Case 096: Adult Immunization

PATIENT PRESENTATION

Chief Complaint

“I am interested in receiving the influenza vaccine, but I am not sure I should given that vaccine since I had Guillain-Barré a few years ago after receiving the vaccine.”

History of Present Illness

TT is a 70-year-old male with past medical history comprising of type 2 diabetes mellitus, chronic kidney disease stage 3, and obesity who presents to the clinic today for a routine check-up. He has not been vaccinated against influenza in the past 4 years due to Guillain-Barré Syndrome occurring approximately 4 weeks after receipt of influenza vaccination. TT also reports he has been hospitalized for influenza pneumonia 3 years ago and last year that included stints in the intensive care unit.

Link to EMR

Student Work-Up

TARGETED QUESTIONS

1. What is Guillain-Barré Syndrome and its incidence rate?

   Hint: https://www.ninds.nih.gov/health-information/patient-caregiver-education/fact-sheets/guillain-barre-syndrome-fact-sheet

   https://www.cdc.gov/vaccinesafety/concerns/guillain-barre-syndrome.html

2. Describe the signs and symptoms of Guillain-Barré Syndrome.

   Hint: https://www.ninds.nih.gov/health-information/patient-caregiver-education/fact-sheets/guillain-barre-syndrome-fact-sheet

3. Which vaccines need to be given with caution if a patient has experienced Guillain-Barré Syndrome suspectedly due to prior immunization?

   Hint: https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/contraindications.html

4. If the decision is made to immunize, which influenza vaccine formulation is TT eligible to receive today?

   Hint: https://www.cdc.gov/mmwr/volumes/70/rr/rr7005a1.htm#T1_down

5. What are the respective doses of the influenza vaccines TT is eligible to receive?

   Hint: https://www.cdc.gov/mmwr/volumes/70/rr/rr7005a1.htm#T1_down

FOLLOW-UP

TT returns to the clinic approximately 6 months later for another routine check-up. He reports no issues since receiving his influenza vaccination at his prior visit. Per his vaccination record, you realize he is now due for his Tdap/Td booster. What discussion, particularly related to side effects/precautions of this vaccine, should be had with TT prior to administering his Tdap/Td booster today?

Hint: https://www.cdc.gov/vaccines/vac-gen/side-effects.htm

CASE SUMMARY

Global Perspective

Seasonal influenza occurs in different months when comparing the northern and southern hemispheres. In the northern hemisphere, influenza occurs between the months of November and April, whereas in the southern hemisphere, the virus is most infectious between the months of June and October. Several factors are evaluated to determine the annual influenza vaccine composition including the influenza viruses that have circulated during the past year.

Key References