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Topical steroids and antifungals have not only failed to resolve the bilateral rash; the teen says they’ve made it worse. Your Dx?  

Underarm Eruption in a Teenaged Boy

The lesion on this 6-year-old boy occupies almost the entire left side of his nose. The mother attributed it to an injury her son had sustained 2½ weeks earlier, when he was hit in the face by a baseball.

Is this lesion the result of an injury, as the boy’s mother suspected, or something else?

Clinical Topics

Scaly Plaque on the Nose

Some vaccinations for adults are recommended by the CDC's Advisory Committee on Immunization Practices (ACIP) for all adults, regardless of health, lifestyle, or occupational factors. Others are highly recommended for specific populations that may be at greater risk for a vaccine-preventable disease. A simple mnemonic from 

guides clinicians to consider factors related to health, age, lifestyle, and occupation, or HALO, when making an initial decision about vaccination for a specific adult. A definitive decision, the organization says, should be based on the more detailed information published in the complete vaccine recommendations of the ACIP.

The short slide show above summarizes the HALO factors most relevant to consider for 17 adult vaccines. 

A review of 4 factors can help primary care clinicians with an initial decision about adult vaccination: health, age, lifestyle, and occupation (HALO).

Toolkits

17 Vaccines for Adults: Who to Consider for Each 

Acromegaly was diagnosed in a 36-year-old woman who presented with loss of vision in the right eye that had initially involved the peripheral field. MRI scans of the brain revealed a 6 × 6 × 4-cm sellar mass with suprasellar and parasellar extension encasing the right cavernous sinus and carotid artery.

A. Excess growth hormone production from the pituitary gland as a result of a functional adenoma is the most common cause.

B. It remains undiagnosed for up to 10 years on average.

C. The diagnostic test of choice is an oral glucose tolerance test.

D. End-organ manifestations (eg, arthropathy, cranial nerve palsies, diabetes) contribute to overall mortality increase.

Acromegaly was diagnosed in a 36-year-old woman who presented with loss of vision in the right eye that had initially involved the peripheral field. Which statement about acromegaly is NOT true?

Acromegaly: A Pop Quiz

Infectious disease expert Amesh Adalja, MD, explains how primary care clinicians can effectively respond to vaccine hesitancy in one-on-one conversations with patients

Vaccine Hesitancy: Communication Strategies for Primary Care That Preserve Trust

"Your goal is to persuade patients that this vaccine is the right choice for them, and to do that, you have to address a patient where they are."

That is what infectious disease physician and Johns Hopkins Center for Health Security senior scholar Amesh Adalja, MD, said to 

 in a recent interview. A strong, clear recommendation from a trusted clinician remains the single most important predictor of whether 

—a leverage point squarely in primary care. In the video above, Dr Adalja discusses how he calibrates his approach by setting: an advocacy tone for the public square, and a patient-centered tone in the exam room that protects the relationship while moving the conversation forward. For busy frontline physicians, the take-home is practical: start with your routine, confident recommendation and then personalize the discussion to the patient’s specific worry. 

Amesh Adalja, MD, is an adjunct assistant professor at the Johns Hopkins Bloomberg School of Public Health and founder of

, an infectious disease-related project management, consulting, media, and strategy firm.

The following transcript has been lightly edited for style and clarity.

What communication strategies have you found most effective in addressing vaccine hesitancy without damaging the patient-physician relationship?

It all depends on the setting and the context. When I'm on television talking about vaccines, I'm much more forceful and argumentative because I'm trying to talk to the general public and combat the antivaccine movement. When you're talking to an individual patient, you have to do it in a different manner, because your goal is different. Your goal is to persuade that patient that this vaccine is the right choice for them. To do that, you have to address a patient where they are. So that may mean asking them, what particular thing are you worried about with this vaccine, and what is the issue, and then really try and tackle that issue with information leaning on the fact that you are their doctor, that they trust you, that they tell you things that they don't tell anybody else, and you have a really sacred relationship with them, and that is very valuable. We know from studies that a primary care physician's persuasion is one of the most important tools to get a patient to take a health promoting behavior, or to do a health promoting behavior, and to stop a health negating behavior. That's something that clinicians need to recognize and rely on, and just know that there are 

 to look at all of these types of common antivaccine myths that get propagated by the antivaccine movement, that percolate into your into your doctor's office. You have tools to be able to address them.

Explore more from our conversation with Dr Adalja on countering misinformation and 2025 vaccine policy changes:

How to Defuse Vaccine Safety Concerns Without Derailing the Visit

Amesh Adalja, MD, Breaks Down 2025 Vaccine Policy Shifts for Primary Care


Amesh Adalja, MD, infectious disease physician, outlines effective communication strategies that respect patient concerns while reinforcing physician credibility.

The mother of a 10-year-old boy brings him in for evaluation of his moles (which are all benign). During the visit, the mother asks about the lesions on the first 2 knuckles of his right hand; she initially noticed them several months earlier. The boy is otherwise healthy.

White Knuckles

According to the World Health Organization, 

saves approximately 4 to 5 million lives annually. The remarkable number is supported by estimates published in the 

 in 2024 that vaccination against 14 different diseases saved 154 million lives over the past 5 decades.

 than age 5 years and of that group 101 million were infants younger than 1 year.

 Beyond the prevention of death, authors of the 2024 study found that 

 translated to an average of 66 years of full health.

While vaccination coverage for core immunizations among both children and adults in the United States remains high overall, recent CDC surveillance highlights notable disparities in uptake between states and population subgroups.

 Gaps in insurance coverage, logistical challenges, and misinformation are persistent barriers, continuing to impact communities unevenly and contributing to lower coverage rates in some regions and among specific demographic groups.

A recent study conducted by WalletHub examined the 50 states and the District of Columbia across 16 key metrics to see where Americans appear to be most responsible about getting vaccines. The data set ranges from the rates of children, teens and adults vaccinated against various diseases to the share of people without health insurance.

The findings presented in this PPT provide timely insights into these disparities and influencing factors by comparing states on three key dimensions: 1) Children & Teenagers Immunization Rates, 2) Adult & Elderly Vaccination Rates, and 3) Immunization Uptake Disparities & Influencing Factors. The data can inform clinicians, educators, and policymakers seeking to direct resources, strengthen outreach, and promote equitable protection against preventable illness.

Shattock AG, Johnson HC, Sim SY, et al. Contribution of vaccination to improved survival and health: modelling 50 years of the Expanded Programme on Immunization. 

. 2024;43(10441):2307-2316. doi:10.1016/S0140-6736(24)00850-X

Vaccination coverage among adults in the United States, National Health Interview Survey, 2022. Centers for Disease Control and Prevention. October 4, 2024. Accessed September 12, 2025. https://www.cdc.gov/adultvaxview/publications-resources/adult-vaccination-coverage-2022.html

McCann A. States that vaccinate the most. September 9, 2025. Accessed September 9, 2025. https://wallethub.com/edu/states-that-vaccinate-the-most/66237

Northeastern states consistently ranked highest on measures including rates of flu vaccination across age groups, number of teens vaccinated against HPV, and older individuals with shingles vaccination. 

Martin Reichel, MD

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