A healthy 12-month-old boy is brought to the physician for a routine examination. He started walking last week and can say "mama," "dada," "night-night," and "go." He eats a well-rounded diet and drinks whole milk twice a day. The patient lives with his mother, who is 17 weeks pregnant. His growth parameters and physical examination are normal. He is scheduled to receive measles-mumps-rubella, varicella, inactivated poliovirus, and pneumococcal conjugate vaccinations today. Which of the following is the best next step in management of this patient?

Question

A healthy 12-month-old boy is brought to the physician for a routine examination.  He started walking last week and can say "mama," "dada," "night-night," and "go."  He eats a well-rounded diet and drinks whole milk twice a day.  The patient lives with his mother, who is 17 weeks pregnant.  His growth parameters and physical examination are normal.  He is scheduled to receive measles-mumps-rubella, varicella, inactivated poliovirus, and pneumococcal conjugate vaccinations today.  Which of the following is the best next step in management of this patient?

Quizplus · Accepted Answer

Explanation: 11ec2b69_bfa2_caf2_8f63_fde2136138ce_MD0005_00 Immunocompetent children can receive all standard immunizations regardless of the pregnancy status of household contacts. Although pregnant women should not receive live virus vaccines due to the theoretical risk of fetal infection, the risk of contracting an infection from a recipient of a live virus vaccine is very low. Delaying vaccines until after pregnancy (Choice E) is not recommended as vaccines make it less likely that a child will contract the disease and bring it home to the mother. Infection with wild-type varicella and rubella poses a far more significant threat to a pregnant woman. (Choice B) The varicella vaccine can be administered safely to a patient who lives with a pregnant woman. The risk of a post-vaccination rash is very low. Isolation from a pregnant patient is unnecessary unless the vaccinated patient develops a rash. (Choices C and D) Unlike the oral (attenuated) poliovirus vaccine, the inactivated (killed) vaccine does not result in the vaccinated individual "shedding" poliovirus. The pneumococcal vaccine is a conjugate vaccine, meaning that it is comprised of small segments of bacterial polysaccharides linked to proteins. These vaccines cannot cause infection in the recipient or the recipient's household contacts. Educational objective: Pregnant women should not receive live virus vaccines, but their household members should get all routine immunizations on schedule. Delaying vaccines is not recommended, as vaccines make it less likely that children will contract the disease and expose pregnant women to wild-type infection. References: Vaccinations for pregnant women. (http://www.ncbi.nlm.nih.gov/pubmed/25560127) Maternal immunization: an update for pediatricians. (http://www.ncbi.nlm.nih.gov/pubmed/23910028) Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices (ACIP). (http://www.ncbi.nlm.nih.gov/pubmed/17585291) Prevention of measles, rubella, congenital rubella syndrome, and mumps, 2013: summary recommendations of the Advisory Committee on Immunization Practices (ACIP). (http://www.ncbi.nlm.nih.gov/pubmed/23760231)

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