October Week 2: Vaccine Surveillance and Influenza Vaccine






Case 1: 

You are seeing a 6 month old male infant in the clinic for the first time for a WCC. Mom has the list of the immunization records. He has not received HepB, Polio and HIB vaccines, has 1 dose of DTap and
PCV, and 2 doses of Rotavirus. Mom says she changed PCP because some
disagreements in the infants’ care. He has been overall healthy, lives with
parents and attends to day care. After the interview and physical exam you
explain to mom that today he should receive some vaccines; at that moment she tells you which vaccines she will accept to give to him, she only does 2 shots at a time, and does not understand why we vaccinate against diseases that have been eradicated or against HepB if her baby is not sexually active and will not receive blood transfusions. She knows about a child in her neighborhood who was diagnosed with Autism 4 months after getting his 1 year old vaccines and she will not take the chance with her son.

What are the risks for this child if he does not receive proper vaccination
based on the official schedules for his age?

Is there an increased risk of side effects to occur when giving more that 2
vaccines at once?

Why is it important to vaccinate against Hepatitis B at that early age?

What sources of information would you refer to when explaining the benefits
of vaccination?

What is the relationship between Autism and Vaccines?

If mom does not agree and you do not feel comfortable with the situation,
what would you do next?

How can you manage vaccine-hesitant parents? 

Case 2: 

An 8 yo male child comes to your office with his parents for his annual
well child check. Five days ago he had mild fever 37.8C for two days, and has had runny nose since then and no other symptoms. When you ask about allergies, mom says that when he eats egg containing products he gets hives, but no other reaction. He has been otherwise very healthy and is up to date with his vaccines. On physical exam, the only positive finding is a moderate amount or clear rinorrhea in both nostrils and mild irritation of the nasal mucosa, rest of the exam is within normal limits. You tell the parents that he is doing very well and growing healthy and that the flu vaccine is available in your office. Mom tells you that he has never received that vaccine, she does not think it is a good idea because of his egg allergies and the fact that he has some nasal congestion.

Who should receive the annual influenza vaccine? When is it contraindicated?

What are the guidelines in terms of the number of doses that should be given?

Should a patient with mild egg allergies should receive the flu vaccine? What are the new alternatives for patients 18 and older?

What are the contraindications to receive LAIV and IIV?

Should this patient receive antiviral treatment? What are the guidelines for antiviral treatment?