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The patient, a 66-year-old male, is at increased risk for pneumonia and other respiratory infections due to his history of heart failure and smoking. He presents with fever and cough, and a chest X-ray shows a new lobar infiltrate. The recommended treatment includes antibiotics, corticosteroids, and oxygen therapy. According to the Centers for Disease Control and Prevention (CDC), adults aged 65 years or older should receive a dose of pneumococcal conjugate vaccine (PCV13) at least 6 months after their last dose, and a repeat dose 6 –12 months later. Therefore, the answer to question 60 is (D) A repeat PPSV23 in 6 –12 months is recommended.