks prior to splenectomy if possible or two weeks post splenectomy.


Single dose - given with Hib/MenC

Hib/MenC vaccine (conjugate)

Administer at least two weeks prior to splenectomy if possible or two weeks post splenectomy.


Single dose - given with PPV


Administer as soon as practical pre or post splenectomy, to afford seasonal protection.



Meningitis ACWY (conjugate vaccine)

Administer at least two weeks prior to splenectomy if possible or two weeks post splenectomy


Single dose- given one month after administration of Hib/MenC and PPV

Further information can be found in the DH Green Book, Chapter 7 and the corresponding disease chapters.

back to topTravel Considerations and Hazards

The risks from over whelming infection in asplenic patients are highest in the first two years following splenectomy.

Individuals who have asplenia or splenic dysfunction will already be taking a prophylactic antibiotic (e.g. penicillin). If they are not then it is worthwhile starting prior to travel, especially if they intend visiting a developing area. In addition a course of antibiotics for immediate standby treatment may be given. This should be used if any feverish symptoms develop, and whilst they seek medical attention.

Once two years have passed the risk of infection is greatly reduced and prophylactic use of antibiotics may be reserved only for the most vulnerable, although carrying standby treatment is always a sensible option.

Infections that may pose a particular problem include

  • Streptococcus pneumoniae
  • Haemophilus influenza type b (Hib)
  • Neisseria meningitis
  • Capnocytophaga canimorsus (a bacterium transmitted through animal bites)
  • Babesiosis (a red cell parasite transmitted by ticks in USA and Northern Europe)
  • Malaria

Preventing tick bites and avoiding contact with animals will reduce the risk of serious infection with Babesiosis andCapnocytophaga canimorsus.

back to topMalaria in Asplenic Travellers

Asplenic travellers are much more likely to develop overwhelming sepsis as well as fulminant malaria because the spleen is essential for the removal of bacteria and parasitised red blood cells from the body.

Malaria can be very severe and rapidly fatal in those with no spleen. Travel to high risk areas should be discouraged especially if serious drug resistance is present or the traveller is unable to tolerate the most effective prophylactic regimes available.

Strict bite avoidance measures should always be emphasised.

This page was last reviewed on 15 August 2011


265 Posts

Posted:  14-Sep-2013 09:28
T&E , thank you for such swift reply. The pt is very blasé about YF and Malaria, she was born and brought up in Guyana , and YF and malaria no issue 50 yrs ago. This pt is a TR from  a local surgery who have done her other vaccine and I want to stay professional and not step in toes when it comes to my travel health advice.  But  I shall quote this travax advice. She is up to date with all the post spleen removal vaccines. It was the YF and now malaria that was my concern. She is generally very fit and well. Thank you


17 Posts

Posted:  16-Sep-2013 14:44
Just one caution though - NHL? was it high grade or Low grade? It maybe that if low grade, you would need advice from the oncologist as that does mean she will be immunosupressed

2784 Posts

Posted:  19-Sep-2013 18:01
For Flo...........just bringing TAD's post re asplenic guidelines and yes fine to give HibMenc as stated here.x 
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