NAPLEX / Miscellaneous

Answer: D. Per the CDC, live attenuated influenza vaccine (LAIV [Flumist]) is an option for healthy, non-pregnant individuals who are between the ages of 2-49. Also, individuals who are age 65 and older may be given standard-dose IIV inactivated (Fluzone), or high dose IIV (Fluzone High-dose), or RIV3 (recombinant influenza vaccine) intramuscularly. Only adults, who are age 18-64, may be given the inactivated IIV vaccine intradermally.
Reference:
Adult Immunization Schedule. Centers for Disease Control and Prevention. http://www.cdc.gov/vaccines/schedules/hcp/adult.html. Updated April 20, 2016. Accessed September 27, 2016.

Answer: D Change can be classified as “antigenic drift”, indicating continual small changes that occur in the genes (surface antigens) of influenza viruses during replication. These changes lead to the requirement of having to review flu vaccine composition yearly, in order to update vaccines to keep up with evolving viruses. “Antigenic Shift,” on the other hand, is a major genetic change in the influenza A viruses. Influenza A virus subtype that occurs as a result from antigenic shift has the potential to cause pandemics. Lastly, the majority of adults have a protective antibody response within 2 weeks after vaccination.
Reference:
Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices – United States, 2016-17 Influenza Season. Centers for Disease Control and Prevention. https://www.cdc.gov/mmwr/volumes/65/rr/rr6505a1.htm. Updated August 25, 2016. Accessed September 27, 2016. 


Answer: C For persons aged ≥65 years, any age-appropriate IIV formulation (standard-dose or high-dose, trivalent or quadrivalent, unadjuvanted or adjuvanted) or RIV3 is an acceptable option. No preference is expressed for any one of these vaccines over another for this age group.
Reference:
Grohskopf L, Sokolow L, Broder K et al. Prevention and Control of Seasonal Influenza with Vaccines. MMWR Recomm Rep. 2016;65(5):1-54. doi:10.15585/mmwr.rr6505a1.

Answer: A Pneumococcal disease is caused by the bacterium Streptococcus pneumoniae (pneumococcus.)
Reference:
Pinkbook | Pneumococcal | Epidemiology of Vaccine Preventable Diseases | CDC. Cdcgov. 2016. Available at: http://www.cdc.gov/vaccines/pubs/pinkbook/pneumo.html. Accessed September 27, 2016.

Answer: D. Influenza vaccine is recommended annually, thus, WM should not skip it this year, and B is incorrect. Also, per the CDC, seasonal influenza outbreaks can occur as early as October, however, most activity peaks in January or later. Thus, it is not too late for WM to receive his vaccine in December, thus A is incorrect. Lastly, antiviral medications such as Tamiflu are an important adjunct to vaccinations. They are recommended as early as possible for any patient with confirmed or suspected influenza who, is 1) Hospitalized, 2) has severe, complicated, or progressive illness or 3) is at higher risk for influenza complications. Thus, WM is not a candidate with the given information and C is incorrect.
Reference:
Key Facts About Seasonal Flu Vaccine. Centers for Disease Control and Prevention. 2016. Available at: http://www.cdc.gov/flu/protect/keyfacts.htm. Accessed September 27, 2016.

Answer: C All adults 65 years or older, should receive a dose of PCV 13 followed by a dose of PPSV23 6-12 months after (if immunocompetent), thus A is incorrect. Adults aged ≥65 years with immunocompromising conditions, functional or anatomic asplenia, cerebrospinal fluid (CSF) leaks, or cochlear implants are recommended to receive PCV13 first, followed by PPSV23 ≥8 weeks later, thus D is incorrect as it does not apply to this patient. When both PCV13 and PPSV23 are to be administered, PCV13 is recommended before PPSV23, based on studies demonstrating a better response to serotypes common to both vaccines when PCV was given first, thus B is incorrect.
Reference:
1. Pinkbook | Pneumococcal | Epidemiology of Vaccine Preventable Diseases | CDC. Cdcgov. 2016. Available at: http://www.cdc.gov/vaccines/pubs/pinkbook/pneumo.html. Accessed September 27, 2016.
2. Intervals Between PCV13 and PPSV23 Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP). Cdcgov. 2016. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6434a4.htm. Accessed September 27, 2016.

