MTM Immunization & Preventive Care 5 — Questions and Answers
Question 1: A pharmacist identifies that a 55-year-old male patient with chronic kidney disease (CKD) stage 3 has never received hepatitis B vaccine. What is the recommended vaccine formulation?
- Standard adult dose (Recombivax HB 10 mcg) in 3-dose series
- High-dose hepatitis B vaccine (Heplisav-B or high-dose Engerix-B 40 mcg) due to impaired immune response (Correct answer)
- No hepatitis B vaccine is recommended for patients with CKD
- Delay hepatitis B vaccination until dialysis begins
Correct answer: High-dose hepatitis B vaccine (Heplisav-B or high-dose Engerix-B 40 mcg) due to impaired immune response
Patients with CKD or on dialysis have impaired immune response and require higher antigen doses (40 mcg) to achieve adequate seroprotection.
Question 2: Which of the following best describes the concept of 'herd immunity' as it applies to preventive care counseling by MTM pharmacists?
- When 50% of a population is immune, outbreaks cannot occur
- When a sufficient proportion of a population is immune, spread of disease is limited, protecting unvaccinated individuals (Correct answer)
- Herd immunity only applies to bacterial infections, not viral
- Herd immunity eliminates the need for individual vaccination once achieved
Correct answer: When a sufficient proportion of a population is immune, spread of disease is limited, protecting unvaccinated individuals
Herd immunity occurs when enough of a population is immune (vaccinated or previously infected) that disease transmission is interrupted, protecting those who cannot be vaccinated.
Question 3: A pharmacist reviews a medication list and identifies a patient on eculizumab (Soliris) for paroxysmal nocturnal hemoglobinuria (PNH). Which vaccine is MANDATORY before starting this therapy?
- Hepatitis A vaccine
- Meningococcal vaccines (MenACWY and MenB) (Correct answer)
- Yellow fever vaccine
- Pneumococcal and Hib vaccines only
Correct answer: Meningococcal vaccines (MenACWY and MenB)
Eculizumab inhibits complement C5, dramatically increasing risk of invasive meningococcal disease; both MenACWY and MenB vaccines are required ≥2 weeks before initiation.
Question 4: Which clinical preventive service is recommended by USPSTF with an 'A' grade for all sexually active women aged 24 and younger?
- HIV screening
- Syphilis screening
- Chlamydia and gonorrhea screening (Correct answer)
- Hepatitis C screening
Correct answer: Chlamydia and gonorrhea screening
USPSTF gives an 'A' recommendation to chlamydia and gonorrhea screening for all sexually active women aged 24 and younger, given high prevalence and serious complications.
Question 5: A pharmacist counsels a patient about the interval between live vaccines. The patient received MMR today. When is the earliest she can receive varicella vaccine if not given simultaneously?
- 2 weeks
- 4 weeks (28 days) (Correct answer)
- 6 weeks
- 3 months
Correct answer: 4 weeks (28 days)
If two live vaccines are not given on the same day, they must be separated by at least 28 days (4 weeks) to avoid immune interference.
Question 6: According to USPSTF recommendations, which vitamin/mineral supplementation should be recommended to prevent neural tube defects in persons planning or capable of pregnancy?
- Vitamin A 5,000 IU daily
- Folic acid 0.4-0.8 mg daily (Correct answer)
- Iron 27 mg daily
- Vitamin D 600 IU daily
Correct answer: Folic acid 0.4-0.8 mg daily
USPSTF recommends 0.4-0.8 mg (400-800 mcg) of folic acid daily for all persons planning or capable of becoming pregnant to prevent neural tube defects.
Question 7: An MTM pharmacist identifies that a 67-year-old patient received PCV13 at age 65 but has not received PPSV23. Based on current ACIP guidance, what should be recommended?
- No further pneumococcal vaccines are needed after PCV13 at age 65
- PPSV23 should be given at least 1 year after PCV13
- Switch to PCV15 or PCV20 now, which eliminates the need for PPSV23 (Correct answer)
- PPSV23 should have been given first; the series must restart
Correct answer: Switch to PCV15 or PCV20 now, which eliminates the need for PPSV23
Current ACIP guidance recommends PCV15 followed by PPSV23, or PCV20 alone; if the patient received PCV13, PCV20 or PCV15+PPSV23 can still be used to complete protection.
MTM Immunization & Preventive Care 5
A pharmacist identifies that a 55-year-old male patient with chronic kidney disease (CKD) stage 3 has never received hepatitis B vaccine.
What is the recommended vaccine formulation?