If a 46-year-old man with diabetes has not received a Td booster in 19 years, which vaccines should he receive?

In this scenario, it's essential to consider the vaccination recommendations for adults, particularly those with underlying health conditions like diabetes. The patient is due for a Td booster, as it is recommended every 10 years. However, since he has not received a Td booster in 19 years, he should receive a Tdap booster instead, which provides protection against tetanus, diphtheria, and pertussis.

Additionally, adults aged 19 through 64 years with diabetes are recommended to receive pneumococcal vaccines, specifically PCV13 followed by PPSV23. However, since the options provided only include PPSV23 in a different format alongside the Tdap and influenza vaccine, it’s important to include all relevant vaccines for this patient's age and health status.

Moreover, annual influenza vaccination (IIV) is also recommended, helping to prevent influenza-related complications, especially in individuals with diabetes.

Therefore, the combination of PCV13, Tdap, and IIV covers the necessary immunizations for this patient, addressing both the routine needs and the specific considerations related to his diabetes. This combination ensures comprehensive protection against vaccine-preventable diseases.