Question 86#

Live rubella vaccine should be given to:

A. Children between one year and puberty

Correct Answer A:
Rubella vaccine is recommended for all children and for adolescents and adults without documented evidence of immunity. It is especially important to verify that all women of child-bearing age are immune to rubella before they get pregnant. 

The first dose of MMR (measles, mumps, rubella) should be given on or after the first birthday; the recommended range is from 12-15 months. A dose given before 12 months of age may not be counted, so the child's medical appointment should be scheduled with this in mind. 

The second dose is usually given when the child is 4-6 years old, or before he or she enters kindergarten or first grade. However, the second dose can be given anytime as long as it is at least four weeks after the first dose. MMR can only be given through age 12 years. 

Severely immunocompromised persons should not be given MMR vaccine. Women are advised not to receive the rubella vaccine during pregnancy as a safety precaution based on the theoretical possibility of a live vaccine causing disease, in this case "congenital rubella syndrome". 

Question 87#

Active immunization is important in the control of each of the following childhood communicable diseases, except:   

A. Diphtheria

Correct Answer D:

Immunizations exists for polio (IPV) and for diphtheria, tetanus and pertussis (DTaP) and for measles, mumps and rubella (MMR). Currently there is no vaccine against scarlet fever.

Question 88#

An 18-year-old patient presents with his father for a pre-college physical examination. The student plans to attend college in a nearby state and will live in a university-owned residence hall. A review of his record shows that he received all of the currently recommended immunizations on time throughout childhood.

The benefits of vaccination against which one of the following organisms should be discussed during this visit?  

A. Measles

Correct Answer D:

College freshmen, especially those who live in dormitories, are at a modestly increased risk for meningococcal disease compared with other persons of the same age, and vaccination with the currently available quadrivalent meningococcal polysaccharide vaccine will decrease their risk. The Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention recommends that incoming and current college freshmen, and their parents, be informed about meningococcal disease and the benefits of vaccination. This is particularly true for those who live in dormitories and residence halls. In this case, the patient has received vaccinations against measles, polio, pertussis, and tetanus at the recommended times, and booster vaccinations are not indicated now. 

Question 89#

Which one of the following is current recommendation regarding influenza vaccine?

A. Recommend influenza vaccine to all persons age 50 and over

Correct Answer E:

Recommended recipients of influenza vaccine for the 2013-2014 season:

People at high risk of influenza-related complications or hospitalization: 

• Adults (including pregnant women) and children with the following chronic health conditions: cardiac or pulmonary disorders (including bronchopulmonary dysplasia, cystic fibrosis and asthma); diabetes mellitus and other metabolic diseases; cancer, immune compromising conditions (due to underlying disease and/or therapy); renal disease; anemia or hemoglobinopathy; conditions that compromise the management of respiratory secretions and are associated with an increased risk of aspiration; morbid obesity (BMI ≥ 40); and children and adolescents with conditions treated for long periods with acetylsalicylic acid.
• People of any age who are residents of nursing homes and other chronic care facilities. People ≥ 65 years of age.
• All children 6 to 59 months of age.
• Healthy pregnant women (the risk of influenza-related hospitalization increases with length of gestation, i.e. it is higher in the third than in the second trimester).
• Aboriginal Peoples. 

People capable of transmitting influenza to those at high risk:

• Health care and other care providers in facilities and community settings who, through their activities, are capable of transmitting influenza to those at high risk of influenza complications.
• Household contacts (adults and children) of individuals at high risk of influenza-related complications (whether or not the individual at high risk has been immunized): household contacts of individuals at high risk, as listed in the section above; household contacts of infants < 6 months of age as these infants are at high risk of complications from influenza but cannot receive influenza vaccine; and members of a household expecting a newborn during the influenza season. Those providing regular child care to children ≤ 59 months of age, whether in or out of the home.
• Those who provide services within closed or relatively closed settings to persons at high risk (e.g. crew on a ship). 

Others: 

• People who provide essential community services.
• People in direct contact during culling operations with poultry infected with avian influenza.

Note: Healthy persons aged 5 to 64 years who do not have contraindications to influenza vaccine are also encouraged to receive influenza vaccine even if they are not in one of the recommended recipient groups.

Question 90#

Which one of the following is a contraindication to immunization with MMR?

A. The patient had a tuberculosis skin test (PPD) within the previous 2 days

Correct Answer D:

The failure to provide immunizations because of perceived contraindications is one of the most common reasons for an inadequately protected population. A PPD may be falsely negative if administered 2-30 days after MMR administration, not the reverse. If the patient is immunodeficient or pregnant, rather than a household contact, then MMR is contraindicated. Breastfeeding is not a contraindication.