Which one of the following preventive measures is recommended for nearly all international travelers to developing countries?
Correct Answer B:
More than a dozen vaccines are available for diseases with a high prevalence in developing countries. The primary care physician should make sure that international travelers are up to date on routine immunizations, given that vaccine-based immunity to tetanus, diphtheria, polio, and measles wanes over time, and that these diseases are highly prevalent abroad. While location-specific situations may require particular immunizations such as typhoid, yellow fever, or hepatitis B vaccine, and/or administration of -globulin, hepatitis A vaccine is recommended for nearly all international travelers.
The intranasal live, attenuated influenza vaccine would be appropriate for which one of the following?
Correct Answer A:
The live, attenuated influenza vaccine (LAIV) is administered intranasally. Based on effectiveness, efficacy and immunogenicity data, NACI (National Advisory Committee on Immunization) recommends LAIV for use in healthy children and adolescents 2-17 years of age (choice A). Furthermore, NACI recommends that LAIV can be used for the prevention of influenza in healthy adults 18 to 59 years of age.
→ NACI recommends that LAIV can be used in children 24 months and older with stable, non-severe asthma. LAIV should not be used in those with severe asthma (choice B) (as defined as currently on oral or high dose inhaled glucocorticosteriods or active wheezing) and those with medically attended wheezing in the seven days prior to vaccination.
→ It is contraindicate in individuals with occurrence of Guillain-Barré Syndrome (choice C) within eight weeks of any prior influenza vaccination.
→ It is contraindicate in pregnant women (choice D).
→ NACI recommends that LAIV can be used for the prevention of influenza in healthy adults 18-59 years of age (NACI Recommendation Grade A) (choice E is incorrect).
A 67-year-old male sees you for knee pain from osteoarthritis. It has not responded to his usual treatment, and you treat him with an intra-articular corticosteroid injection. It is mid-November, and he tells you that he has not received the influenza vaccine this year. He has also never received pneumococcal vaccine. He has a history of allergic rhinitis, treated with intranasal corticosteroids.
Which one of the following is true regarding pneumococcal vaccine and injected influenza vaccine for this patient?
Correct Answer E:
Low-dose topical, oral, nasal, and intra-articular corticosteroids are not immunosuppressive and do not contraindicate administration of any vaccine. Injected influenza vaccine and pneumococcal vaccine can be given together. Neither is a live vaccine.
Which one of the following is true regarding the schedule for administering rotavirus vaccine?
The rotavirus (RV) vaccine is an oral vaccine recommended for infants in a 3-dose schedule at ages 2, 4, and 6 months (OR in 2 doses at 2 and 4 months of age). The first dose should be given between 6 and 14 weeks of age, with additional doses given at 4- to 10-week intervals. The vaccine cannot be initiated after 14 weeks of age and should not be administered after 32 weeks of age. Available data indicate RV vaccine is safe and effective in preterm infants.
The first rotavirus vaccine was taken off the market in 1999 after an increased risk of intussusception was noted in infants when the first dose of the vaccine was given after 12 weeks of age. Because of this, the two vaccines licensed in 2006 carry the recommendation that the vaccine not be initiated in infants over 12 weeks of age. There is no data regarding safety and efficacy after this age.
You would recommend pneumococcal vaccine for which one of the following?
A single dose of pneumococcal 23-valent polysaccharide vaccine is recommended for all adults 65 years of age and older, and for adults less than 65 years of age in long term care facilities or who have conditions putting them at increased risk of pneumococcal disease. Some conditions include:
Therefore, all persons between the ages of 19 and 64 who smoke should receive this vaccine (choice A). One-time revaccination after 5 years is recommended for persons with chronic renal failure, asplenia (functional or anatomic), or other immunocompromising conditions. Because there are insufficient data to recommend repeated administration of Pneu-P-23 vaccine, re-vaccination following a second dose is not routinely recommended.
→ The diabetic patient (choice B) and the nursing-home resident (choice C) have both received one immunization and should not receive a second dose until age 65.
→ The patient with chronic renal failure (choice D) in this question has already received two immunizations.
→ The 71-year-old (choice E) has already been immunized after age 65, and a repeat immunization is not recommended.
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