Critical Care Medicine-Infections and Immunologic Disease>>>>>Antimicrobial Therapy and Resistance
Question 3#

A 19-year-old football player sustains a blunt abdominal injury during practice at a local college. He quickly becomes pale and hypotensive and is rushed to the emergency room, where splenic rupture is confirmed. He undergoes emergent splenectomy, survives, and is now admitted to the ICU for further care.

Which vaccines should you give Immediately?

A. Meningococcus, Haemophilus influenzae type B (HiB), and the 23- valent pneumococcus vaccine, followed by 13-valent pneumococcus vaccine 8 weeks later
B. Meningococcus, seasonal influenza, varicella zoster virus, and shingles
C. HiB, 23-valent pneumococcus vaccine, and 13-valent pneumococcus vaccine
D. No vaccinations now—wait until at least 2 weeks after splenectomy to administer vaccines

Correct Answer is D


Correct Answer: D

Asplenic and hyposplenic individuals are particularly susceptible to infections caused by encapsulated bacteria, including Neisseria meningitides, Streptococcus pneumoniae, and H. influenzae. It is recommended that all individuals anticipated to become asplenic or hyposplenic be vaccinated against N. meningitides, S. pneumoniae, H. influenzae and seasonal influenza at least 2 weeks before elective splenectomy, or at least 2 weeks after emergent splenectomy. Individuals without evidence of immunity to measles, mumps, rubella, and varicella should also be vaccinated against these viral pathogens, in addition to receiving a booster dose of tetanus, diphtheria, and pertussis vaccine. The order and timing of pneumococcal vaccination is important, and it is generally recommended that the 23-valent pneumococcus vaccine be administered first, with the 13- valent vaccine to be given 8 weeks later. However, individuals who already received the 23-valent vaccine should be given the 13-valent vaccine at least 12 months after receiving the 23-valent vaccine.


  1. Bonanni P, Grazzini M, Niccolai G, et al. Recommended vaccinations for asplenic and hyposplenic adult patients. Hum Vaccin Immunother. 2017;13:359-368.
  2. Yorkgitis BK. Primary care of the blunt splenic injured adult. Am J Med. 2017;130:365.e1-365.e5.