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  #1  
Old 06-02-2012
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Question pneumococcal vaccination...!

A 65-year-old man is evaluated during a routine examination. Medical history is significant for hypertension, asthma, and type 2 diabetes mellitus; three years ago, he was admitted to the hospital with respiratory failure and was treated for pneumonia. He received pneumococcal immunization upon his hospital discharge. He is a current smoker with a 50 pack-year history. His medications are lisinopril, metformin, aspirin, and an albuterol inhaler that he uses as needed. He has no allergies. Vital signs are normal. The results of the physical examination are normal.
Which of the following pneumococcal immunization

strategies is the most appropriate for this patient?

(A) Administer one dose of pneumococcal vaccine now
(B) Administer one dose of pneumococcal vaccine in 2 years
(C) Administer a dose of pneumococcal vaccine now and every 5 years thereafter
(D) No need for additional pneumococcal vaccination
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Old 06-02-2012
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B - Administer one dose of pneumococcal vaccine in 2 years
i think if a pt had received one before 65, he/she should receive another one after 65 with interval of 5 years b/w them > ??
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Old 06-02-2012
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Originally Posted by tyagee View Post
A 65-year-old man is evaluated during a routine examination. Medical history is significant for hypertension, asthma, and type 2 diabetes mellitus; three years ago, he was admitted to the hospital with respiratory failure and was treated for pneumonia. He received pneumococcal immunization upon his hospital discharge. He is a current smoker with a 50 pack-year history. His medications are lisinopril, metformin, aspirin, and an albuterol inhaler that he uses as needed. He has no allergies. Vital signs are normal. The results of the physical examination are normal.
Which of the following pneumococcal immunization

strategies is the most appropriate for this patient?

(A) Administer one dose of pneumococcal vaccine now
(B) Administer one dose of pneumococcal vaccine in 2 years
(C) Administer a dose of pneumococcal vaccine now and every 5 years thereafter
(D) No need for additional pneumococcal vaccination

may be C............
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Originally Posted by bisho View Post
B - Administer one dose of pneumococcal vaccine in 2 years
i think if a pt had received one before 65, he/she should receive another one after 65 with interval of 5 years b/w them > ??
ya thats correct
and do we repeat after that ?
i have a query...
Q. patient is diabetic say 55 year old. so till he reaches 65 yr, how many pneumo shots he had received ?
is it every 5 years or one time event ? confusing
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Old 06-02-2012
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Originally Posted by tyagee View Post
ya thats correct
and do we repeat after that ?
i have a query...
Q. patient is diabetic say 55 year old. so till he reaches 65 yr, how many pneumo shots he had received ?
is it every 5 years or one time event ? confusing
Pneumococcal polysaccharide vaccine (Pneumovax is one brand) gives at least 85% protection in those under 55 years of age for five years or longer. Immunization is suggested for those at highest risk of infection, including those 65 years or older; generally the vaccine should be a single lifetime dose, as there is a high risk of side effects if repeated. The standard 23-valent vaccines are ineffective for children under two years old.
The current guidelines of the American College of Physicians call for administration of the immunization between ages 2 and 65 when indicated, or at age 65. If someone received the immunization before age 60, the guidelines call for a one-time revaccination.
Revaccination at periodic intervals is also indicated for those with other conditions such as asplenia or nephrotic syndrome.

Quote:
At this time, two vaccines for prevention of pneumococcal disease are licensed for use in adults. ACIP currently recommends a single dose of PPSV23 for all persons aged 65 years and older. In addition, for adults aged 19 through 64 years, PPSV23 should be administered to those with immunocompromising conditions (including chronic renal failure or nephrotic syndrome); those with functional or anatomic asplenia; those who are immunocompetent and have chronic conditions such as alcoholism, diabetes mellitus, or chronic lung disease; those who are smokers; and those with cochlear implants or cerebrospinal fluid leaks (2). Adults who received PPSV23 before age 65 years for any indication should receive another dose of the vaccine at age 65 years or later if at least 5 years have passed since their previous dose. A second dose of PPSV23 is recommended 5 years after the first dose for persons aged 19 through 64 years with functional or anatomic asplenia and for persons with immunocompromising conditions. ACIP does not recommend routine revaccinations with PPSV23 because of insufficient data regarding clinical benefit, particularly the degree and duration of protection, and safety
As an adult, do I need the PPSV vaccine?

All adults 65 years of age and older.
Anyone 2 through 64 years of age who has a long-term health problem such as: heart disease, lung disease, sickle cell disease, diabetes, alcoholism, cirrhosis, leaks of cerebrospinal fluid or cochlear implant.
Anyone 2 through 64 years of age who has a disease or condition that lowers the body’s resistance to infection, such as: Hodgkin’s disease; lymphoma or leukemia; kidney failure; multiple myeloma; nephrotic syndrome; HIV infection or AIDS; damaged spleen, or no spleen; organ transplant.
Anyone 2 through 64 years of age who is taking a drug or treatment that lowers the body’s resistance to infection, such as: long-term steroids, certain cancer drugs, radiation therapy.
Any adult 19 through 64 years of age who is a smoker or has asthma.
Residents of nursing homes or long-term care facilities.

My elderly neighbor got a second pneumococcal shot. I thought just one was required.
Vaccination is not done routinely, but a single revaccination dose is recommended for groups of people at highest risk of serious infection. No one should receive more than two doses of PPSV23.

For example, persons who received a first dose when they were younger than age 65 years should receive a second dose at age 65 years if at least five years have elapsed since the previous dose. Likewise, persons age two years through 64 years who are at high risk for pneumococcal disease due to certain long-term health problems, in particular immunosuppression, HIV infection, and not having a functional spleen (or having no spleen) should get a second dose five or more years after the first dose.
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