American Board of Internal Medicine (ABIM) Certification Practice Exam

When should the zoster vaccine be given to patients undergoing solid organ transplantation?

1. Only in later recovery phases

2. 4 weeks before transplantation if immune

3. 2 weeks post-transplantation

4. Only once the patient is deemed stable

The correct answer is: 4 weeks before transplantation if immune

The zoster vaccine is administered to provide protection against herpes zoster (shingles), and timing is crucial in the context of solid organ transplantation. When considering vaccination for individuals undergoing solid organ transplantation, the ideal time to administer the zoster vaccine is four weeks prior to the transplant procedure. This timing is important because it allows sufficient time for the immune response to develop before the patient undergoes immunosuppressive therapy, which typically begins immediately after transplantation. Vaccinating four weeks before transplantation ensures that the patient is immune to the varicella-zoster virus, reducing the risk of developing shingles post-transplant when they are at higher risk due to immunosuppression. It's also important to note that administering the vaccine too close to the time of transplantation or after the procedure can be ineffective or pose additional risks, as the immune system may not be robust enough to respond to the vaccine adequately under immunosuppressive conditions. In contrast, options that suggest delaying vaccination until after transplantation or only when the patient is stable do not provide the optimal protective effect and may leave the patient vulnerable to developing herpes zoster during a period when their immune system is compromised. Hence, the best practice indicates that patients should receive the zoster vaccine four weeks before their solid organ