A girl child has had recurrent yeast and respiratory viral infections since she was 3 months old. Considering studies for her immune status, which of the following vaccines is contraindicated?

Killed IPV (Inactivated Poliovirus Vaccine)

DPT (Diphtheria, Pertussis, Tetanus)

In which of the following disorders, vaccines are not contraindicated in the person suffering from that disease?

Complement deficiency disorders

All of the following regarding rotavirus vaccine are correct except?

Cannot be given after 6 months of age

Available as monovalent and pentavalent

A young male came to the hospital with a clean-cut wound without any bleeding. The patient received a full course of tetanus vaccination 10 years ago. What is the best management for this patient?

Human tetanus immunoglobulin only

Human tetanus immunoglobulin and a full course of vaccine

A person reports 4 hours after having a clean wound without laceration. He had taken TT 10 years before. The next step in management is:

Full course Tetanus vaccine to be given

In a case of meningitis, Neisseria meningitides was grown in culture after 48 hours. Which measure is to be taken immediately ?

Antibiotic treatment of contacts

Vaccination in Special Populations for INI-CET: High-Yield Microbiology Lessons

Pregnant & Lactating Women - Bundle of Joy Shots

📌 C/I Live Vaccines: "My Vain Boy Loves Icecream On Yachts" (MMR, Varicella, BCG, LAIV, OPV, Yellow Fever).

Status	Vaccines	Key Points
Contraindicated	MMR, Varicella, BCG, Live Influenza (LAIV), OPV (Sabin), Yellow Fever	Live vaccines: Risk to fetus
Recommended	Tdap, Inactivated Influenza (IIV)	Tdap: 27-36 wks each pregnancy; IIV: any trimester, protects mother & newborn
Special Circumstances	Hepatitis B, Rabies	High-risk exposure; Post-exposure prophylaxis (PEP) for Rabies

⭐ Tdap vaccine is recommended during each pregnancy (27-36 weeks), irrespective of prior vaccination.

Immunocompromised Hosts - Guarding the Vulnerable

General Principle: ⚠️ AVOID LIVE VACCINES. Prefer killed, subunit, toxoid, recombinant vaccines.
HIV Infection:
- CD4 count guides.
- MMR, Varicella if CD4 > 200 cells/µL (no AIDS illness).
- Avoid: BCG, OPV, Yellow Fever, live typhoid.
Post-Transplant (Solid Organ/HSCT):
- Inactivated: 3-6 months post-transplant.
- Live: Delayed (≥24 months post-HSCT, off immunosuppression, no GVHD).
Asplenia:
- Risk: Encapsulated bacteria.
- 📌 SHiN vaccines: S. pneumoniae, H. influenzae b, N. meningitidis.
- ⭐ > Patients with asplenia should receive pneumococcal, meningococcal, and Hib vaccines, preferably 2 weeks before elective splenectomy or as soon as possible after.
Chronic Steroids/DMARDs:
- High-dose steroids (Prednisone ≥20mg/d ≥14d)/DMARDs: AVOID LIVE VACCINES.
- Vaccinate pre-therapy if possible.

Extremes of Age & Others - Cradle to Cane Care

Preterm Infants (<37 wks):
- Chronological age; full doses.
- BCG: Defer <2kg (or <2.5kg).
- Hep B (<2kg BW):
  - Mom HBsAg (+): Vaccine+HBIG at birth (1st dose).
  - Mom HBsAg (-): 1st dose @ 1mo/discharge/>2kg.
  - Mom HBsAg (?): Vaccine at birth (+HBIG). Test mom.
⭐ Preterms: full doses by chronological age. BCG deferred <2kg-2.5kg. Hep B (<2kg): if mom HBsAg (+), vaccine+HBIG at birth; if (-), 1st dose >2kg/1mo.
Elderly (≥65 years):
- Influenza: Annual.
- Pneumococcal: PCV13 then PPSV23 (1 yr apart; 8 wks if IC).
- Zoster: Recombinant preferred.
Chronic Diseases (Key Vaccines):
- Diabetes: Influenza, Pneumococcal, Hep B (19-59y; consider ≥60y).
- CKD: High-dose Hep B, Pneumococcal, Influenza.
- CLD: Hep A, Hep B, Pneumococcal, Influenza.

High‑Yield Points - ⚡ Biggest Takeaways

Pregnant women: Avoid live vaccines (MMR, Varicella). Give Tdap at 27-36 weeks.

Immunocompromised: Avoid live vaccines. CD4 count critical in HIV (MMR if CD4 >200).

Asplenia: Vaccinate against Pneumococcal, Meningococcal, Hib. Give pre-splenectomy or ASAP post-op.

Premature infants: Use chronological age, not corrected; full doses.

HIV-infected children: Avoid BCG if symptomatic. MMR/Varicella if CD4% ≥15%.

High-dose steroids (>20mg/day >14 days): Live vaccines: wait 1 month post-therapy.

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Vaccination in Special Populations