A 6-month-old girl is brought to the office for a well-child visit and routine vaccinations. The patient is exclusively breastfed and is urinating and stooling normally. One month ago, she was hospitalized for intussusception that was reduced successfully by air enema. The patient lives in a small apartment with her mother, brother, and maternal aunt, who is pregnant. Vital signs are normal. On examination, she has mild nasal congestion and clear rhinorrhea. The remainder of the examination is normal. Her mother is very concerned about the potential side effects of vaccinations. Which of the following is this patient's contraindication to the rotavirus vaccination?

Question

A 6-month-old girl is brought to the office for a well-child visit and routine vaccinations.  The patient is exclusively breastfed and is urinating and stooling normally.  One month ago, she was hospitalized for intussusception that was reduced successfully by air enema.  The patient lives in a small apartment with her mother, brother, and maternal aunt, who is pregnant.  Vital signs are normal.  On examination, she has mild nasal congestion and clear rhinorrhea.  The remainder of the examination is normal.  Her mother is very concerned about the potential side effects of vaccinations.  Which of the following is this patient's contraindication to the rotavirus vaccination?

Quizplus · Accepted Answer

11ec25c8_d681_7d36_bc81_c3ffadc1d91b_MD0003_00 Rotavirus is the most common cause of gastroenteritis in infants and young children worldwide. The virus is highly contagious and is transmitted by the fecal-oral route through direct contact or fomites. Symptoms include fever, vomiting, and watery diarrhea and may last days to a week. Affected children often develop severe dehydration requiring hospitalization. The rotavirus vaccine is the best defense against infection and has dramatically reduced the global incidence of rotavirus-related hospitalizations and deaths. The live attenuated oral vaccine series is typically administered between age 2-6 months. The vaccine is generally well tolerated but is associated with a very small risk of intussusception, which may be related to virus-induced intestinal inflammation. Although current vaccine formulations have a far lower risk (1-6 cases per 100,000) than prior versions, infants with a history of intussusception should not receive the vaccine. In infants with no intussusception history, the benefit of disease prevention outweighs the low probability of this complication. Other contraindications to rotavirus vaccine include severe combined immunodeficiency and previous anaphylactic reaction to the vaccine or its ingredients. (Choice A) The administration of multiple vaccinations at a single visit is safe, increases vaccine compliance, and optimizes protection at a young age. Live attenuated and inactivated vaccines may be given on the same day. (Choice B) The patient's feeding regimen has no impact on vaccine safety. Breastfed babies may receive live virus vaccines. (Choice D) Live virus vaccinations should not be administered to pregnant women due to the theoretical risk of fetal infection. However, live virus vaccinations can be safely administered to household contacts of pregnant women because transmission of vaccine-derived infection is exceedingly rare. (Choice E) Vaccines can be administered safely during minor illnesses (eg, upper respiratory infection, otitis media). They should be postponed until recovery from moderate or severe illnesses (eg, high fever) because manifestations of the underlying illness can be incorrectly attributed to the vaccine or vice versa. Educational objective: The rotavirus vaccine effectively prevents most cases of rotavirus gastroenteritis. It is contraindicated in patients with a history of intussusception due to the small risk of this complication. References: Rotavirus vaccines: effectiveness, safety, and future directions. (http://www.ncbi.nlm.nih.gov/pubmed/29388076) Risk of intussusception after monovalent rotavirus vaccination. (http://www.ncbi.nlm.nih.gov/pubmed/24422678) Intussusception risk after rotavirus vaccination in U.S. infants. (http://www.ncbi.nlm.nih.gov/pubmed/24422676)

A 6-Month-Old Girl Is Brought to the Office for a Well-Child