Examkin

Question

Difficulty: EasyPreventive Care and Immunizations

A 4-year-old boy is brought to the clinic for a well-child visit. Three months ago, he was diagnosed with minimal change disease. He experienced a relapse one month ago and has been taking oral prednisone at a dose of 2 mg/kg/day2 \text{ mg/kg/day} for the past four weeks. His blood pressure is normal, and a physical examination shows resolving periorbital edema. The parents note he is due for his routine pre-kindergarten vaccinations and ask if they can be administered today. Which of the following vaccines must be withheld from this patient at this visit?

  1. Varicella vaccineAnswer
  2. B
    Diphtheria, tetanus, and acellular pertussis (DTaP) vaccine
  3. C
    Inactivated poliovirus vaccine (IPV)
  4. D
    Inactivated influenza vaccine (IIV)
  5. E
    Pneumococcal conjugate vaccine (PCV)

Answer

Varicella vaccine
The Varicella vaccine is a live-attenuated viral vaccine. In patients with healthy immune systems, the attenuated virus replicates locally to induce immunity without causing clinical disease. However, in patients experiencing severe immunosuppression—such as those taking high-dose systemic corticosteroids (prednisone ≥2 mg/kg/day\geq 2 \text{ mg/kg/day} or ≥20 mg/day\geq 20 \text{ mg/day} for ≥14\geq 14 days)—cellular immunity is profoundly impaired. Administering a live vaccine to this patient risks uncontrolled replication of the vaccine strain, potentially resulting in severe, disseminated varicella infection. Therefore, it must be withheld until the patient has been off high-dose corticosteroids for at least 1 month.

Step-by-Step Solution

1
Identify the patient's immune status based on current medications.
The patient is severely immunosuppressed because he is receiving high-dose systemic corticosteroids (prednisone at 2 mg/kg/day2 \text{ mg/kg/day} for ≥14\geq 14 days).
Pharmacologic immunosuppression alters standard immunization protocols.
2
Determine the general contraindications for vaccines in immunosuppressed individuals.
Live-attenuated vaccines are contraindicated.
Immunocompromised patients lack the cellular immunity required to control live-attenuated vaccine strains, risking severe, disseminated disease.
3
Classify the vaccines listed in the options as live-attenuated or inactivated.
Varicella is live-attenuated. DTaP, IPV, IIV, and PCV are inactivated or toxoid vaccines.
Only the live-attenuated vaccine must be withheld today.

Key Concept

Live-attenuated vaccines (e.g., MMR, Varicella, Rotavirus) are contraindicated in patients with severe immunosuppression, including those receiving high-dose systemic corticosteroids (defined as prednisone ≥2 mg/kg/day\geq 2 \text{ mg/kg/day} or ≥20 mg/day\geq 20 \text{ mg/day} for ≥14\geq 14 consecutive days).
Estimated Time:45s
Rate this question

Topics

Preventive Care and Immunizations

More questions from this topic