American Board of Internal Medicine (ABIM) Certification Practice Exam

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How should pneumococcal vaccinations be administered to patients with anatomic asplenia?

PPSV23 followed by PCV13
PCV13 followed by PPSV23
Only PPSV23
Only PCV13

The correct answer is: PCV13 followed by PPSV23

In patients with anatomic asplenia, the recommended vaccination strategy involves administering PCV13 (Pneumococcal Conjugate Vaccine) followed by PPSV23 (Pneumococcal Polysaccharide Vaccine). This approach is based on the immunological benefits each vaccine provides and the increased susceptibility of these patients to pneumococcal infections due to their lack of a functioning spleen. PCV13 is given first because it includes a broader range of pneumococcal serotypes and is designed to elicit a stronger immune response, particularly in vulnerable populations such as those with asplenia. After a certain interval, PPSV23 is administered. This vaccine covers additional serotypes not included in PCV13 and is effective in boosting immunity. The timing between the two vaccines is crucial; typically, PPSV23 is recommended to be given at least 8 weeks after PCV13 to ensure an optimal immunological response. Together, this two-step vaccination approach enhances protection against invasive pneumococcal disease by leveraging the unique properties of each vaccine, which is especially important in patients at high risk due to asplenia.