Vaccination coverage in 595 adult patients undergoing total splenectomy in the Hospital Clinic of Barcelona during 1992–2002 was studied. The rates of cover for pneumococcal, Haemophilus influenzae type b and meningococcal vaccines were 63, 63 and 61% respectively, during 2000–2002; 32, 17 and 22% in 1997–1999; and 24, 9 and 8% in 1992–1996. Multivariate analysis showed a greater risk of no vaccination in splenectomies due to trauma, malignant neoplasms of solid organs and incidental splenectomy compared with both neoplastic and non-neoplastic haematological disease, and those patients undergoing splenectomy before 2001. Coverage ([ges ]1 vaccine) since 1997 in patients with haematological diseases was 83·5% (71/85), haematological neoplasias 69·2% (18/26), solid organ neoplasms 38·3% (36/94), incidental splenectomy 35·6% (16/45), and traumas 28·4% (21/74). Mandatory hospital admission of patients undergoing splenectomy offers a good opportunity for vaccination of these patients. Specific vaccination policies should be developed to take advantage of this circumstance.