Examkin

Question

Difficulty: MediumImmunizations and Vaccine-Preventable Diseases

A 15-month-old girl is evaluated in the pediatric transplant clinic for a routine follow-up visit. Three months ago, she underwent a deceased-donor renal transplantation for congenital nephrotic syndrome. She is currently maintained on an immunosuppressive regimen of tacrolimus and mycophenolate mofetil. Her medical records indicate that she received all standard routine immunizations at 2, 4, and 6 months of age, but she missed her 12-month well-child visit due to her hospitalization and surgery. Which of the following vaccines are indicated and safe to administer at this visit? (Select all that apply)

  1. Hepatitis A vaccineAnswer
  2. Pneumococcal conjugate vaccineAnswer
  3. C
    Measles, mumps, and rubella vaccine
  4. D
    Varicella vaccine
  5. E
    Intranasal live attenuated influenza vaccine

Answer

The indicated and safe vaccines are the Hepatitis A vaccine and the Pneumococcal conjugate vaccine.
The correct vaccines to administer are the Hepatitis A vaccine and the Pneumococcal conjugate vaccine because both are inactivated vaccines routinely recommended at 12 to 15 months of age. Inactivated vaccines do not carry a risk of causing active infection and are safe to administer to immunocompromised patients, such as those on anti-rejection medications following a solid-organ transplant.

Step-by-Step Solution

1
Identify the patient's age and missing routine immunizations.
The patient is 15 months old and missed her 12-month vaccines. The standard schedule at 12-15 months includes MMR, Varicella, Hib, Pneumococcal conjugate, and Hepatitis A.
Determining the baseline immunization schedule establishes which vaccines are potentially due.
2
Assess the patient's immune status and medical contraindications.
The patient is actively immunosuppressed (maintained on tacrolimus and mycophenolate mofetil) following a renal transplant.
Immunosuppression is a critical factor that alters the standard immunization schedule, specifically regarding the safety of live vaccines.
3
Filter the due vaccines based on the patient's immune status.
Live-attenuated vaccines (MMR, Varicella, intranasal influenza) are strictly contraindicated. Inactivated vaccines (Hepatitis A, Pneumococcal conjugate, Hib) are safe and should be administered.
Live-attenuated vaccines can cause severe, disseminated disease in immunocompromised patients, whereas inactivated vaccines pose no infectious risk.

Key Concept

Live-attenuated vaccines (such as MMR and Varicella) are contraindicated in patients on active immunosuppressive therapy following solid-organ transplantation; however, age-appropriate inactivated vaccines should be safely administered.
Rate this question

Topics

Immunizations and Vaccine-Preventable Diseases

More questions from this topic