During a routine pre-kindergarten health assessment, a five-year-old boy is evaluated for his immunization needs. His medical history is notable for an orthotopic liver transplant performed two years ago due to decompensated biliary atresia. The patient has been doing well and takes daily tacrolimus and mycophenolate mofetil to prevent allograft rejection. A review of his immunization registry reveals he received all standard infant and toddler vaccines by his second birthday, but no vaccines since then. His vital signs and physical examination today are within normal limits. Which of the following vaccines should be administered to this patient at today's visit? (Select all that apply)
- Diphtheria, tetanus, and acellular pertussis (DTaP) vaccineCevap
- Inactivated poliovirus vaccine (IPV)Cevap
- CMeasles, mumps, and rubella (MMR) vaccine
- DVaricella vaccine
- ELive attenuated influenza vaccine (LAIV)
Cevap
The correct vaccines to administer are the Diphtheria, tetanus, and acellular pertussis (DTaP) vaccine and the Inactivated poliovirus vaccine (IPV).
The patient is a five-year-old child due for routine pre-kindergarten boosters, which normally include DTaP, IPV, MMR, and Varicella. Because he is taking anti-rejection medications (tacrolimus and mycophenolate) following a solid organ transplant, he is in a state of severe, iatrogenic immunosuppression. In this high-risk population, inactivated vaccines such as DTaP and IPV are safe and highly recommended to prevent severe infections. Therefore, they should be administered at this visit.
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Live-attenuated vaccines (such as MMR, Varicella, and LAIV) are strictly contraindicated in severely immunocompromised patients, including those on maintenance immunosuppression following solid organ transplantation, due to the risk of disseminated vaccine-strain infection.