American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the recommendation for varicella immunization after hematopoietic stem cell transplantation?

1. Must be administered 2 weeks post-transplant

2. 2 doses if seronegative after 24 months

3. Not recommended at any stage

4. Only recommended if GVHD is present

The correct answer is: 2 doses if seronegative after 24 months

The recommendation for varicella immunization after hematopoietic stem cell transplantation involves administering two doses of the varicella vaccine if the patient is seronegative for varicella-zoster virus after 24 months post-transplant. This approach is rooted in the understanding that patients who have undergone hematopoietic stem cell transplantation are at increased risk for infections, and varicella can be a serious complication in this population due to their typically weakened immune system. After 24 months, if immunological recovery has occurred, patients can be assessed for their varicella immunity status. Those who are seronegative (indicating they lack immunity to the virus) are recommended to receive the varicella vaccine, as long as there are no contraindications such as ongoing immunosuppression. Administering two doses provides better protection by ensuring the immune system responds adequately to the vaccine. Other options in the question do not align with current guidelines. Administering the vaccine 2 weeks post-transplant is too soon, considering the patient's immune system may still be significantly compromised. Not recommending the vaccine at any stage disregards the potential for recovery of immune function and the importance of preventing varicella. Lastly, recommending the vaccine only in the