A 12-month-old girl is brought to the clinic for a routine well-child visit. She was diagnosed with acute lymphoblastic leukemia three months ago and is currently receiving induction chemotherapy. The parents are concerned about her development because she cannot run yet. Her mother reports that the child stands independently, takes a few steps on her own, uses a neat pincer grasp, specifically calls her parents "mama" and "dada", and waves goodbye. The parents ask which vaccines she is allowed to receive today. Which of the following is the most appropriate recommendation for this patient?
- Administer the Haemophilus influenzae type b vaccineAnswer
- BAdminister the measles, mumps, and rubella vaccine
- CAdminister the varicella vaccine
- DAdminister the live-attenuated intranasal influenza vaccine
- EWithhold all vaccines and refer for a developmental evaluation
Answer
The most appropriate recommendation is to administer the Haemophilus influenzae type b vaccine, as it is an inactivated vaccine and safe for immunocompromised hosts.
The patient is severely immunocompromised due to active chemotherapy for acute lymphoblastic leukemia. In this setting, live-attenuated vaccines are absolutely contraindicated due to the risk of causing severe, disseminated disease. However, inactivated and conjugate vaccines, such as the Haemophilus influenzae type b (Hib) vaccine, are completely safe to administer. The patient's development is entirely normal for her age (she has achieved her 12-month milestones of standing, initial independent steps, neat pincer grasp, and specific babbling), so there is no indication for a developmental evaluation.
Step-by-Step Solution
Key Concept
Live-attenuated vaccines are strongly contraindicated in severely immunocompromised patients (e.g., those on active chemotherapy). Inactivated, toxoid, and conjugate vaccines are safe to administer.