Vaccine hesitancy approaches US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Vaccine hesitancy approaches. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Vaccine hesitancy approaches US Medical PG Question 1: An 11-year-old boy is brought to his pediatrician by his parents for the routine Tdap immunization booster dose that is given during adolescence. Upon reviewing the patient’s medical records, the pediatrician notes that he was immunized according to CDC recommendations, with the exception that he received a catch-up Tdap immunization at the age of 8 years. When the pediatrician asks the boy’s parents about this delay, they inform the doctor that they immigrated to this country 3 years ago from Southeast Asia, where the child had not been immunized against diphtheria, tetanus, and pertussis. Therefore, he received a catch-up series at 8 years of age, which included the first dose of the Tdap vaccine. Which of the following options should the pediatrician choose to continue the boy’s immunization schedule?
- A. A single dose of Td vaccine at 18 years of age
- B. A single dose of Td vaccine now
- C. No further vaccination needed
- D. A single dose of Tdap vaccine now
- E. A single dose of Tdap vaccine at 13 years of age (Correct Answer)
Vaccine hesitancy approaches Explanation: ***A single dose of Tdap vaccine at 13 years of age***
- The CDC recommends a **minimum interval of 5 years** between Tdap doses when Tdap is given as part of a catch-up series.
- Since this patient received his first Tdap at age 8, the earliest he should receive the adolescent booster is at **age 13** (5 years later).
- This timing ensures adequate spacing while still providing the recommended adolescent booster for **pertussis, tetanus, and diphtheria** protection.
- The 5-year interval prevents excessive antigen exposure and optimizes immune response.
*A single dose of Tdap vaccine now*
- Giving Tdap now would result in only a **3-year interval** from the previous Tdap dose at age 8.
- This violates the CDC recommendation of a **minimum 5-year interval** between Tdap doses.
- Shorter intervals may increase local reactogenicity without improving protection.
*A single dose of Td vaccine now*
- While this would provide tetanus and diphtheria protection, it would **not protect against pertussis**, which is a critical component of adolescent vaccination.
- The Tdap vaccine is specifically recommended for adolescents to boost waning pertussis immunity.
- Additionally, giving it now would still be earlier than the recommended 5-year interval from the previous pertussis-containing vaccine.
*A single dose of Td vaccine at 18 years of age*
- This option would result in a **10-year gap** from the last pertussis-containing vaccine, leaving the adolescent vulnerable during high-risk years.
- The adolescent Tdap booster is specifically timed for ages 11-13 to protect during peak transmission periods in middle and high school.
- Waiting until 18 would miss the critical window for pertussis protection.
*No further vaccination needed*
- While the patient completed a catch-up series, the CDC still recommends an **adolescent Tdap booster** even for those who received Tdap in a catch-up series.
- The adolescent booster is important to maintain immunity against pertussis, which wanes significantly over time.
- The booster should be given at age 13 to maintain the 5-year minimum interval.
Vaccine hesitancy approaches US Medical PG Question 2: A 12-month-old girl is brought to her pediatrician for a checkup and vaccines. The patient’s mother wants to send her to daycare but is worried about exposure to unvaccinated children and other potential sources of infection. The toddler was born at 39 weeks gestation via spontaneous vaginal delivery. She is up to date on all vaccines. She does not walk yet but stands in place and can say a few words. The toddler drinks formula and eats a mixture of soft vegetables and pureed meals. She has no current medications. On physical exam, the vital signs include: temperature 37.0°C (98.6°F), blood pressure 95/50 mm Hg, pulse 130/min, and respiratory rate 28/min. The patient is alert and responsive. The remainder of the exam is unremarkable. Which of the following is most appropriate for this patient at this visit?
- A. Meningococcal vaccine
- B. Gross motor workup and evaluation
- C. Rotavirus vaccine
- D. Referral for speech pathology
- E. MMR vaccine (Correct Answer)
Vaccine hesitancy approaches Explanation: ***MMR vaccine***
- The **measles, mumps, and rubella (MMR) vaccine** is recommended for administration at **12-15 months of age**.
- This timing offers protection against these common childhood diseases, which is especially important for children attending **daycare**.
