Have These Patients Been Immunized Appropriately?

A Case-Based Challenge

Robert H. Hopkins, Jr., MD


August 06, 2014

Assessing the Healthy Adult

Dr. Jones has not had an adult dose of Tdap vaccine, so he should receive this as soon as possible. According to current Advisory Committee on Immunization Practices (ACIP) recommendations, the Tdap vaccine can be administered once in all adults not previously vaccinated; and this can be done at any time interval following prior tetanus vaccination. Subsequent booster vaccinations against tetanus (Td) should be administered every 10 years. In addition, Dr. Jones should receive annual influenza vaccine to reduce his risk of acquiring influenza and/or transmitting influenza to others. Because he has had prior varicella illness, he does not need varicella vaccination. Neither hepatitis A vaccine nor pneumococcal polysaccharide vaccine are routinely recommended in adults aged 40 years nor are these routinely recommended for healthcare workers.

Case #2: What About the Adult With Chronic Disease?

Mr. Roberts is a 54-year-old man who has recently moved to your community to help care for his aging mother and new granddaughter. He has diabetes and has been treated with insulin for over a decade. He has provided you with a glucose log that shows that his diabetes is under reasonable control. He does not recall receiving any immunizations in the past decade other than a Tdap vaccine in the emergency department after slicing his finger with a box-cutter when unpacking from his recent move. He also reports that he "got all his shots as a kid."


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.