Administration of the pneumococcal polysaccharide vaccine is indicated in this patient because he smokes cigarettes.
The pneumococcal polysaccharide vaccine is typically administered to adults aged 65 and older. However, smokers, residents of nursing homes or other long-term care facilities, and patients with a number of chronic medical conditions should be given the pneumococcal vaccine even if they have not yet reached age 65; they then require a second dose after the age of 65, with at least 5 years between doses. Typically, only one dose is necessary after the age of 65, but for those individuals, who may be predisposed to infection because of a weakened immune system, a second dose after five years of receiving the first dose is recommended. For those age 19-64, a booster 5 years after the first dose may be recommended if renal failure, abnormal immune system or functional/anatomical asplenia.
Vaughn and Miller discuss the expansion of immunization recommendations to encompass all adults with asthma as well as all smokers. They note that individuals with asthma have double the risk of invasive pneumococcal disease, while smokers have quadruple the risk.
Huss et al. present a meta-analysis of the pneumococcal polysaccharide vaccine's efficacy in adult patients. Interestingly, they failed to find a significant reduction in pneumococcal pneumonia, all-cause pneumonia, or all-cause mortality in vaccinated patients. These results persisted in subgroup analyses of the elderly and patients with chronic illness.
Illustration A shows the current CDC adult immunization schedule.
Answer 1: Hepatitis A vaccination is indicated for men who have sex with men, illicit drug users, and patients with chronic liver disease, and travel to certain countries among other indications. None of these apply to this patient.
Answer 2: Hepatitis B vaccination is indicated for sexually active individuals not in mutually monogamous relationships, men who have sex with men, injection drug users, healthcare personnel, and patients with a number of chronic medical conditions. None of these apply to this patient.
Answer 3: Zoster vaccination is indicated at age 60.
Answer 5: Td booster administration is indicated every 10 years; this patient received Td 6 years previously.
Vaughn JA, Miller RA. Update on immunizations in adults. Am Fam Physician. 2011 Nov 1;84(9):1015-20.
PMID:22046942 (Link to Abstract)
Huss A, Scott P, Stuck AE, Trotter C, Egger M. Efficacy of pneumococcal vaccination in adults: a meta-analysis. CMAJ. 2009 Jan 6;180(1):48-58. doi: 10.1503/cmaj.080734. Erratum in: CMAJ. 2009 May 12;180(10):1038.
PMID:19124790 (Link to Abstract)