*Meningococcal vaccine*
- The routine **meningococcal vaccine (MenACWY)** is typically recommended for adolescents at **11-12 years of age**, with a booster at 16 years.
- While there are specific circumstances for earlier vaccination (e.g., high-risk conditions), it is **not routine** for a 12-month-old.
*Gross motor workup and evaluation*
- The patient's motor development, standing in place but not yet walking, is **within the normal range** for a 12-month-old.
- A definitive **gross motor workup** would generally be considered if there were more significant delays or regressions.
*Rotavirus vaccine*
- The **rotavirus vaccine** series is typically given at **2, 4, and 6 months of age**, with the final dose administered no later than **8 months of age**.
- A 12-month-old is **outside the recommended age range** for initiating or completing this vaccine series.
*Referral for speech pathology*
- Saying "a few words" at 12 months is **within the normal developmental milestone** for expressive language at this age.
- A referral for **speech pathology** would generally be indicated for more significant language delays.
Vaccine hesitancy approaches US Medical PG Question 3: A 7-year-old African-American boy presents to his physician with fatigue, bone and abdominal pain, and mild jaundice. The pain is dull and remitting, and the patient complains it sometimes migrates from one extremity to another. His mother reports that his jaundice and pain have occurred periodically for the past 5 years. At the time of presentation, his vital signs are as follows: the blood pressure is 80/50 mm Hg, the heart rate is 87/min, the respiratory rate is 17/min, and the temperature is 36.5°C (97.7°F). On physical examination, the patient appears to be pale with mildly icteric sclera and mucous membranes. On auscultation, there is a soft systolic ejection murmur, and palpation reveals hepatosplenomegaly. His musculoskeletal examination shows no abnormalities. Laboratory investigations show the following results:
Complete blood count
Erythrocytes
3.7 x 106/mm3
Hgb
11 g/dL
Total leukocyte count
Neutrophils
Lymphocytes
Eosinophils
Monocytes
Basophils
7,300/mm3
51%
40%
2%
7%
0
Platelet count
151,000/mm3
Chemistry
Total bilirubin
3.1 mg/dL (53 µmol/L)
Direct bilirubin
0.5 mg/dL (8.55 µmol/L)
A peripheral blood smear shows numerous sickle-shaped red blood cells. Among other questions, the patient’s mother asks you how his condition would influence his vaccination schedule. Which of the following statements is true regarding vaccination in this patient?
- A. The patient’s condition does not affect his chances to get any infection; thus, additional vaccinations are not advised.
- B. The patient should not receive meningococcal, pneumococcal, or Haemophilus influenzae vaccines, because they are likely to cause complications or elicit disease in his case.
- C. The patient should receive the pneumococcal polysaccharide vaccine as soon as possible, because he is at higher risk of getting pneumococcal infection than other children.
- D. The patient should receive serogroup B meningococcal vaccination at the age of 10 years. (Correct Answer)
- E. The patient should receive serogroup B meningococcal vaccination as soon as possible, because he is at higher risk of getting meningococcal infection than other children.
Vaccine hesitancy approaches Explanation: ***The patient should receive serogroup B meningococcal vaccination at the age of 10 years.***
- Patients with **sickle cell disease** (SCD) have **functional asplenia**, increasing their risk for invasive meningococcal disease from encapsulated bacteria.
- The **MenACWY vaccine** should be given starting at age 2 months for high-risk children with asplenia, with boosters every 5 years.
- The **MenB vaccine series** is recommended specifically for individuals **10 years and older** with anatomic or functional asplenia, including SCD patients.
- This statement correctly identifies the age-appropriate timing for MenB vaccination according to **ACIP guidelines**.
*The patient should receive serogroup B meningococcal vaccination as soon as possible, because he is at higher risk of getting meningococcal infection than other children.*
- While SCD patients are at increased risk for meningococcal infections, the **MenB vaccine is not recommended before age 10 years**, even in high-risk patients.
- At age 7, this patient should receive **MenACWY** if not already vaccinated, but MenB vaccination should wait until age 10.
- The timing "as soon as possible" is incorrect for MenB vaccine in this 7-year-old patient.
