Peds ID Board Review

Peds ID Board ReviewFeb 2011Dr Guada Lopez MartiPediatric Infectious DiseasesMarshall UniversityQuestion 1

The parents of a healthy 4-year-old boy are seeking your advice regarding the need for additional measles vaccination for their son. In reviewing the boys vaccination history, you note that he has received one dose of measles vaccine (as measles-mumps-rubella [MMR]) at the age of 12 months. You inform the parents that he should receive a second dose of measles vaccine. Of the following, the MOST important reason to recommend a second dose of measles vaccine for this child is that:A. one dose of measles vaccine fails to induce immunity in approximately 5% of children B. one dose of measles vaccine is associated with a low antibody-mediated response C. one dose of measles vaccine is associated with a poor cell-mediated responseD. one dose of measles vaccine is associated with significant loss of protection with time (waning immunity)E. the child received the first dose of vaccine prior to 15 months of age

Answer 1: A one dose of measles vaccine fails to induce immunity in approximately 5% of children

The currently available and licensed measles vaccine in the United States is a live attenuated strain produced in chick embryo cell culture One dose of measles vaccine administered to children after their first birthdays immunologically mimics natural measles infection and induces excellent cell-mediated and antibody-mediated responses in 95% of vaccineesPrimary vaccine failure, defined as a failure to seroconvert after vaccination, occurs in approximately 5% of individuals who receive one dose of measles vaccine at 12 to 15 months of age. Thus, antibodies to measles are detected in at least 95% of persons vaccinated at an age-appropriate time. Potential reasons for primary measles vaccine failures include the presence of neutralizing maternal antibody (in children younger than 12 months) or previous receipt of blood products, improperly stored vaccine, or genetic factors

Question 2

You are planning an immunization schedule for a 14-month-old girl who was treated for Kawasaki disease 3 months ago. According to her hospitalization records, she received 18 g (2 g/kg) of immune globulin intravenous (IGIV) as treatment for her disease. Review of her immunization records shows she is due to receive the following vaccines: 4th dose of pneumococcal conjugate vaccine (PCV), booster dose of H. influenzae type b conjugate (Hib) vaccine, 1st doses of hepatitis A, measles-mumps-rubella (MMR) and varicella vaccines. Of the following, the MOST appropriate immunization schedule for this child is administration of:A. all needed vaccines at the next clinic visitB. all needed vaccines 6 months after IGIV was administeredC. all needed vaccines at 11 months after IGIV was administeredD. MMR and varicella vaccines at the next clinic visit and PCV, Hib, and hepatitis A vaccines at least 11 months after IGIV was administeredE. PCV, Hib, and hepatitis A vaccines at the next clinic visit and MMR and varicella vaccines at least 11 months after IGIV was administered

Answer 2: E PCV, Hib, and hepatitis A vaccines at the next clinic visit and MMR and varicella vaccines at least 11 months after IGIV was administered Table: Suggested Interval Between Administration of HISG and Live-virus Vaccines (MMR and Varicella) Dose of HISG(mg/kg) Suggested Interval