A 66-year-old patient who has no significant pulmonary or other medical problems receives a pneumococcal vaccination. Under the current guidelines, when, if ever, does this patient need an additional pneumococcal vaccination?
—Gerald S. Roberts, MD, New Hyde Park, N.Y.

The answer depends on the age and the immune status of the individual. As your patient received his vaccination after age 65, there is no recommendation by the CDC to revaccinate. Revaccination for pneumococcal disease may be done if an individual received vaccine prior to age 65, as there is some evidence that waning immunity can occur. In this patient, the CDC would recommend revaccination only if there is a change in immune status afterward (i.e., due to organ transplantation, leukemia, splenectomy, chronic steroids), and this should be done five years after the initial vaccination.
—Cedric W. Spak, MD, MPH (114-21)

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