American Board of Internal Medicine (ABIM) Certification Practice Exam

For patients who undergo hematopoietic stem cell transplantation, when should PCV13 be administered post-transplant?

1. As soon as possible after transplantation

2. 3-6 months after transplantation

3. 1 year after transplantation

4. 6-12 months after transplantation

The correct answer is: 3-6 months after transplantation

Patients who undergo hematopoietic stem cell transplantation (HSCT) experience significant immunosuppression, which puts them at increased risk for infections, particularly from encapsulated organisms like Streptococcus pneumoniae. The timing of administering the pneumococcal conjugate vaccine (PCV13) is crucial in providing adequate protection once the patient's immune system begins to recover. Administering PCV13 typically occurs 3 to 6 months after transplantation. During this time frame, patients often have regained sufficient immune function to respond appropriately to the vaccine. This allows for the generation of meaningful immune responses, making vaccination effective in reducing the risk of pneumococcal disease. While vaccination as soon as possible after transplantation may seem beneficial, the patient's immune system is not yet capable of mounting an adequate response due to the effects of the transplant itself and the immunosuppressive therapy they are likely receiving. Vaccine administration much earlier than 3 months post-transplant can lead to an inadequate immune response, leaving the patient vulnerable to infections. Therefore, the timing of 3-6 months post-transplant strikes an important balance, aligning with clinical guidelines that prioritize both the safety of the patient and the effectiveness of the immunization process.