Case 095: Pediatric Immunizations

PATIENT PRESENTATION

Chief Complaint

“We are here for my son’s well-child check-up. With the COVID-19 pandemic, we have missed these visits for the last couple years. He has pretty bad allergies, if he needs vaccines, will they be safe for him?”

History of Present Illness

A 7-year-old male child who comes to the primary care clinic for annual well-child check-up. He has not been seen for the last 2 years. Patient also has a history of attention deficit hyperactivity disorder and allergic rhinitis, including multiple food allergies. Pharmacist to review immunization record and discuss any necessary immunizations as well as risk for adverse events given the patient’s underlying comorbidities.

Link to EMR

Student Work-Up

TARGETED QUESTIONS

1. What should be evaluated to determine if Ishaan should receive immunizations today?

   Hint: See guide to vaccine contraindications and precautions (by the CDC), https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/contraindications.html

2. What adverse effects should the patient’s father be educated about regarding Ishaan’s immunizations?

   Hint: See CDC Talking to Parents about Vaccines: https://www.cdc.gov/vaccines/hcp/conversations/conv-materials.html

3. What strategies are recommended to prevent and manage vaccine adverse reactions?

   Hint: See guide to preventing and managing adverse reactions (by the CDC), https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/adverse-reactions.html

   See CDC Talking to Parents about Vaccines: https://www.cdc.gov/vaccines/hcp/conversations/conv-materials.html

4. Is premedication (e.g., acetaminophen) before immunizations appropriate for Ishaan? Why or why not?

   Hint: See CDC Talking to Parents about Vaccines: https://www.cdc.gov/vaccines/hcp/conversations/conv-materials.html

5. Which of Ishaan’s needed vaccines is/are likely to cause body temperature elevation?

   Hint: See guide to preventing and managing adverse reactions (by the CDC), https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/adverse-reactions.html

   See CDC Talking to Parents about Vaccines: https://www.cdc.gov/vaccines/hcp/conversations/conv-materials.html

FOLLOW-UP

Ishaan and his father return to the clinic 6 weeks later for re-evaluation of his allergic rhinitis symptoms and follow up for his vaccine schedule. He has not been seen since his previous appointment in July. Ishaan is well nourished, not in distress, with mild gastroenteritis. His body temperature is 37.5°C. The pediatrician asks you if it is okay to give his immunizations today and which ones he currently needs. Is it appropriate to administer immunizations today? If so, which ones?

Hint: See guide to vaccine contraindications and precautions (by the CDC), https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/contraindications.html

CASE SUMMARY

Global Perspective

Immunization of children remains a significant public health concern internationally. According to the WHO, immunizations do not reach every child worldwide, resulting in an estimated 1.5 million deaths from diseases preventable by vaccines recommended by the WHO. There have also been shifts in rates of vaccination from 2019 onward.^1,2 For example, there has been a decline in DTaP series vaccination, from 86% to 83%, globally. In 2020, ...