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Myasthenic crisis — ABIM Board MCQ

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HardNeurologyMyasthenic crisisABIM Board

A 55-year-old woman with rheumatoid arthritis takes methotrexate and will start adalimumab in three weeks. She has never received recombinant zoster vaccine and has no acute illness. Which vaccination plan is most appropriate?

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Correct answer: D — Begin the two-dose recombinant zoster vaccine series now

The best answer is “Begin the two-dose recombinant zoster vaccine series now”. Recombinant zoster vaccine is nonlive and strongly recommended for adults receiving immunosuppressive therapy. When feasible, vaccination before escalation may improve immunogenicity, but ongoing treatment is not a reason to omit it. Live zoster vaccine is not the indicated US product and live vaccines generally require careful timing around biologics.

Reference: 2022 ACR Guideline for Vaccinations in Rheumatic and Musculoskeletal Diseases: https://pmc.ncbi.nlm.nih.gov/articles/PMC10291822/