From the Guidelines
The most appropriate additional vaccine to administer at this visit is C, Herpes zoster recombinant vaccine. This patient is 45 years old with advanced chronic kidney disease, which is an immunocompromising condition that puts him at higher risk for herpes zoster (shingles) 1. The recombinant zoster vaccine (Shingrix) is recommended for immunocompromised adults aged 19 and older, regardless of previous history of herpes zoster or receipt of zoster vaccine live (Zostavax) 1. The patient has a history of chickenpox, indicating prior varicella-zoster virus infection, which can reactivate as shingles. Some key points to consider in vaccine administration for this patient include:
- Hepatitis A vaccine is not indicated as a priority since there are no specific risk factors mentioned.
- Hepatitis B vaccine is unnecessary as the patient already has hepatitis B surface antibody positivity, indicating immunity.
- Regarding pneumococcal vaccines, while they are important for patients with chronic kidney disease, the herpes zoster vaccine represents the most urgent need at this visit given the patient's immunocompromised status and prior varicella infection 1. It's also worth noting that the patient's vaccination history and current health status should be taken into account when determining the best course of action for vaccination, as outlined in guidelines such as those from the Advisory Committee on Immunization Practices (ACIP) 1.
From the Research
Patient's Medical History and Current Condition
The patient is a 45-year-old man with advanced chronic kidney disease due to IgA nephropathy. He has a history of chickenpox but no history of shingles. His current medications include carvedilol, diltiazem, lisinopril, and sevelamer. He has completed only the required childhood vaccinations and has recently received the COVID-19 immunization.
Laboratory Studies
The patient's laboratory studies show:
- Hepatitis A virus IgM antibody: Negative
- Hepatitis B surface antigen: Negative
- Hepatitis B surface antibody: Positive
- Hepatitis C virus antibody: Negative
- Inactivated influenza vaccine has been administered.
Recommended Vaccine
Based on the patient's medical history and current condition, the most appropriate additional vaccine to administer at this visit is:
- C Herpes zoster recombinant vaccine
Justification
The patient has a history of chickenpox, which increases his risk of developing shingles (herpes zoster) due to the reactivation of the varicella-zoster virus 2. The herpes zoster recombinant vaccine is recommended for adults aged 50 years and older, as well as for immunocompromised adults aged 19 years and older 3, 4, 5, 6. Although the patient is 45 years old, his advanced chronic kidney disease may increase his risk of developing shingles, making the herpes zoster recombinant vaccine a suitable option. The vaccine has been shown to be effective in preventing shingles and related complications, with a moderate to high vaccine efficacy and an acceptable safety profile 2, 3, 4.
Key Points
- The patient's history of chickenpox increases his risk of developing shingles.
- The herpes zoster recombinant vaccine is recommended for adults at increased risk of shingles.
- The vaccine has been shown to be effective in preventing shingles and related complications.
- The patient's advanced chronic kidney disease may increase his risk of developing shingles, making the vaccine a suitable option.