Patient Thinks He Gets Too Many Vaccines, but I Have to Recommend More

Charles P. Vega, MD


July 13, 2023

This is a clinical scenario drawn from my own practice. I'll tell you what I plan to do, but I'm most interested in crowdsourcing a response from all of you to collectively determine best practice. So please answer the polling question and contribute your thoughts in the comments, whether you agree or disagree.

The Most Vaccinated Man in the World?

You are seeing a 67-year-old man for a wellness visit. He has a history of type 2 diabetes, chronic kidney disease stage 3aA2, hypertension, and heart failure with reduced ejection fraction. You review his vaccine history and find that he has received these immunizations in your practice:

  • Influenza: 10 doses given (last dose 3 years ago)

  • Tdap: One dose given 6 years ago

  • Pneumococcal: One dose of pneumococcal polysaccharide vaccine-23 (PPSV23) given 8 years ago, and another dose of PPSV23 given 2 years ago

  • COVID-19: Three doses of mRNA-based vaccine, with the last dose given in February 2022

You ask the patient if he has received any vaccines outside your practice, and he responds, "Absolutely not. You guys poke me just about every time I'm here. I feel like the most vaccinated guy in the world."

Of course, he has other health maintenance issues to discuss. He is overdue for colorectal cancer screening and has never discussed prostate cancer screening. Beside strongly recommending restarting routine influenza vaccination in the fall, what would you recommend for this patient regarding his vaccination status?


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