*The patient's condition does not affect his chances to get any infection; thus, additional vaccinations are not advised.*
- This is completely false. **Sickle cell disease causes functional asplenia**, which dramatically increases the risk of overwhelming sepsis from encapsulated organisms (*S. pneumoniae*, *N. meningitidis*, *H. influenzae* type b).
- Additional vaccinations beyond the routine schedule are **essential and life-saving** for SCD patients.
*The patient should not receive meningococcal, pneumococcal, or Haemophilus influenzae vaccines, because they are likely to cause complications or elicit disease in his case.*
- This is dangerously incorrect. These vaccines are **specifically recommended and safe** for patients with SCD.
- Patients with functional asplenia are at **highest risk** for invasive disease from these encapsulated bacteria, making vaccination crucial.
- These vaccines do not cause complications or elicit disease in SCD patients; they are inactivated or subunit vaccines.
*The patient should receive the pneumococcal polysaccharide vaccine as soon as possible, because he is at higher risk of getting pneumococcal infection than other children.*
- While SCD patients are at high risk for pneumococcal infection, the vaccination schedule is specific: **PCV13** in infancy, followed by **PPSV23** at age 2 years and older.
- At age 7, if not previously vaccinated, catch-up vaccination is needed, but "as soon as possible" without specifying the proper sequence (PCV13 first, then PPSV23) and "polysaccharide vaccine" alone is imprecise.
- The correct answer focuses on MenB at age 10, which is the most specific guideline-based recommendation among the options.
Vaccine hesitancy approaches US Medical PG Question 4: A 15-year-old female presents to her family physician for an annual school physical exam and check-up. She is accompanied by her mother to the visit and is present in the exam room. The patient has no complaints, and she does not have any past medical problems. She takes no medications. The patient reports that she remains active, exercising 5 times a week, and eats a healthy and varied diet. Which of the following would be the best way for the physician to obtain a more in-depth social history, including sexual history and use of alcohol, tobacco, or recreational drugs?
- A. Disallow the mother to be present in the examination room throughout the entirety of the visit
- B. Give the patient a social history questionnaire to fill out in the exam room
- C. Ask the mother to step outside into the hall for a portion of the visit (Correct Answer)
- D. Ask the patient the questions directly, with her mother still in the exam room
- E. Speak softly to the patient so that the mother does not hear and the patient is not embarrassed
Vaccine hesitancy approaches Explanation: ***Ask the mother to step outside into the hall for a portion of the visit***
- This approach allows the physician to speak with the adolescent **privately and confidentially**, which is crucial for obtaining sensitive information such as sexual history, drug use, and mental health concerns.
- Adolescents are more likely to disclose personal information when their parents are not present, fostering trust and ensuring **comprehensive history-taking** vital for their well-being.
*Disallow the mother to be present in the examination room throughout the entirety of the visit*
- This is an **overly restrictive** approach that might create tension or distrust between the physician, patient, and parent, especially at the start of the visit.
- While privacy is essential for sensitive topics, parental presence can be valuable for discussing general health, family history, and **treatment plans**, especially for younger adolescents.
*Give the patient a social history questionnaire to fill out in the exam room*
- While questionnaires can be useful for gathering basic information, they often **lack the nuance** of a direct conversation and may not prompt the patient to elaborate on sensitive issues.
- Furthermore, having the mother present while the patient fills out a questionnaire on sensitive topics still **compromises confidentiality** and may lead to incomplete or dishonest answers.
*Ask the patient the questions directly, with her mother still in the exam room*
- Asking sensitive questions with a parent present is **unlikely to yield truthful and complete answers**, as adolescents may feel embarrassed, judged, or fear parental disapproval.
- This approach compromises the **confidentiality** that is fundamental to building trust with adolescent patients.
*Speak softly to the patient so that the mother does not hear and the patient is not embarrassed*
- Speaking softly is **unprofessional** and still does not guarantee privacy, as the mother might still overhear parts of the conversation.
- This method also **fails to establish true confidentiality**, which is central to building rapport and encouraging open communication with adolescent patients about sensitive topics.
