Infections and Vaccines
When can the MMR and Varicella vaccines be administered to a 15 month with HIV infection?
MMR and Varicella vaccines can be administered if the CD4+ T lymphocyte percentage >= 15%
Administer a single dose of the MMR vaccine at least 2 weeks prior to departure.
A 6 year old girl is brought in by her aunt. She has never received vaccines before. Which vaccines should she receive today to start catching her up?
DTaP, Hep B, IPV, Hep A, MMR, Varicella
What are the 4 contraindications for the varicella vaccine?
1. Severe Allergic Reaction (anaphylaxsis)
2. Severe suppression or patients taking systemic corticosteroids (>=2mg/kg/day or >20mg/day prednisone) for at least 2 weeks or more.
3. Pregnancy or possibility of pregnancy within 4 weeks
4. Recent administration of immunoglobulin
Parents of a 3 month old have decided after extensive research that they are not going to vaccinate. What is the most appropriate next best step in the child's care?
Provide educational materials and ask to follow up visit in several weeks.
A 14 month old infant comes into the clinic 1 week after being discharged from the hospital for being treated for Kawasaki disease with high dose IVIG and Aspirin. She received MMR vaccine within 6 days of hospitalization. What is the best immunization schedule for her for the MMR vaccine?
A repeat dose in 11 months, and another dose between 4-6 years of age.
1 dose of Hep A vaccine, second dose 6 months later
A 6 year old received her first set of shots today including DTaP, IPV, MMRV, Hep A, Hep B. When can she come back for her next catch up vaccines?
4 weeks
What are the contraindications to the Rota virus vaccine?
History of intussusception or severe combined immunodeficiency
Which vaccines are administered SQ ?
MMR, Varicella, IPV
A 4 year old boy with Sickle Cell Disease has received PCV15 and 2,4,6 months and has not received any pneumococcal vaccines since then. What additional vaccinations are necessary to decrease the risk of severe pneumococcal infection for this patient ?
1 dose of PCV 15 and 1 dose of PPSV23 8 weeks later and 2nd dose of PPSV23 5 years after the first dose.
OR 1 dose of PCV 20 with no additional doses necessary within 5 years
While away at college, a 20 year old student's records were check and he received his last Tdap at age 9. He also received Td for a dirty wound 2 years ago. He recently was on campus with 2 confirmed cases of pertussis 1 week apart. Should he receive another Tdap vaccine immediately?
Yes, Tdap is recommended as a booster at the 11-12 year old well child visit. Tdap booster is recommended every 10 years.
Also 5 day course of azithromycin is recommended for treatment and post exposure prophylaxis.
In a patient < 13 years old, what vaccines requires a minimum interval between dose 1 and dose 2 of 3 months.
Varicella
What 4 vaccines are contraindicated or not recommended in pregnancy
MMR, Varicella, HPV, LAIV
4 day old ex 32 week infant who is 1.8 kg is doing well in the NICU. His mother's records indicate that she is Hep B surface antigen negative. When should he receive his Hepatitis B vaccine?
At hospital discharge or 1 month of chronological age, which ever comes first.
An infant was born via emergency CS. He weighs 1.65kg. Her mother is Hepatitis B surface antigen positive. What is the appropriate immunization schedule to prevent the perinatal transmission of Hep B virus to the infant?
Administration of Hep B vaccine and Hep B immunoglobulin at birth. And Hep B vaccine at 1, 2-3 months and 6 months of age
A 14 year old healthy girl with no PMHX from PR comes to clinic to establish care. She has all of her vaccines except Varicella. She does not remember every getting chicken pox when she was a child. What is the recommended schedule for varicella immunization for this patient?
In the absence of a reliable history of a natural (wild) varicella infection. She should receive 1 dose today, and her second dose in at least 4 weeks (28 days) after the first.
Can a previously unimmunized 16 week male receive the Rota vaccine?
No, the first dose of the Rota vaccine can only be administered between 6 weeks and 14 weeks and 6 days
What are two of the contraindications to the "nasal flu vaccine" LAIV?
1. Pregnancy
2. Children 2-4 years of age with asthma or history of wheezing < 12 months
3. Immunosuppressive disorder
4. Cochlear implant/CSF leak
5. Anaphylaxis to a component
6. Daily salicylate therapy
DTaP, Hep B, MMR, IPV
A 4 year old F comes to his annual visit. His specialists recommend that he recieves the MCV4 vaccine. What condition does he have that predisposes him to invasive meningococcal disease?
C5-C9 deficiency
17 y/o M came to the emergency room in Honduras when working on a farm. He required 18 sutures and his wound was extensively irrigated due to significant contamination with soil and dirt. He received 2 DTaP vaccinations before age 6 and a Td at age 11. What currently outlines Tetanus prophylaxis in this patient?
Tdap immunization and 250 U Tetanus Immunoglobulin prior to discharge.
21 month old M comes for catch up vaccines. Upon review of his shot record you notice that he has never been vaccinated against Hib and PCV. How should he be caught up?
1 dose of Hib
2 doses of PCV 15 or PCV 20 >=8 weeks apart
What are 3 of the contraindications for the DTaP vaccine?
1. Anaphylaxis after a previous dose of DTaP
2. Children who develop encephalopathy within 7 days of a previous DTaP dose administration.
3. Infants and young children with a progressive neurologic disorder (infantile spasms, uncontrolled seizure disorder, progressive encephalopathy)
4. DTaP is not licensed or recommended for children 7 years or older
What is the minimum age that requires only one dose of the influenza vaccine in a child who has never been immunized against influenza?
9 years old