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CDE Diabetes

Practice Exam: Influenza, Pneumococcal, Hepatitis B and Herpes Zoster Vaccinations (Chapter 19 & Updates)

People with diabetes are at a significantly higher risk for morbidity and mortality from vaccine-preventable diseases compared to the general population. The Clinical Practice Guidelines emphasize that vaccination is a critical, yet often overlooked, component of comprehensive diabetes care.

This practice exam tests your ability to apply the 2018 Guidelines and the most recent 2024/2025 Immunization Tool recommendations, covering routine schedules and specific indications for high-risk adults.

Key Concepts Covered in This Exam:

  • Influenza: Understanding the recommendation for annual vaccination to reduce hospitalization rates (by approx. 40%) and death during flu season.
  • Pneumococcal Updates: Mastering the updated protocols which now recommend one dose of Pneu-C-21 or Pneu-C-20 for adults, regardless of their previous vaccination status with Pneu-C-13 or Pneu-P-23.
  • Hepatitis B: Recognizing that adults with diabetes are at higher risk of Hepatitis B infection (e.g., from assisted blood glucose monitoring) and should be immunized if not vaccinated in childhood.
  • Herpes Zoster (Shingles): Identifying the recommendation for the Recombinant Zoster Vaccine (RZV) for adults 50 years, including those who have previously received the live vaccine.
  • Emerging Vaccines: Reviewing new guidance for COVID-19 boosters and the individualized recommendation for Respiratory Syncytial Virus (RSV) vaccination in high-risk populations, including those with diabetes.

1. The natural process of aging predisposes older people to herpes zoster through which mechanism?

2. How often should people with diabetes receive influenza vaccination?

3. The primary infection syndrome of varicella-zoster virus presents as which condition?

4. What percentage of Canadians are expected to develop herpes zoster at some point in their lives?

5. In the Dutch case-control study, influenza vaccination reduced hospitalization rates for which of the following conditions by 70%?

6. What is the leading cause of hepatocellular carcinoma (HCC) worldwide?

7. Hepatitis B outbreaks in long-term care facilities have been linked to which of the following practices in people with diabetes?

8. What is the most common complication of herpes zoster that persists after lesions have healed?

9. Which of the following is NOT mentioned as a condition associated with increased risk of herpes zoster according to the guidelines?

10. Adults with diabetes between ages 23 to 59 years are at approximately what increased risk of acute hepatitis B compared to adults without diabetes?

11. The major risk factor for development of herpes zoster is:

12. Evidence from studies has demonstrated that diabetes mellitus is often accompanied by which immune system abnormality?

13. In a Dutch case-control study, how much higher was the incidence of complications in unvaccinated individuals compared to those vaccinated against influenza?

14. What proportion of herpes zoster cases occur in adults 50 years of age and older?

15. The herpes zoster (shingles) rash results from reactivation of latent virus in which anatomical location?

16. Influenza vaccination is associated with approximately what percentage reduction in mortality for high-risk individuals?

17. Which types of diabetes are associated with higher risk of hepatitis B virus (HBV) infection?

18. In a Canadian cohort study, which of the following was observed in working-age adults with diabetes regarding influenza?