Vaccination among splenectomy patients: can unavailability or ignorance justify failure in administration?

Splenectomy (elective or emergency) increases susceptibility to life-threatening infections, particularly overwhelming post-splenectomy infection (OPSI) from encapsulated organisms. Despite clear guidelines recommending pneumococcal, meningococcal, haemophylus, and influenza vaccinations, coverage remains suboptimal, especially in low-resource settings such as India. Poor vaccine uptake is driven by a lack of awareness among patients and providers, financial constraints, limited availability, and weak post-operative follow-up systems. Adults face greater challenges due to out-of-pocket costs and emergency surgery, while children, despite receiving pentavalent vaccines, often miss boosters. Ethically, systemic failures in providing recommended vaccines represent breaches in distributive justice and accountability. Strengthening vaccine counselling, training healthcare providers, and integrating adult vaccines into national programmes are essential. Clinical trials should explore the safety and cost-effectiveness of paediatric pentavalent vaccines in adults when isolated haemophilus vaccines are unavailable. Bridging the gap between guidelines and practice is not only clinically necessary but an ethical imperative to protect these vulnerable.