Vaccine hesitancy approaches US Medical PG Question 5: A vaccination campaign designed to increase the uptake of HPV vaccine was instituted in chosen counties of a certain state in order to educate parents not only about the disease itself, but also about why children should be vaccinated against this viral sexually transmitted disease. At the end of the campaign, children living in counties in which it was conducted were 3 times more likely to receive the HPV vaccine compared with children living in counties where no campaign was instituted. As well, after evaluating only the counties that were part of the vaccination campaign, the researchers found that families with higher incomes were 2 times more likely to vaccinate their children against HPV compared with families with lower incomes. What conclusion can be drawn from these results?
- A. Family income appears to be an effect modifier. (Correct Answer)
- B. The vaccination campaign appears to have been ineffective.
- C. The vaccination campaign is the study outcome.
- D. The vaccine uptake is the study exposure.
- E. Family income appears to be a confounder.
Vaccine hesitancy approaches Explanation: ***Family income appears to be an effect modifier.***
- An **effect modifier** occurs when the relationship between an exposure (vaccination campaign) and an outcome (vaccine uptake) differs across categories of a third variable (family income).
- Here, the campaign's effect on vaccine uptake is *different* depending on family income (higher-income families were still more likely to vaccinate even within campaign counties), indicating **effect modification**.
*The vaccination campaign appears to have been ineffective.*
- The campaign actually led to a **3-fold increase** in HPV vaccine uptake in campaign counties compared to non-campaign counties, demonstrating its effectiveness in increasing overall uptake.
- While income still played a role, the campaign itself achieved its primary goal of increasing vaccination rates where implemented.
*The vaccination campaign is the study outcome.*
- The **vaccination campaign** is the **exposure** or intervention being studied, as its impact on vaccination rates is being assessed.
- The **outcome** is the **HPV vaccine uptake** (i.e., whether children received the vaccine or not).
*The vaccine uptake is the study exposure.*
- **Vaccine uptake** is the **outcome** or the dependent variable that is being measured, to see if it changes in response to the campaign.
- The **exposure** is the **vaccination campaign** itself, or living in a county with a campaign.
*Family income appears to be a confounder.*
- A **confounder** is a variable that is associated with both the exposure and the outcome, and *distorts* the observed association between them.
- While family income is associated with vaccine uptake, its main role here is to show *how* the campaign's effect varied by income, not necessarily to create a spurious association between the campaign and uptake where none existed. If it were a confounder, it would need to be associated with both the campaign (which it isn't, as campaigns were in specific counties regardless of income distribution) and the outcome, and not be on the causal pathway.
Vaccine hesitancy approaches US Medical PG Question 6: You are a resident on a pediatric service entering orders late at night. Upon arrival the next morning, you note that you had mistakenly ordered that low molecular weight heparin be administered to a 17-year-old patient who does not need anti-coagulation. When you talk to her, she complains about the "shot" she had to get this morning but is otherwise well. How should you handle the situation?
- A. Since there was no lasting harm to the patient, it is not necessary to disclose the error
- B. Tell the patient and her parents about the error (Correct Answer)
- C. You cannot disclose the error as a resident due to hospital policy
- D. Tell the patient, but ask her not to tell her parents
- E. Speak to risk management before deciding whether or not to disclose the error
Vaccine hesitancy approaches Explanation: ***Tell the patient and her parents about the error***
- Full **disclosure of medical errors** is a fundamental ethical principle, even if no lasting harm occurred, because it promotes trust and transparency.
- As a **minor**, the patient's parents/guardians have the right to be informed about medical errors affecting their child's care and safety.
*Since there was no lasting harm to the patient, it is not necessary to disclose the error*
- This statement is incorrect because the **absence of harm** does not negate the ethical obligation to disclose a medical error; it is crucial for patient trust and learning from mistakes.
- Failing to disclose an error, even if harmless, can erode trust and is considered a breach of **professional integrity and transparency**.
*You cannot disclose the error as a resident due to hospital policy*
- While hospital policies may guide the process of disclosure (e.g., involving attending physicians or risk management), they do not prevent residents from participating in or initiating the disclosure of an error.
