American Board of Internal Medicine (ABIM) Certification Practice Exam

Who should receive both hepatitis A vaccination and immune globulin before traveling to an endemic area?

1. Only children younger than 12

2. Individuals over 60 years old

3. Persons older than 40, those with chronic conditions, and immunocompromised individuals

4. Only pregnant women

The correct answer is: Persons older than 40, those with chronic conditions, and immunocompromised individuals

The recommendation for receiving both hepatitis A vaccination and immune globulin before traveling to an endemic area is particularly aimed at persons older than 40, those with chronic health conditions, and immunocompromised individuals. This group is at a higher risk for severe disease and complications associated with hepatitis A infection. Hepatitis A can lead to significant morbidity, especially in populations that may have compromised immune systems or underlying health issues. The immune globulin provides immediate passive immunity and is especially crucial for individuals who may not respond adequately to the vaccine alone due to their health status or age. For example, chronic liver disease can heighten the risk of hepatitis A, making it vital for individuals with such comorbidities to have both forms of protection prior to exposure. Additionally, travelers who are older may not have the same robustness in their immune response as younger travelers, necessitating extra precautions against infection. In contrast, while children, those over 60 years, and pregnant women may have their own considerations for vaccination, the specific combination of vaccination and immune globulin is essential for the group mentioned in the correct answer due to their increased risk factors associated with hepatitis A.