What vaccinations should be updated for a 54-year-old female patient with diabetes who has not received any vaccinations in the past 10 years?

Vaccination Update for 54-Year-Old Female with Diabetes

This patient requires immediate catch-up vaccination with Tdap (or Td), pneumococcal vaccines (PCV13 followed by PPSV23), annual influenza vaccine, hepatitis B series, and consideration for recombinant zoster vaccine, given her 10-year vaccination gap and diabetes status. 1

Priority Vaccinations for This Patient

Tetanus-Diphtheria-Pertussis (Tdap/Td)

• Administer 1 dose of Tdap immediately if she has not received it previously, regardless of when her last tetanus-containing vaccine was given 1
• If her last tetanus vaccination was >10 years ago (which it is), Tdap should replace the Td booster 1, 2
• After Tdap, continue with Td boosters every 10 years 1
• The minor trauma mentioned makes this particularly urgent for wound prophylaxis considerations 2

Pneumococcal Vaccination (Critical for Diabetes)

• Administer PCV13 first, followed by PPSV23 at least 8 weeks later for patients aged 19-64 with diabetes 1
• People with diabetes are at significantly increased risk for bacteremic pneumococcal infection with mortality rates as high as 50% 1
• At age 65 or older, she will need an additional dose of PPSV23 (at least 5 years after the previous PPSV23) 1

Influenza Vaccination

• Administer annual influenza vaccine immediately and every year thereafter 1
• Influenza vaccination in people with diabetes significantly reduces influenza and diabetes-related hospital admissions 1
• Use inactivated influenza vaccine (IIV) or recombinant influenza vaccine (RIV); live attenuated vaccine is contraindicated in diabetes 1

Hepatitis B Vaccination

• Administer a 2- or 3-dose hepatitis B series (depending on vaccine formulation) 1
• This is specifically recommended for unvaccinated adults with diabetes ages 18-59 years 1
• People with diabetes have higher rates of hepatitis B due to potential contact with infected blood through glucose monitoring devices 1

Recombinant Zoster Vaccine (RZV)

• Consider administering 2-dose RZV series (2-6 months apart) if she is age 50 or older 1, 3
• RZV is preferred over the older live zoster vaccine due to higher efficacy 3
• This can be given starting at age 50 years 1

Vaccination Schedule Approach

Immediate visit priorities:

• Tdap (most urgent given trauma and 10-year gap) 1, 2
• PCV13 (first pneumococcal dose for diabetes) 1
• Influenza vaccine (if during flu season) 1
• Initiate hepatitis B series (dose 1) 1

Follow-up at 8 weeks:

• PPSV23 (at least 8 weeks after PCV13) 1
• Hepatitis B dose 2 (timing depends on vaccine formulation) 1

Follow-up at 6 months:

• Hepatitis B dose 3 (if 3-dose series) 1
• RZV dose 1 (if age ≥50) 1

Follow-up at 8-12 months:

• RZV dose 2 (2-6 months after dose 1) 1

Common Pitfalls to Avoid

• Do not delay Tdap waiting for the 10-year interval to pass; it can be given regardless of when the last tetanus vaccine was received 1, 2
• Do not reverse the pneumococcal vaccine sequence; PCV13 must come before PPSV23 in previously unvaccinated adults with diabetes 1
• Do not forget annual influenza vaccination every subsequent year, as this significantly reduces diabetes-related complications 1
• Do not overlook hepatitis B vaccination in diabetic patients under age 60, as this is a specific CDC recommendation for this population 1

Documentation and Patient Education

• Document all vaccines administered with dates and lot numbers 2
• Educate the patient about the importance of annual influenza vaccination 1
• Provide a vaccination record card and schedule for follow-up doses 2
• Emphasize that diabetes increases her risk for vaccine-preventable diseases, making catch-up vaccination critical 1, 4