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Zorluk: OrtaImmunizations and Vaccine-Preventable Diseases

An initial primary care visit is conducted for a 26-year-old man who recently moved to the area. He has a history of fistulizing Crohn disease diagnosed two years prior. He is currently maintained on infliximab infusions, which have successfully induced and maintained clinical remission. The patient's medical history is otherwise unremarkable. A review of his immunization records indicates completion of standard early childhood vaccine series, with his last set of immunizations administered at 11 years of age. Today's physical examination reveals normal vital signs and no acute findings. In addition to administering an age-appropriate inactivated influenza vaccine, which of the following immunizations are indicated for this patient today? (Select all that apply)

  1. 20-valent pneumococcal conjugate vaccineCevap
  2. Recombinant zoster vaccineCevap
  3. C
    Live attenuated influenza vaccine
  4. D
    Measles, mumps, and rubella vaccine
  5. E
    Varicella vaccine

Cevap

The indicated vaccines are the 20-valent pneumococcal conjugate vaccine and the recombinant zoster vaccine.
The indicated vaccines are the 20-valent pneumococcal conjugate vaccine (PCV20) and the recombinant zoster vaccine (RZV). Patients receiving immunosuppressive biologic therapies, such as the TNF-alpha inhibitor infliximab, are at significantly increased risk for certain infections. The Advisory Committee on Immunization Practices (ACIP) recommends pneumococcal vaccination (PCV20 alone, or PCV15 followed by PPSV23) for adults aged 19-64 years with immunocompromising conditions. Additionally, the recombinant zoster vaccine (RZV) is strongly recommended for adults aged 19 years and older who are or will be immunodeficient or immunosuppressed due to disease or therapy. Because both of these are non-live vaccines (PCV20 is an inactivated conjugate; RZV is recombinant), they are safe and appropriately indicated to prevent serious infections in this patient.

Adım Adım Çözüm

1
Identify the patient's immune status based on his medical history and current medications.
The patient is actively receiving infliximab (a TNF-alpha inhibitor) for Crohn disease, rendering him significantly immunosuppressed.
Determining immune status is the critical first step because it dictates both the indications for specific high-risk vaccines and the absolute contraindications for others.
2
Determine the indications for inactivated and recombinant vaccines in immunosuppressed adults.
Adults on immunosuppressive therapy should receive targeted pneumococcal vaccination (e.g., PCV20) and the recombinant zoster vaccine (RZV), regardless of their young age.
Immunocompromised patients are at a substantially elevated risk for invasive pneumococcal disease and herpes zoster reactivation.
3
Evaluate the safety of live-attenuated vaccines in this patient.
Live-attenuated vaccines are strictly contraindicated.
Administration of live vaccines to a patient on a biologic immunosuppressant carries an unacceptable risk of causing severe, disseminated vaccine-strain infection.

Anahtar Kavram

Patients receiving biologic immunosuppressants (such as TNF-alpha inhibitors) require targeted vaccinations against opportunistic pathogens using inactivated or recombinant vaccines. Live-attenuated vaccines are absolutely contraindicated in this population due to the risk of severe vaccine-strain infection.
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Immunizations and Vaccine-Preventable Diseases

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