A 6-month-old girl is brought to the office in January for well-child care. The patient is formula-feeding exclusively and has not yet started solid foods. She is voiding and stooling normally, and her growth and developmental milestones are appropriate for age. Today, she is due for the third dose of diphtheria-tetanus-pertussis, inactivated polio, Haemophilus influenzae type b, pneumococcal, and hepatitis B vaccines. The patient has not received an influenza vaccine, but she has received all previous immunizations with no adverse reactions. Her mother states, "I have several concerns about vaccinations. Is it safe to give my daughter shots if she had fever last week? The fever lasted only a day, but she is still coughing and congested. I also read that the flu shot contains egg, and I'm worried about an allergic reaction because my husband is allergic to eggs, and I don't know how my daughter will react. Finally, I just found out that I'm pregnant, and I am afraid of exposure to germs from the vaccines." Temperature is 36.7 C (98 F), pulse is 118/min, and respirations are 28/min. Physical examination shows nasal congestion, clear rhinorrhea, and clear postnasal drip. The lungs are clear to auscultation and the rest of the examination is normal. Which of the following is the most appropriate recommendation for this patient?

Question

A 6-month-old girl is brought to the office in January for well-child care.  The patient is formula-feeding exclusively and has not yet started solid foods.  She is voiding and stooling normally, and her growth and developmental milestones are appropriate for age.  Today, she is due for the third dose of diphtheria-tetanus-pertussis, inactivated polio, Haemophilus influenzae type b, pneumococcal, and hepatitis B vaccines.  The patient has not received an influenza vaccine, but she has received all previous immunizations with no adverse reactions.  Her mother states, "I have several concerns about vaccinations.  Is it safe to give my daughter shots if she had fever last week?  The fever lasted only a day, but she is still coughing and congested.  I also read that the flu shot contains egg, and I'm worried about an allergic reaction because my husband is allergic to eggs, and I don't know how my daughter will react.  Finally, I just found out that I'm pregnant, and I am afraid of exposure to germs from the vaccines."  Temperature is 36.7 C (98 F), pulse is 118/min, and respirations are 28/min.  Physical examination shows nasal congestion, clear rhinorrhea, and clear postnasal drip.  The lungs are clear to auscultation and the rest of the examination is normal.  Which of the following is the most appropriate recommendation for this patient?

Quizplus · Accepted Answer

Explanation: 11ec2b69_c175_b553_8f63_4532fa6a6f0c_MD0005_00 Unvaccinated and underimmunized children are at risk for contracting potentially life-threatening diseases and for transmitting them to unprotected hosts. However, some parents are hesitant to vaccinate due to erroneous beliefs regarding vaccine effects. Open communication and education are key factors in dispelling misconceptions. The safety and efficacy of childhood immunizations are well established, and parents should be reassured that vaccines are generally well tolerated. The most common side effects are low-grade fever and injection site pain. Vaccines can be administered during mild illness (eg, common cold) as vaccination should not worsen symptoms. Children normally have 8-10 viral illnesses a year, so waiting for complete resolution of symptoms could significantly delay immunizations (Choice E). Influenza generally occurs during winter in the United States; however, the peak of outbreaks varies year to year and may differ by location, such as November in southern states and mid-January in northeastern states. In addition, sporadic cases occur early and late, so the vaccine is recommended throughout the entire flu season (September to April) (Choice A). Influenza vaccine is an inactivated intramuscular injection with no live virus component. It is safe to administer to household contacts of pregnant (Choice C) or immunocompromised patients. In fact, pregnant women should also receive the vaccine due to increased susceptibility to infectious complications. The influenza vaccine contains a small amount of egg protein, but those with anaphylaxis to egg can receive the vaccine in an outpatient or inpatient setting. Since anaphylaxis after vaccines is rare (<1.5 per 1 million vaccines), egg allergy (personal or family history) is not a contraindication (Choice B). This patient has no absolute contraindications to immunizations, so she should receive all recommended vaccines today. Educational objective: The influenza vaccine is recommended for all individuals age >6 months. It is inactivated and contains no live virus, so it can be safely administered to those with pregnant contacts. As with other vaccines, mild illness is not a contraindication to its administration. References: How to communicate with vaccine-hesitant parents. (http://www.ncbi.nlm.nih.gov/pubmed/21502238) Safety of influenza vaccine administration in egg-allergic patients. (http://www.ncbi.nlm.nih.gov/pubmed/20368312) Risk of anaphylaxis after vaccination in children and adults. (http://www.ncbi.nlm.nih.gov/pubmed/26452420)

A 6-Month-Old Girl Is Brought to the Office in January