SPECIAL REPORT: Adult Vaccination Post-Test

Our month of weekly adult vaccination quizzes is complete. Take the comprehensive post-test and see what you've learned.

For the past month we have offered a series of interactive educational quizzes on the essential role of vaccination in adults and particularly in populations whose impaired immunity makes them especially vulnerable to vaccine-preventable diseases.

If you have followed along, starting with the Introduction and Pre-test and progressing through Part I: Adult Vaccination: Patients with Diabetes Mellitus;  Part II: Older Adults; Part III: Meningococcal and HPV Infections: Who’s at Risk?; and Part IV: Vaccination in Special Populations, you will recognize the questions in this Post-test, and we hope you will also recall reading about the answers in one or more of the Special Report sections. 

Good luck!



Answer: A

The sooner after the diagnosis of diabetes an individual is vaccinated against hepatitis B the better. Although the study in the supporting reference looked at the absence of other typical risk factors for acquiring hepatitis B, there is more to the story. Twenty-nine hepatitis B outbreaks in diabetics were investigated. Twenty-five out of 29 were a consequence of contaminated blood glucose monitors.1 Protecting diabetics against hepatitis B infections by vaccination is an important primary care responsibility. Preventing hepatitis B in the study’s at-risk cohort (ages 20-59) saved $75,100 per every quality adjusted life year.1




Answer: A, B, and D should not receive the live vaccine.

Patients infected with HIV who have a CD4 count of ≤200 cells/µL should not be given live zoster vaccine.2 The group in option C (≥500 cells/µL) would be eligible for the immunization.




Answer: B and D are True

HPV is not a live vaccine, so it can be given to those with lower CD4 counts, at the discretion of the treating physician.3 Safety of the vaccine during pregnancy is unknown, however, so it should not be administered to pregnant women.




Answer: A, B, and C

Note that influenza vaccination is also recommended in asplenic individuals. Asplenic individuals are at risk for fatal sepsis. As a result, they also receive precautions when they experience fever similar to those for persons exposed to meningococcus.4




Answer: All statements are true.5


Thank you for your participation; please leave us a comment below on other topics related to adult vaccinination you are interested in -- or anything else you would like to read about on Patient Care.

For Part I: Adult Vaccination: Patients with Diabetes Mellitus

For Part II: Older Adults

For Part III: Meningococcal and HPV Infections: Who’s at Risk?

For Part IV: Vaccination in Special Populations


1. Centers for Disease Control and Prevention (CDC).Use of hepatitis B vaccination for adults with diabetes mellitus: recommendations of the Advisory Committee on Immunization Practices (ACIP).MMWR Morb Mortal Wkly Rep. 2011 Dec 23;60:1709-11.

2. Rubin LG, Levin MJ, Ljungman P, et al. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin. Inf. Dis. 2014; 58:e44. http://cid.oxfordjournals.org/content/58/3/e44.long

3. CDC. Vaccine information for adults. HIV Infection and Adult Vaccination.  http://www.cdc.gov/vaccines/adults/rec-vac/health-conditions/hiv.html

4. Rubin LG, Schaffner W. Clinical practice: Care of the asplenic patient. N Engl J Med. 2014; 371:349-356. http://www.nejm.org/doi/full/10.1056/NEJMcp1314291

5. Soni R, Horowitz B, Unruh M. Immunization in end-stage renal disease: opportunity to improve outcomes. Semin Dial. 2013;26:416-426. http://onlinelibrary.wiley.com/doi/10.1111/sdi.12101/abstract;jsessionid=6BEAD64A884CB7B5B807E2409778A01B.f03t03

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