- The resident's role involves acknowledging the error and initiating the appropriate steps for disclosure, often in collaboration with their **supervising physician**.
*Tell the patient, but ask her not to tell her parents*
- This is unethical and legally problematic because, as a **minor**, the patient's parents or legal guardians have the right to be informed about significant medical events and errors related to their child's care.
- Asking the patient to withhold information from her parents undermines **parental rights** and creates an inappropriate and potentially harmful dynamic.
*Speak to risk management before deciding whether or not to disclose the error*
- While consulting **risk management** is an important step in the process of disclosing a medical error to ensure compliance and support, it should not be a prerequisite for the decision to disclose.
- The ethical imperative is to disclose the error; risk management primarily guides *how* to best disclose it, not *whether* to disclose it.
Vaccine hesitancy approaches US Medical PG Question 7: A 9-month-old boy is brought to a pediatrician by his parents for routine immunization. The parents say they have recently immigrated to the United States from a developing country, where the infant was receiving immunizations as per the national immunization schedule for that country. The pediatrician prepares a plan for the infant’s immunizations as per standard US guidelines. Looking at the plan, the parents ask why the infant needs to be vaccinated with injectable polio vaccine, as he had already received an oral polio vaccine back in their home country. The pediatrician explains to them that, as per the recommended immunization schedule for children and adolescents in the United States, it is important to complete the schedule of immunizations using the injectable polio vaccine (IPV). He also mentions that IPV is considered safer than OPV, and IPV has some distinct advantages over OPV. Which of the following statements best explains the advantage of IPV over OPV to which the pediatrician is referring?
- A. IPV is known to produce higher titers of mucosal IgG antibodies than OPV
- B. IPV is known to produce virus-specific CD4+ T cells that produce interleukins and interferons to control polio viruses
- C. IPV is known to produce higher titers of mucosal IgA antibodies than OPV
- D. IPV is known to produce higher titers of serum IgG antibodies than OPV (Correct Answer)
- E. IPV is known to produce virus-specific CD8+ T cells that directly kill polio-infected cells
Vaccine hesitancy approaches Explanation: ***IPV is known to produce higher titers of serum IgG antibodies than OPV***
- The **injectable polio vaccine (IPV)** is an **inactivated vaccine** that primarily induces a systemic immune response, leading to high levels of **serum IgG antibodies**. These antibodies are crucial for preventing **viremia** and subsequently protecting against paralytic poliomyelitis.
- While OPV (oral polio vaccine) induces both mucosal and humoral immunity, IPV's strength lies in its ability to generate robust systemic immunity without the risk of vaccine-associated paralytic polio (VAPP), a rare but serious complication of OPV.
*IPV is known to produce higher titers of mucosal IgG antibodies than OPV*
- IPV primarily stimulates **systemic immunity** rather than strong mucosal immunity, meaning it does not typically produce higher titers of mucosal IgG antibodies than OPV.
- Mucosal immunity, especially IgA, is better stimulated by vaccines administered orally, like **OPV**, as it directly interacts with the gut-associated lymphoid tissue.
*IPV is known to produce virus-specific CD4+ T cells that produce interleukins and interferons to control polio viruses*
- Both IPV and OPV can induce **CD4+ T cell responses**, but this statement does not highlight a distinct advantage of IPV over OPV.
- While CD4+ T cells are important for immune coordination and antibody production, the primary advantage of IPV is its **safety profile** and systemic antibody levels, not necessarily a superior CD4+ T cell response.
*IPV is known to produce higher titers of mucosal IgA antibodies than OPV*
- **OPV**, being an oral vaccine, is highly effective at inducing a strong **mucosal IgA response** in the gut, which is important for preventing viral shedding and transmission.
- **IPV**, administered parenterally, produces minimal to no mucosal IgA response, making this statement incorrect.
*IPV is known to produce virus-specific CD8+ T cells that directly kill polio-infected cells*
- **Cytotoxic CD8+ T cells** are primarily involved in clearing cells infected with intracellular pathogens.
- While both vaccines may induce some cellular immunity, their primary mechanism for protecting against polio is through **neutralizing antibodies**, and the induction of CD8+ T cells is not the principal advantage of IPV over OPV.
