一位 65 歲病人在完成基礎疫苗接種後準備出院。哪種疫苗建議所有 65 歲及以上成人接種一次（或一個完整劑次）以預防帶狀疱疹？

核心概念：老年人免疫接種計畫。帶狀疱疹（俗稱皮蛇）在老年群體中發病率高且易有神經痛併發症。為何正確答案 C 對：重組帶狀疱疹疫苗（Shingrix）是目前美國 CDC 建議 50 歲以上成人的首選，通常需接種兩劑，其保護效力顯著優於舊款。為何其他選項錯：選項 B 水痘疫苗是用於未曾患病的人，不等於預防帶狀疱疹；選項 A 是預防肺炎鏈球菌，與帶狀疱疹無關；選項 D 是舊型的活性減毒疫苗，目前在美國市場已逐漸被 C 選項取代，因為保護力較低且有禁忌症限制。臨床思路：護理師應告知病人，即使以前得過帶狀疱疹或打過舊款疫苗，仍應接種 Shingrix 以獲得更好的保護。

Core concept: immunization for older adults. Herpes zoster (commonly known as shingles) has a high incidence in the older population and is frequently complicated by postherpetic neuralgia. Why option C is correct: the recombinant zoster vaccine (Shingrix) is currently the preferred vaccine recommended by the U.S. CDC for adults aged 50 and older, generally given as a two-dose series, and offers significantly greater protective efficacy than the older product. Why the other options are incorrect: option B, the varicella vaccine, is intended for individuals who have never had chickenpox and is not equivalent to shingles prevention; option A protects against pneumococcal disease and is unrelated to shingles; option D is the older live attenuated vaccine, which has been progressively replaced by option C in the U.S. market because of lower efficacy and contraindications. Clinical approach: the nurse should inform the patient that even those who have previously had shingles or received the older vaccine should still receive Shingrix for better protection.

在美國，Shingrix 通常由商業保險或 Medicare Part D 給付。在台灣，帶狀疱疹疫苗目前多為自費項目，護理師在衛教時除了強調效益，也常需說明費用與兩劑接種的間隔時間（2-6 個月）。