American Board of Internal Medicine (ABIM) Certification Practice Exam

Which of the following patients should not receive varicella immunization after transplantation?

1. Patients who are immune

2. Patients with chronic illness

3. Patients who received a live vaccine before

4. Patients post-transplantation

The correct answer is: Patients post-transplantation

Varicella immunization is a live attenuated vaccine that is typically contraindicated in certain populations due to the risk of complications from the vaccine itself. In the context of transplantation, patients who have undergone transplant procedures often have compromised immune systems as a result of immunosuppressive therapy to prevent organ rejection. Receiving live vaccines, including varicella, can lead to serious complications in these patients, including the potential for vaccine-related varicella infection, which can be particularly severe in immunocompromised individuals. Post-transplantation patients are at increased risk for infections due to their altered immune response, and administering a live virus vaccine during this period poses substantial risks. Therefore, individuals who are post-transplantation should not receive varicella immunization to ensure their safety and to avoid the risk of vaccine-related infections. Other options propose scenarios that may have specific considerations regarding immunization, but the critical concern remains that the immunosuppressive state after transplantation represents a significant contraindication for the administration of live vaccines like varicella.