Pediatric Immunizations Questions – Part 1

  1. Which of the following is an absolute contraindication for repeat DTaP doses?
  1. Temperature of >104° F (>40.5° C) for less than 48 hours after vaccination with DTaP
  2. Seizure more than 3 days after receiving DTaP
  3. Stable neurologic disorder
  4. Persistent, inconsolable crying lasting more than 3 hours within 48 hours after receiving DTaP
  5. Encephalopathy within a week of receiving DTaP
  1. A 6 month old infant received Hepatitis B vaccine at birth. Your office used Pediarix vaccine at 2 and 4 months. Can Pediarix also be used at 6 months?
  1. No, because the infant should not get a fourth Hepatitis B vaccine
  2. Yes, because getting the fourth Hepatitis B vaccine makes the infant even more immune to Hepatitis B
  3. Yes, because the fourth Hepatitis B causes no harm
  4. No, because combination vaccines should not be used at 6 months
  1. A mother is concerned about the cost of vaccinating her 6 month old child. Her husband lost his job last month and they have no health insurance. You reassure her about her baby’s vaccines because
  1. The pharmaceutical firm donates the vaccines for children with no insurance.
  2. The child now qualifies for the Vaccines for Children Program.
  3. The child will qualify for the Vaccines for Children Program in 3 months.
  4. Since the child is so young, when they get insurance, you can use the catch-up schedule to give the recommended vaccines.

  1. The parents of a 2 month old child refuse to immunize their child. In your community, a 16 year old has been diagnosed with pertussis. What should you inform the parents?
  1. Herd immunity provides complete protection to prevent the child from getting pertussis.
  2. Passive immunity provides the child complete protection from pertussis.
  3. Active immunity following DTaP gives the most protection from pertussis.
  4. The child has no antibodies to pertussis.
  1. Which of the following is the appropriate management of an infant born to a Hepatitis B surface antigen positive mother?
  1. Administer Hepatitis B vaccination only after birth.
  2. Delay Hepatitis B vaccine until after the infant’s 2 month well-child exam so that you can check Hepatitis B titers prior to administration.
  3. Administer Hepatitis B immune globulin and Hepatitis B vaccine within 12 hours of birth.
  4. Administer Hepatitis B immune globulin after birth, followed by Hepatitis B vaccine 24 hours later.

Match the vaccine needed to each case (one answer per case)

  1. ____2 month old infant at a routine well child exam
  2. ____1 month old infant that did not receive a birth dose of Hepatitis B vaccine
  3. ____Neonate born to a Hepatitis B surface antigen positive mother
  4. ____4 month old infant that has not received any vaccines since birth
  5. ____2 year old who has received 4 doses of PCV-7 vaccine
  1. PCV-13
  2. HBIG and Hepatitis B vaccine
  3. Hepatitis B vaccine
  4. Pediarix®, PCV-13, Hib, Rotavirus
  5. Pentacel®, PCV-13, Hepatitis B

Pediatric Immunization Answers – Part 1

  1. e. Encephalopathy within a week after receiving DTaP is an absolute contraindication for repeat DTaP. DTaP can be given to patients with fever after vaccination, seizure more than 3 days after DTaP, presence of a stable neurologic disorder, or with crying after immunization. Answers a and d are precautions for administration of future doses of DTaP.
  1. c. If Pediarix is given, the fourth dose of Hepatitis B does no harm.
  1. b. A child who is uninsured, has Medicaid, is Native American or an Alaskan Native is eligible for the Vaccines for Children Program.
  1. c. Herd and passive immunity help prevent pertussis but are not complete protection. Active immunity from DTaP gives the most protection from pertussis.
  1. c. Hepatitis B and Hepatitis B Immune globulin should be given within 12 hours after birth.
  1. d. The standard immunization schedule for all 2 month old infants is DTaP, IPV, Hepatitis B, Hib and Rotavirus. Pediarix® is a combination vaccine composed of DTaP, IPV and Hepatitis B.
  1. c. This infant needs to be started on its Hepatitis B immunization series. The baby cannot receive any other vaccines until it is 6 weeks old.
  1. b. All infants born to a Hepatitis B surface antigen positive mother should receive Hepatitis B immune globulin (HBIG) and Hepatitis B vaccine within 12 hours of birth, administered simultaneously in separate sites. The infant should be tested for Hepatitis B surface antigen and antibody 3-6 months after completion of the Hepatitis B immunization series.
  1. e. This infant is behind on immunizations. Catch-up dosing should be started immediately with the standard 2 month old vaccines, with the exception of Rotavirus. Rotavirus vaccine cannot be administered after 15 weeks of age. Pentacel® is a combination vaccine composed of DTaP, IPV and Hib. The other vaccines needed are Hepatitis B and PCV-13.
  1. a. This child has completed a full PCV-7 series. With the release of PCV-13, all children through the age of 5 with a completed series should receive a one-time booster of PCV-13.

AFMRD Presents: A Comprehensive Immunization Curriculum for Family Medicine Residency Programs