Vaccine hesitancy approaches US Medical PG Question 8: A 4-year-old boy is brought to the emergency department with difficulty breathing. His mother reports that he developed a fever last night and began to have trouble breathing this morning. The boy was born at 39 weeks gestation via spontaneous vaginal delivery. He is unvaccinated (conscientious objection by the family) and is meeting all developmental milestones. At the hospital, his vitals are temperature 39.8°C (103.6°F), pulse 122/min, respiration rate 33/min, blood pressure 110/66 mm Hg, and SpO2 93% on room air. On physical examination, he appears ill with his neck hyperextended and chin protruding. His voice is muffled and is drooling. The pediatrician explains that there is one particular bacteria that commonly causes these symptoms. At what age should the patient have first received vaccination to prevent this condition from this particular bacteria?
- A. At birth
- B. At 2-months-old (Correct Answer)
- C. Between 9- and 12-months-old
- D. At 6-months-old
- E. Between 12- and 15-months-old
Vaccine hesitancy approaches Explanation: ***At 2-months-old***
- The clinical presentation with **high fever**, **difficulty breathing**, **neck hyperextension**, **muffled voice**, and **drooling** in an unvaccinated child strongly suggests **epiglottitis**, likely caused by *Haemophilus influenzae type b* (Hib).
- The **Hib vaccine** is routinely given starting at **2 months of age** as part of the multi-dose primary series to protect against this life-threatening condition.
*At birth*
- While some vaccines like **Hepatitis B** are given at birth, the Hib vaccine is not typically administered at this age.
- Vaccinating at birth would not align with the standard immunization schedule for *Haemophilus influenzae type b*.
*Between 9- and 12-months-old*
- This age range typically corresponds to the **measles, mumps, and rubella (MMR)** and **varicella** vaccines, or a booster dose of other vaccines, not the initial primary series for Hib.
- Delaying the first Hib vaccination until this age would leave infants vulnerable during a critical period.
*At 6-months-old*
- By 6 months, a child should have already received at least **two doses** of the Hib vaccine if following the recommended schedule.
- Administering the first dose at 6 months would significantly delay protection against invasive Hib disease.
*Between 12- and 15-months-old*
- This age range is typically when the **final booster dose** of the Hib vaccine is given, not the initial vaccination.
- The primary series for Hib should have been completed much earlier to provide timely protection.
Vaccine hesitancy approaches US Medical PG Question 9: A 4-month-old boy is brought to the physician by his parents for a well-child examination. He has cystic fibrosis diagnosed by newborn screening. His parents report frequent feedings and large-volume and greasy stools. His 4-year-old brother has autism. Current medications include bronchodilators, pancreatic enzyme supplements, and fat-soluble vitamins. He is at the 18th percentile for height and 15th percentile for weight. Scattered wheezes are heard throughout both lung fields. Examination shows a distended and tympanic abdomen with no tenderness or guarding. Which of the following is a contraindication for administering one or more routine vaccinations?
- A. Allergy to egg protein
- B. History of cystic fibrosis
- C. History of febrile seizures
- D. Fever of 38.2°C (100.7°F) following previous vaccinations
- E. History of intussusception (Correct Answer)
Vaccine hesitancy approaches Explanation: ***History of intussusception***
- A history of **intussusception** is a **contraindication for rotavirus vaccine** administration, as the vaccine itself has a small risk of intussusception, particularly with the first dose.
- The rotavirus vaccine is part of routine childhood immunizations, so this would be a contraindication for one of the routine vaccines.
*Allergy to egg protein*
- Egg allergy is a contraindication primarily for yellow fever vaccine and some influenza vaccines, which are typically not routine vaccinations for a 4-month-old. Many flu vaccines are egg-free or can be safely administered to those with egg allergy under supervision.
- The MMR vaccine is generally safe for those with egg allergy since the amount of egg protein is negligible.
*History of cystic fibrosis*
- **Cystic fibrosis** itself is **not a contraindication** to routine vaccinations; in fact, patients with chronic conditions like CF are often *more* encouraged to receive vaccinations to prevent severe infections.
