A 5-year-old boy presents to the clinic for a pre-kindergarten health assessment. He was diagnosed with acute lymphoblastic leukemia three months ago and is actively undergoing induction chemotherapy. According to his electronic health record, he completed his primary infant vaccination series appropriately but has not received any vaccine doses since 24 months of age. His parents are requesting that his pre-school immunizations be updated today so he can eventually attend school. Which of the following vaccines are absolutely contraindicated for this patient at this time? (Select all that apply)
- Measles, mumps, and rubella (MMR) vaccineAnswer
- Varicella vaccineAnswer
- CDiphtheria, tetanus, and acellular pertussis (DTaP) vaccine
- DInactivated poliovirus vaccine (IPV)
- EQuadrivalent inactivated influenza vaccine
Answer
The Measles, mumps, and rubella (MMR) vaccine and the Varicella vaccine.
The correct answers identify live-attenuated viral vaccines. For pediatric patients with severe cellular immunodeficiency, such as those receiving active induction chemotherapy for acute lymphoblastic leukemia, all live-attenuated vaccines are strictly contraindicated. The patient lacks the necessary cellular immunity to appropriately respond to the weakened virus, creating a substantial risk for uncontrolled viral replication and severe, disseminated vaccine-strain infection.
Step-by-Step Solution
Key Concept
Live-attenuated vaccines (such as MMR and Varicella) are absolutely contraindicated in severely immunocompromised patients, including those actively receiving systemic chemotherapy, due to the risk of uncontrolled vaccine-strain viral infection.