Shots in the Dark
Polly is 5 years old and received IPV at 2, 4, and 6 months. What does she still need?
What is one IPV dose now?
The final IPV dose must be given at age 4 years or older and at least 6 months after the prior dose.
A 10-month-old is traveling internationally in 2 weeks and has not received MMR. What should be given before travel, and does it count toward the routine series?
What is one MMR dose now, and no—it does not count toward the routine series?
Infants 6–11 months traveling internationally should receive one MMR dose, then still receive the routine 2-dose series after 12 months.
Dia is 12 years old with type 1 diabetes. Which vaccine should she receive every year to reduce her risk of severe seasonal illness?
What is influenza vaccine?
Children with diabetes are at higher risk of complications from influenza and should receive annual influenza vaccination.
What is the cut-off age for giving a DTaP?
What is < 7 years of age?
Do not give DTAP to children >=7 years of age. After that, Tdap is recommended at 11-12 years of age, followed by a Td or Tdap booster every 10 years thereafter.
Intussee is 4 months old and received rotavirus vaccine 2 weeks ago. He now presents with episodic crying, vomiting, and “currant jelly” stool. Will he receive future rotavirus doses?
What is no -further rotavirus vaccine (contraindicated after intussusception)?
History of intussusception is a contraindication to further rotavirus vaccine. This presentation is also a classic post-vaccine timing concern that must be recognized as true disease requiring urgent evaluation.
A 24 mo girl is taken into emergency protective custody due to medical neglect. Her immunization record states that she received HepB vaccine at birth; at 2 mo she received Pediarix, Hib, and PCV15. Do one or more of the vaccine series need to be restarted in this patient because she was last vaccinated > 1 year ago?
What is no - vaccines don't need to be restarted?
A vaccine series does not need to be restarted, regardless of the time that has elapsed between doses.
Rubi is a pregnant adolescent and has no documented MMR vaccine. What is the plan?
What is give MMR postpartum?
MMR is a live vaccine and is contraindicated during pregnancy.
Coco has a cochlear implant and completed the routine infant PCV series with PCV15. What is the most likely next pneumococcal step after age 2?
What is one dose of PCV20 or PPSV23?
Children with cochlear implants who completed a PCV series but have not received PCV20 may need either PCV20 or PPSV23, at least 8 weeks after the last PCV dose.
A child is hospitalized with moderate-to-severe acute illness and is due for routine vaccines. What is the usual approach?
What is defer until the acute illness improves?
Moderate or severe acute illness is a precaution; vaccinate once clinically improved unless the benefit of immediate protection outweighs the risk.
Rotie is a 2-month-old who recently received rotavirus vaccine. His immunocompromised sibling asks if contact is safe because “he might catch the vaccine virus ?”
What is yes - contact is safe?
Vaccine virus shedding can occur but transmission risk is very low. Good hand hygiene is recommended, but routine household contact is generally safe.
Rota is 16 weeks old and has never received rotavirus vaccine. What should you do?
What is do not start the rotavirus series?
Do not initiate rotavirus vaccine at age 15 weeks, 0 days or older.
A child is to have a PPD and MMR today. Can you give both today at the same office visit?
What is yes - you give both today at the same office visit?
Tuberculin skin test can be performed any time before or in the same day of immunization with MMR. If not the same day, then you must wait 4-6 weeks before placing the PPD (measles vaccine can temporarily suppress tuberculin reactivity).
Hibby is 7 years old with sickle cell disease and has never received Hib vaccine. Does Hib catch-up still matter?
What is yes—give 1 Hib dose?
Healthy children ≥5 years usually do not need Hib catch-up, but unvaccinated children with anatomic/functional asplenia do.
Preemie is 2 months old, medically stable, and was born at 30 weeks. Shots or not?
What is shots—based on chronological age?
Preterm infants generally receive routine vaccines according to chronological age, not corrected age.
Tetanus Timmy develops severe local swelling, pain, and induration after receiving Td booster, with symptoms beginning 6–12 hours after vaccination. Is he ok to receive future boosters?
