Internal Medicine

	Answer 4 Influenza vaccine and tetanus booster. The influenza vaccine is recommended for individuals aged 50 years and older on an annual basis.7 Because the patient received the influenza vaccine 3 years ago, he is overdue for the next vaccination. A tetanus booster (tetanus toxoid) is recommended routinely every 10 years. In cases in which patients have wounds that may be contaminated with tetanus bacilli (in this case, due to injury involving a rusty nail), a tetanus booster is recommended if it has been 5 years or more since the last tetanus vaccination.7 Pneumococcal vaccination is recommended for adults aged 65 years and older;7 this patient was recently vaccinated (1 month prior to this clinic visit) and therefore does not require revaccination. REFERENCES 7. Centers for Disease Control and Prevention. Recommended adult immunization schedule—United States, October 2007-September 2008. Available at www.cdc.gov/mmwR/preview/mmwrhtml/mm5641-immunizationa1.htm. Accessed 7 Apr 2008. Click here to return to the questions
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