SPECIAL REPORT: Adult Vaccination Post-Test

For the past month we have offered a series of interactive educational quizzes on the essential role of vaccination in adults and particularly in populations whose impaired immunity makes them especially vulnerable to vaccine-preventable diseases.

If you have followed along, starting with the Introduction and Pre-test and progressing through Part I: Adult Vaccination: Patients with Diabetes Mellitus;  Part II: Older Adults; Part III: Meningococcal and HPV Infections: Who’s at Risk?; and Part IV: Vaccination in Special Populations, you will recognize the questions in this Post-test, and we hope you will also recall reading about the answers in one or more of the Special Report sections. 

Good luck!

ANSWER AND DISCUSSION »

Answer: A

The sooner after the diagnosis of diabetes an individual is vaccinated against hepatitis B the better. Although the study in the supporting reference looked at the absence of other typical risk factors for acquiring hepatitis B, there is more to the story. Twenty-nine hepatitis B outbreaks in diabetics were investigated. Twenty-five out of 29 were a consequence of contaminated blood glucose monitors.¹ Protecting diabetics against hepatitis B infections by vaccination is an important primary care responsibility. Preventing hepatitis B in the study’s at-risk cohort (ages 20-59) saved $75,100 per every quality adjusted life year.¹

ANSWER AND DISCUSSION »

Answer: A, B, and D should not receive the live vaccine.

Patients infected with HIV who have a CD4 count of ≤200 cells/µL should not be given live zoster vaccine.² The group in option C (≥500 cells/µL) would be eligible for the immunization.

ANSWER AND DISCUSSION »

Answer: B and D are True

HPV is not a live vaccine, so it can be given to those with lower CD4 counts, at the discretion of the treating physician.³ Safety of the vaccine during pregnancy is unknown, however, so it should not be administered to pregnant women.

ANSWER AND DISCUSSION »

Answer: A, B, and C

Note that influenza vaccination is also recommended in asplenic individuals. Asplenic individuals are at risk for fatal sepsis. As a result, they also receive precautions when they experience fever similar to those for persons exposed to meningococcus.⁴

ANSWER AND DISCUSSION »

Answer: All statements are true.⁵

Thank you for your participation; please leave us a comment below on other topics related to adult vaccinination you are interested in -- or anything else you would like to read about on Patient Care.

For Part I: Adult Vaccination: Patients with Diabetes Mellitus

For Part II: Older Adults

For Part III: Meningococcal and HPV Infections: Who’s at Risk?

For Part IV: Vaccination in Special Populations

References:

1. Centers for Disease Control and Prevention (CDC).Use of hepatitis B vaccination for adults with diabetes mellitus: recommendations of the Advisory Committee on Immunization Practices (ACIP).MMWR Morb Mortal Wkly Rep. 2011 Dec 23;60:1709-11.

2. Rubin LG, Levin MJ, Ljungman P, et al. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin. Inf. Dis. 2014; 58:e44. http://cid.oxfordjournals.org/content/58/3/e44.long

3. CDC. Vaccine information for adults. HIV Infection and Adult Vaccination.  http://www.cdc.gov/vaccines/adults/rec-vac/health-conditions/hiv.html

4. Rubin LG, Schaffner W. Clinical practice: Care of the asplenic patient. N Engl J Med. 2014; 371:349-356. http://www.nejm.org/doi/full/10.1056/NEJMcp1314291

5. Soni R, Horowitz B, Unruh M. Immunization in end-stage renal disease: opportunity to improve outcomes. Semin Dial. 2013;26:416-426. http://onlinelibrary.wiley.com/doi/10.1111/sdi.12101/abstract;jsessionid=6BEAD64A884CB7B5B807E2409778A01B.f03t03