During a routine health maintenance visit, the parents of a -year-old girl inquire about her eligibility for required preschool immunizations. The patient was diagnosed with standard-risk acute lymphoblastic leukemia (ALL) two years ago. She successfully completed induction and consolidation therapy and is currently in the maintenance phase of her treatment, taking daily oral mercaptopurine and weekly oral methotrexate. She has been feeling well, with no recent fevers, weight loss, or respiratory symptoms. Her temperature is (), blood pressure is , and heart rate is . Physical examination reveals a well-appearing, active child with no lymphadenopathy or hepatosplenomegaly.
Laboratory evaluation shows:
Hemoglobin:
Leukocyte count:
Absolute neutrophil count:
Platelet count:
A review of her immunization record indicates that she received all scheduled vaccines during her first year of life but has not yet received her - to -year booster series, which includes the diphtheria, tetanus, and acellular pertussis (DTaP), inactivated poliovirus (IPV), measles, mumps, and rubella (MMR), and varicella vaccines.
Which of the following is the most appropriate next step in management regarding her immunizations?
- Administer the DTaP and IPV vaccines today, but withhold the MMR and varicella vaccines until at least months after chemotherapy is completedAnswer
- BAdminister the DTaP, IPV, MMR, and varicella vaccines today to ensure full preschool requirements are met
- CWithhold all vaccines today because her laboratory results indicate severe neutropenia
- DAdminister the DTaP, IPV, MMR, and varicella vaccines today because her current medications do not contraindicate their use
- EWithhold all vaccines today because all immunizations are universally contraindicated during active chemotherapy regimens