- The patient's symptoms (poor growth, greasy stools, wheezing) are manifestations of CF, not reasons to defer vaccination.
*History of febrile seizures*
- A history of **febrile seizures** is generally **not a contraindication** to routine vaccinations.
- Parents should be counseled on fever management after vaccination, but the risk of recurrent febrile seizures is not increased by vaccination to a level that warrants deferral.
*Fever of 38.2°C (100.7°F) following previous vaccinations*
- A **low-grade fever** after vaccination is a common and **expected immune response**, not a contraindication for future doses.
- Only a **severe allergic reaction** (e.g., anaphylaxis) to a previous dose of a vaccine or one of its components is a contraindication to subsequent doses of that specific vaccine.
Vaccine hesitancy approaches US Medical PG Question 10: An 8-year-old boy is brought to the physician because of a 7-day history of a progressively worsening cough. The cough occurs in spells and consists of around 5–10 coughs in succession. After each spell he takes a deep, noisy breath. He has vomited occasionally following a bout of coughing. He had a runny nose for a week before the cough started. His immunization records are unavailable. He lives in an apartment with his father, mother, and his 2-week-old sister. The mother was given a Tdap vaccination 11 years ago. The father's vaccination records are unavailable. His temperature is 37.8°C (100.0°F). Examination shows no abnormalities. His leukocyte count is 42,000/mm3. Throat swab culture and PCR results are pending. Which of the following are the most appropriate recommendations for this family?
- A. Administer oral azithromycin to the baby and father and Tdap vaccination to the father
- B. Administer oral azithromycin to all family members and Tdap vaccination to the father and mother (Correct Answer)
- C. Administer oral azithromycin to all family members and Tdap vaccination to the father
- D. Administer oral erythromycin to all family members and Tdap vaccination to the father
- E. Administer oral trimethoprim-sulfamethoxazole to the father and baby and Tdap vaccination to the father
Vaccine hesitancy approaches Explanation: ***Administer oral azithromycin to all family members and Tdap vaccination to the father and mother***
- The 8-year-old boy presents with classic symptoms of **pertussis** (whooping cough), including **paroxysmal cough**, post-tussive emesis, and a preceding catarrhal phase (runny nose). The high **leukocyte count** further supports this diagnosis. Given his exposure, the 2-week-old sister is at high risk of severe sequelae.
- **Prophylactic antibiotics** (e.g., azithromycin) are indicated for all close contacts, especially infants and pregnant women, to prevent the spread of *Bordetella pertussis*. Tdap vaccination is recommended for the father (whose vaccination status is unknown) and the mother, as her last Tdap was 11 years ago, and there is a high-risk infant in the household.
*Administer oral azithromycin to the baby and father and Tdap vaccination to the father*
- This option misses administering **prophylactic antibiotics** to the mother and **Tdap vaccination** to the mother, both of whom are close contacts and have a high-risk infant in the household.
- The mother's Tdap vaccination from 11 years ago may no longer provide sufficient protection, especially with a neonate in the home.
*Administer oral azithromycin to all family members and Tdap vaccination to the father*
- While this option correctly suggests prophylactic antibiotics for all family members, it incorrectly omits **Tdap vaccination for the mother**, whose last vaccination was 11 years ago.
- Updating the mother's Tdap vaccination status is crucial, especially in a household with a 2-week-old infant.
*Administer oral erythromycin to all family members and Tdap vaccination to the father*
- **Erythromycin** is an alternative macrolide for pertussis treatment/prophylaxis, but **azithromycin** is preferred due to a shorter course and better tolerability, especially in infants.
- This option also incorrectly omits **Tdap vaccination for the mother**.
*Administer oral trimethoprim-sulfamethoxazole to the father and baby and Tdap vaccination to the father*
- **Trimethoprim-sulfamethoxazole** is a less preferred antibiotic for pertussis prophylaxis/treatment and is generally reserved for patients who cannot tolerate macrolides.
- This option incorrectly limits antibiotic prophylaxis to only the father and baby, excluding the mother and the 8-year-old boy, and also omits **Tdap vaccination for the mother**.
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