American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the recommended immunization for Hepatitis B in patients after hematopoietic stem cell transplantation?

1. 1 dose if not immune

2. 2 doses if already immune

3. 3 doses if indications for nontransplant patients are met

4. No immunization required

The correct answer is: 3 doses if indications for nontransplant patients are met

The recommended immunization for Hepatitis B in patients after hematopoietic stem cell transplantation is to administer three doses of the vaccine if the indications for nontransplant patients are met. This approach is based on the understanding that patients who have undergone hematopoietic stem cell transplantation are at a heightened risk for infections due to their compromised immune systems. Post-transplant, many patients may have a loss of immunity, including against Hepatitis B, and vaccination is essential to restore protection. The three-dose series is crucial because it enhances the likelihood of developing an adequate immune response in this immunologically vulnerable group. The vaccination schedule generally involves doses given at 0, 1, and 6 months. Furthermore, patients who were previously immune might also benefit from revaccination to ensure levels of immunity are appropriately sustained. Therefore, if the individual shows indications that would warrant vaccination similar to nontransplant patients, providing the complete series ensures that optimal protection is achieved. In this context, other answers do not align with current medical guidelines regarding immunization strategies post-transplantation, by either underestimating the number of doses required or prematurely concluding that immunization is unnecessary.