American Board of Family Medicine (ABFM) Practice Exam

Which condition is NOT indicated for a second dose of the pneumococcal polysaccharide vaccine in children?

1. Sickle cell disease

2. Functional asplenia

3. Asthma

4. HIV+

The correct answer is: Asthma

The pneumococcal polysaccharide vaccine (PPSV23) is recommended for certain high-risk groups of children to prevent serious pneumococcal infections. Among the conditions listed, sickle cell disease, functional asplenia, and HIV are all associated with an increased risk of pneumococcal disease and therefore warrant a second dose of the vaccine. Sickle cell disease leads to increased susceptibility due to the compromised spleen function, making those patients more vulnerable to bacterial infections. Similarly, individuals with functional asplenia, whether due to congenital conditions or surgical removal of the spleen, also face heightened risks from encapsulated bacteria like Streptococcus pneumoniae, which the vaccine targets. Children living with HIV experience immune system compromise, increasing their risk for pneumococcal infections, thus indicating the need for additional vaccine doses. In contrast, asthma, while it is a common chronic condition, does not inherently place children at a significantly higher risk for pneumococcal disease compared to the other listed conditions. Therefore, children with asthma typically do not require a second dose of the pneumococcal polysaccharide vaccine as they do not meet the specific high-risk criteria that justify the additional dose. This makes asthma the correct answer to