General IM Q9

A 22-year-old man is evaluated during a pre-employment examination. The patient is starting a new job as a registered nurse. He is asymptomatic. He received the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine 7 years ago and the influenza vaccine during the last influenza season. Approximately 6 months ago, he received one dose of the measles, mumps, and rubella (MMR) vaccine because of lack of documented immunity on serologic testing. Medical history is negative for chronic medical conditions. He is a nonsmoker, and he does not plan to travel outside of the United States in the near future. He takes no medications.

Physical examination is normal.

Laboratory studies are significant for a positive result on a hepatitis B surface antibody test. Hepatitis B surface antigen, hepatitis B core antibody, and hepatitis A IgG antibody levels are undetectable.

Which of the following is the most appropriate vaccination strategy for this health care worker?

A Administer a second dose of MMR vaccine

B Administer the hepatitis A vaccine

C Administer the hepatitis B vaccine

D Administer the 23-valent pneumococcal polysaccharide vaccine

E No vaccination at this time

Choose an Answer Above

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