Answer: D. Adults who are 65 years or older, who have previously received one or more doses of PPSV23, should receive a dose of PCV13 if they have not received it. A dose of PCV13 should be given one or more years after receipt of the most recent PPSV23 dose, thus C is wrong. In this case, the patient would be receiving it 2 years after her PPSV23 shot. No additional dose of PPSV23 is indicated for adults vaccinated with PSC23 at age 65 or older, thus B is wrong. The recommended lifetime maximum dose of PCV13 is 1, and 3 doses of PPSV23. The interval between PPSV23 doses should be at least 5 years, thus A is wrong.
Reference:
1. Adult Immunization Schedule. Centers for Disease Control and Prevention. http://www.cdc.gov/vaccines/schedules/hcp/adult.html. Updated April 20, 2016. Accessed September 27, 2016 


Answer: B Adults aged 65 or older who are immunocompetent and who have not received PCV13 but who have 1 or more doses of PPSV23at age <65 years administer PCV13 at least 1 year after the most recent dose of PPSV23, thus C is wrong. Then, administer a dose of PPSV23 at least 1 year after PCV13 and at least 5 years after the most recent dose of PPSV23, thus D is wrong. The interval between PPSV23 doses should be at least 5 years, thus A is wrong.
Reference:
1. Adult Immunization Schedule. Centers for Disease Control and Prevention. http://www.cdc.gov/vaccines/schedules/hcp/adult.html. Updated April 20, 2016. Accessed September 27, 2016 


Answer: A Rationale: Adults who are 19 years or older with immunocompromising conditions such as multiple myeloma, who have not received either PCV13 or PPSV23  administer PCV13 followed by PPSV23 at least 8 weeks after PCV13, thus B, C, and D are wrong.
Reference:
1. Adult Immunization Schedule. Centers for Disease Control and Prevention. http://www.cdc.gov/vaccines/schedules/hcp/adult.html. Updated April 20, 2016. Accessed September 27, 2016

Answer: B. A single dose of zoster vaccine is recommended for all adults 60 years or older, regardless of whether they report a prior episode of herpes zoster, thus A is wrong. Also, although 2nd and 3rd episodes of herpes zoster can occur, the annual incidence of recurrence is not known. Although the FDA recommends the administration of the vaccine for individuals 50 years or older, the ACIP recommends that vaccinations begin at 60 years, thus C and D are incorrect.
Reference:
1. Shingles | Clinical Overview - Varicella Vaccine | Herpes Zoster | CDC. Cdcgov. 2016. Available at: http://www.cdc.gov/shingles/hcp/clinical-overview.html. Accessed September 27, 2016.
2. Adult Immunization Schedule. Centers for Disease Control and Prevention. http://www.cdc.gov/vaccines/schedules/hcp/adult.html. Updated April 20, 2016. Accessed September 27, 2016

Answer: C. Influenza vaccine is recommended annually, thus JM is a candidate, as he hasn’t received it since 2013. Patient is also a candidate for the herpes zoster vaccine as he is over the age of 60. A Tdap booster is recommended every 10 years, thus JM is a candidate as his last Tdap was 12 years ago. Lastly, patient is a candidate for the PCV13 vaccine as it is recommend 1 or more years after PPSV23 shot (given 3 yeas ago.) Patient is not a candidate for MMR, as individuals, who have been born prior to 1957 are considered immune to measles and mumps (patient born in 1944.)
Reference:
1. Adult Immunization Schedule. Centers for Disease Control and Prevention. http://www.cdc.gov/vaccines/schedules/hcp/adult.html. Updated April 20, 2016. Accessed September 5, 2016