A 35-year-old woman comes to the clinic for a routine health maintenance visit. She was diagnosed with severe Crohn disease 4 years ago, which is currently well-controlled on a regimen of infliximab and azathioprine. She feels well and has no acute complaints. She has a 10-pack-year smoking history but quit 2 years ago. Her most recent cervical cancer screening was normal 1 year ago, following three consecutive normal annual screenings. She received a tetanus, diphtheria, and acellular pertussis (Tdap) booster 4 years ago and the inactivated influenza vaccine 2 months ago. She has never received a pneumococcal vaccine. Which of the following is the most appropriate next step in preventive care for this patient?
- Administer the recombinant zoster vaccineAnswer
- BAdminister the measles, mumps, and rubella (MMR) vaccine
- CAdminister the 23-valent pneumococcal polysaccharide vaccine (PPSV23) alone
- DPerform a dual-energy x-ray absorptiometry (DEXA) scan
- ESchedule a low-dose chest computed tomography (LDCT)
Answer
The correct answer is to administer the recombinant zoster vaccine.
The correct answer is to administer the recombinant zoster vaccine. This patient is significantly immunocompromised due to her treatment with infliximab (a tumor necrosis factor-alpha inhibitor) and azathioprine for Crohn disease. The Advisory Committee on Immunization Practices (ACIP) recommends two doses of the recombinant zoster vaccine (RZV) for the prevention of herpes zoster and its complications in adults aged 19 years and older who are or will be immunodeficient or immunosuppressed because of disease or therapy. Unlike older zoster vaccines, RZV is an inactivated, recombinant vaccine and is completely safe to administer to immunocompromised patients.
Step-by-Step Solution
Key Concept
Adults aged 19 years and older who are immunodeficient or immunosuppressed due to disease or therapy should receive two doses of the recombinant zoster vaccine (RZV). Furthermore, live-attenuated vaccines are contraindicated in these patients.