A 12-month-old boy is brought to the office for a routine checkup. The patient had an upper respiratory tract infection and otitis media a month ago and was treated with antibiotics. He completed the full course of antibiotics and has been well. The patient has no other past medical history and has met all developmental milestones. He takes no medications, and his immunizations are up-to-date. The patient is allergic to penicillin, which causes a rash. His older sister was diagnosed with infantile-type polycystic kidney disease and underwent kidney transplantation 2 months ago. She is receiving immunosuppressive therapy. The patient is scheduled to receive the varicella vaccine today. Which of the following is the most accurate statement regarding varicella vaccination in this patient?

Question

A 12-month-old boy is brought to the office for a routine checkup.  The patient had an upper respiratory tract infection and otitis media a month ago and was treated with antibiotics.  He completed the full course of antibiotics and has been well.  The patient has no other past medical history and has met all developmental milestones.  He takes no medications, and his immunizations are up-to-date.  The patient is allergic to penicillin, which causes a rash.  His older sister was diagnosed with infantile-type polycystic kidney disease and underwent kidney transplantation 2 months ago.  She is receiving immunosuppressive therapy.  The patient is scheduled to receive the varicella vaccine today.  Which of the following is the most accurate statement regarding varicella vaccination in this patient?

Quizplus · Accepted Answer

Explanation: 11ec2b69_bf8c_5c97_8f63_63c130badedc_MD0005_00 The varicella-zoster virus (VZV) vaccine is a live-attenuated vaccine that is administered typically in 2 doses: the first at age 12-15 months and the second at age 4-6 years. VZV vaccination is recommended in all children without absolute contraindications (Table). However, vaccinating household contacts of transplant recipients is safe and recommended currently by the American Academy of Pediatrics and the Infectious Diseases Society of America. These organizations also recommend that pretransplant patients receive 2 doses of the VZV vaccine at least 4 weeks prior to transplantation. Household contacts who receive the VZV vaccine should be monitored closely for a vaccine-associated VZV rash, which occurs in <10% of children who receive the vaccine and is potentially contagious to immunocompromised individuals. (Choices A and E) If this patient develops a rash, he should be isolated from his sibling until all of the lesions have crusted over. Varicella immunoglobulin (VariZIG) should be administered to varicella-seronegative transplant recipients who have been exposed to VZV. If this patient's sister becomes exposed to VZV or a vaccine-related rash, she should receive VariZIG as soon as possible (within 10 days of initial exposure). (Choice B) Live virus vaccines, including VZV, should not be administered to this patient's sister as she is status post renal transplant and on immunosuppressive therapy. (Choice D) This patient has no contraindications and should receive the VZV vaccine. Educational objective: The varicella-zoster virus (VZV) vaccine can be administered safely to immunocompetent patients with household contacts who are immunocompromised. Although transmission of VZV by a vaccine-related rash is rare, vaccinated individuals should be monitored for a rash and isolated if one develops. References: Vaccinations for adult solid organ transplant recipient: current recommendations. (http://www.ncbi.nlm.nih.gov/pubmed/16182821) Updated recommendations for use of VariZIG--United States, 2013. (http://www.ncbi.nlm.nih.gov/pubmed/23863705)

A 12-Month-Old Boy Is Brought to the Office for a Routine