American Board of Internal Medicine (ABIM) Certification Practice Exam

Which group of patients is particularly emphasized to receive a combination of hepatitis A vaccination and immune globulin before travel?

1. Healthy young adults

2. Travelers under age 18

3. Those with chronic liver disease or immunocompromised individuals

4. Older adults without chronic conditions

The correct answer is: Those with chronic liver disease or immunocompromised individuals

The emphasis on vaccinating individuals with chronic liver disease or those who are immunocompromised before travel with a combination of hepatitis A vaccination and immune globulin stems from their heightened vulnerability to severe complications from hepatitis A infection. Chronic liver disease predisposes individuals to more fulminant hepatic failure following infections, including viral hepatitis. Furthermore, immunocompromised patients—whether due to medications, diseases like HIV, or other factors—are at an increased risk of severe illness from infections due to their weakened immune responses. The additional administration of immune globulin provides immediate passive immunity, which is particularly beneficial for these groups. It offers a higher level of protection, ensuring that they have both long-term immunity from the vaccine and immediate short-term protection from the immune globulin, which is critical when traveling to areas where hepatitis A is endemic. While other populations, such as healthy young adults or older adults without chronic conditions, may also benefit from vaccination, the urgency and necessity for the combined prophylaxis measures are specifically tailored to those at greater risk of adverse outcomes due to hepatitis A infections.