A 62-year-old woman visits your ambulatory care clinic for her annual flu shot. She is a daily smoker, and she has had hypothyroidism, hypertension, and osteoarthritis in the past. You check her immunization records and discover that she had a flu vaccine a year ago, Zostavax two years ago, and Tetanus-diphteria acellular pertussis (Tdap) eight years ago. In addition to the flu vaccine, choose all vaccines that you would you recommend for this patient.

Immunizations are a critical part of patient care in the prevention of certain diseases. It is critical for pharmacists to be able to identify patients who are eligible for and/or have contraindications to specific immunizations. Age, comorbidities, and other patient-specific factors all influence vaccine recommendations. PCV13 is not recommended for this patient. PCV13 is only indicated for individuals aged 19 to 64 with cochlear implants, cerebrospinal fluid (CSF) leaks, asplenia, sickle cell disease, or who are immunocompromised (HIV, solid organ transplant, generalized malignancy, chronic renal failure, etc.). After the age of 65, PCV13 may be considered for this patient. This, however, should be based on clinical decision with the patient. In November 2019, the Centers for Disease Control and Prevention (CDC) amended their PCV13 recommendations, stating that it is no longer recommend for all individuals aged 65 and older. If PCV13 is decided to be given, it should be given at least one year after the most recent pneumococcal vaccine.
Anyone aged 19 to 64 who smokes or has a history of alcoholism, diabetes, chronic heart, liver, or lung disease and has not previously had the recommended pneumococcal vaccine should get PPSV23, according to the CDC. It is recommended that a final dosage of PPSV23 be given at least 5 years after the most recent dose of PPSV23 and at least 8 weeks after the administration of PCV13 if the patient reaches the age of 65.
Patients should receive one Tdap dose, followed by Td administrations every ten years. There are four different types of tetanus vaccines available. Children under the age of 7 should have DTaP (diphtheria, tetanus, and pertussis) or DT (diphtheria and tetanus), while older children and adults should receive Tdap and Td. Adults who have never received Tdap should receive a single dosage, regardless of when they last received Td.
Tdap was given to the patient eight years ago. It is recommended that the Td vaccination be given after 10 years.
In patients aged 50 and older, Shingrix (recombinant zoster vaccine) is recommended and indicated. Even though Zostavax (zoster vaccine live) is FDA-approved for individuals aged 50 and older, the CDC recommends it for patients aged 60 and older. The CDC, on the other hand, prefers Shingrix to Zostavax, and it is advised that patients obtain Shingrix even if they have already gotten Zostavax. Shingrix should be given in two doses, separated by two to six months.