• Most patients received a primary Medicine

children.
immunization
• For those adults against
whotetanus
were neverand
require
diphtheria a total of 3
asgive 3 doses. The principle is
vaccinated,
– Give the Brst 2
vaccinations against tetanus
that– Give
adults
doses the
1−2 third
months
and
– diphtheria.
Give a booster vaccination every 10
dose
Tdap6–12
apart months
instead of Td booster. If the
years
later for life; one of the boosters should
InKuenza wound is dirty, revaccinate after 5
use
InKuenza
Vaccine years.vaccines is recommended annually
a history of cardiopulmonary disease,
for all adults
residents of chronic
regardlesscareoffacilities
age. Patients
derivewho
the
diabetes mellitus, or hemoglobinopathy, or
have should
greatest
season beneBt from an annual inKuenza
are age 50+
vaccina-
also receive
tion.the
Pregnant women who will be
Pneumococcal
in
vaccine.
their second or
Pneumococcal third trimester
vaccine is indicatedduring the
for all
Vaccine
inKuenza
adults
• Those agewith Additionally,
≥65.history of the following
• Those
individu-
sickle-cell with history
als disease of
should receive
or the vaccine
•cardiopulmonary
Alaskan natives disease,
and certain
regardless
splenectomy
•Native of age:
Immunocompromised patients (patients
failure,American
alcoholism, populations
or nephrotic
or cirrhosissyndrome; HIV-
with hematologic malignancies, chronic
positive patients;
shouldorbe patients receiving
Revaccination
renal performed in
age <65
immuno-and were age
suppressive <60 at the time of
medications)
healthy patients
infection (CKD, asplenic
who received
patients,
their initial
primary
after 5 years.
vaccination.
No onePatients
gets with a high risk
vaccination
immunocompromised patients) should be
of
>1 fatal
boosterB shot per
Hepatitis
revaccinated 1x
lifetime.
Hepatitis
Vaccine B vaccine is recommended when
there is
blood products.
a historyAdditionally,
of IV drug abuse,
patientsmale
with a
vaccine. Immunity is
homo-
history
It is also recommended for all childrenreceive
sexuality,
of chronic household
liver diseaseor sexual
should contact
conBrmed
active
with
the but not B
hepatitis monogamous, workers with
age 18, carriers, or STIs,
frequent
through
serologically. those with those who
occupational
exposure exposure to blood, and prison
to blood/
are sexually
inmates.

USMLE® is a joint program of The

and the National
Federation of State Medical Boards of the
Board of Medical 5
United States, Inc.

Page 13 of 503
USMLE Step 2 l
Internal Medicine
Hepatitis A
The hepatitis A vaccine protects against the
Vaccine
both of which stimulate active
virus
• Onein contains
>95% of cases. There are 2 types of
immunity
• One againstaalive
contains future
vaccine,
inactivated hepatitis
infection.
For
butthe best protection,
attenuated virus give the vaccine in
A virus
later. Protection against hepatitis A begins
2
Indoses: initial
the United dose and
States, then a booster
the vaccine 6–
is strongly
approximately
in an attempt to2–4 weeks
eradicate aftervirus
the the initial
12 months