American Board of Internal Medicine (ABIM) Certification Practice Exam

What should be the approach for patients who have functional or anatomic asplenia concerning pneumococcal vaccination?

1. Only administer PPSV23

2. Administer both vaccines at the same time

3. Postpone vaccination until age 65

4. Administer PCV13 followed by PPSV23

The correct answer is: Administer PCV13 followed by PPSV23

The recommended approach for patients with functional or anatomic asplenia is to administer PCV13 (Pneumococcal Conjugate Vaccine) followed by PPSV23 (Pneumococcal Polysaccharide Vaccine). This strategy is important because individuals with asplenia are at significantly increased risk for infections due to encapsulated organisms, especially Streptococcus pneumoniae. Administering PCV13 first is crucial as it provides protection against additional serotypes that may not be covered by PPSV23. Following the initial dose of PCV13, PPSV23 is given a minimum of 8 weeks later to cover a broader range of serotypes. This sequence is essential to enhance the overall immune response and provide robust protection against pneumococcal disease. Postponing vaccination until age 65 is not appropriate because individuals with asplenia should receive pneumococcal vaccinations as soon as possible, regardless of age, to protect them from potential infections. Administering only PPSV23 would not provide the comprehensive protection that results from the full vaccination regimen including both PCV13 and PPSV23. While giving both vaccines at the same time might seem efficient, it is not the recommended practice due to the need for