What is caution—delay future tetanus-containing vaccines unless ≥10 years since last dose?
An Arthus-type hypersensitivity reaction is associated with high circulating antibody levels and is a precaution for future tetanus/diphtheria boosters.
Kawasack is a 3 yo boy and received high-dose IVIG 8 months ago for Kawasaki disease and now needs both MMR and varicella for daycare entry in 1 month. Parents insist “just give them so we’re done.” What should you do?
What is defer both vaccines?
High-dose IVIG provides enough passive antibodies to interfere with both MMR and varicella, requiring a prolonged delay (often ~11 months for Kawasaki, 10 months for ITP). Giving now may result in vaccine failure.
Varicella vaccine is contraindicated in children/adolescents receiving what dose -and for how long- of systemic steroids?
What is >= 2mg/kg/day, or >= 20mg/day for children who weigh >= 10kg, for >= 14 days?
The recommended interval between discontinuation of high-dose corticosteroid therapy and immunization with varicella vaccine is at least 1 month. Inhaled, topical, and nasal corticosteroids are not a contraindication to varicella vaccine.
Hugo has HIV infection with CD4 count 300 cells/microL). Can he receive MMR and varicella vaccines?
What is yes -he can receive MMR and varicella vaccines?
Some children with HIV can receive MMR and varicella depending on CD4 percentage/count (> 200 cells/microL) and clinical status.
Albie received albumin 2 weeks ago and is due for MMR today. Shots or not?
What is shots?
Albumin is a non–antibody-containing blood product, so it does not interfere with live vaccines.
Wheezy is 3 years old with moderate persistent asthma. It’s flu season and he is due for influenza vaccination. The clinic only has nasal spray flu vaccine available today. Is it ok to be given today?
What is no - nasal spray flu vaccine today?
Children 2–4 years old with asthma or wheezing in the past 12 months should NOT receive nasal flu vaccine due to increased risk of wheezing. It is also contraindicated for pregnant, immunocompromised or close contact with immunocompromised patients.
Holly P. Vaxwell is a 14-year-old who will turn 15 next month and received her first HPV vaccine today. Her chart shows she previously received a solid organ transplant and is on chronic immunosuppression. Her parent asks, how many doses will she need?
What is a 3-dose HPV series at 0, 1–2, and 6 months?
HPV vaccine schedules depend on age AND immune status:
-Routine healthy adolescents starting HPV before age 15 → 2-dose series
-Starting at age ≥15 OR immunocompromised patients → 3-dose series
What are the 5 subcutaneously administered vaccines?
What is MMR, varicella, MMRV, PPSV23, and IPV?
IPV and PPS23 may be give either IM or subcutaneously
A 15 mo boy with development delay of unknown etiology associated with a poorly controlled seizure disorder never received a pertussis-tetanus-diphteria-containing vaccine. What are the recommendations for immunization in this patient?
What is 2 doses of DT at least 4 weeks apart; 3rd dose 6 months after dose 2; 4th dose at 4-6 years of age?
If a child has a progressive neurologic disorder, a seizure disorder that is not yet under control, or a brief seizure within 3 days or high-fever (>105F) or shock-like state within 48 hours of previous administration of DTaP, this is relatively contraindicated. Encephalopathy and prolonged seizure within 1 week of getting DTaP, contraindicates pertussis component in future vaccinations.
Poly has a history of anaphylactic allergic reaction to Neomycin, which vaccines should be avoided?
What is varicella, polio (IPV), and MMR vaccines?
These vaccines contains traces of NEOmycin, POLYmyxin, and Streptomycin. The patient must be evaluated by an allergist before being given these vaccines.
Traveler received one MenACWY dose at age 9 before traveling internationally. She is now healthy and age 11. Will she receive her routine adolescent MenACWY dose?
What is yes- she will receive her routine 11 yo dose?
A healthy child who received MenACWY before age 10 for travel should still receive routine adolescent doses at 11–12 years and age 16.