A 40-year-old pregnant woman, G4 P3, visits your office at week 30 of gestation. She is very excited about her pregnancy and wants to be the healthiest she can be in preparation for labor and for her baby. What vaccination should she receive at this visit?

Tetanus, diphtheria, and acellular pertussis (Tdap)

Measles, mumps, and rubella (MMR)

Live attenuated influenza vaccine

A 2-year-old boy is brought in by his parents to his pediatrician. The boy was born by spontaneous vaginal delivery at 39 weeks and 5 days after a normal pregnancy. The boy has received all age-appropriate vaccinations as of his last visit at 18 months of age. Of note, the boy has confirmed sickle cell disease and the only medication he takes is penicillin prophylaxis. The parents state that they plan on enrolling their son in a daycare, which requires documentation of up-to-date vaccinations. The pediatrician states that their son needs an additional vaccination at this visit, which is a polysaccharide vaccine that is not conjugated to protein. Which of the following matches this description?

Live attenuated influenza vaccine

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?

IPV is known to produce higher titers of serum IgG antibodies than OPV

IPV is known to produce higher titers of mucosal IgG antibodies than OPV

IPV is known to produce virus-specific CD4+ T cells that produce interleukins and interferons to control polio viruses

IPV is known to produce higher titers of mucosal IgA antibodies than OPV

IPV is known to produce virus-specific CD8+ T cells that directly kill polio-infected cells

An 18-year-old woman presents for a routine check-up. She is a college student with no complaints. She has a 2 pack-year history of smoking and consumes alcohol occasionally. Her sexual debut was at 15 years of age and has had 2 sexual partners. She takes oral contraceptives and uses barrier contraception. Her family history is significant for cervical cancer in her aunt. Which of the following statements regarding cervical cancer screening in this patient is correct?

The patient should undergo screening every 3 years after she turns 21 years of age.

The patient requires annual Pap testing due to her family history of cervical cancer.

HPV testing is more preferable than Pap testing in sexually active women under 21 years of age.

It is reasonable to start Pap-test screening at the current visit and repeat it every 3 years.

The patient does not require Pap testing as long as she uses barrier contraception.

A 7-month-old boy presents to the emergency room with three episodes of vomiting and severe abdominal pain that comes and goes for the past two hours. The patient's most recent vomit in the hospital appears bilious, and the patient had one stool that appears bloody and full of mucous. The mother explains that one stool at home appears to be "jelly-like." On physical exam, a palpable mass is felt in the right lower quadrant of the abdomen. What is the next best diagnostic test for this patient?

Kidney, ureter, bladder radiograph

Complete blood count with differential

New and emerging vaccines for USMLE Step 2 CK: High-Yield Pediatrics Lessons

Pneumococcal Vaccine - Lungs' Little Shield

PCV15 vaccine recommendations for children

Two main types: Pneumococcal Conjugate (PCV) and Polysaccharide (PPSV23) vaccines.
PCV (T-cell dependent):
- Generates robust immune memory & provides herd immunity.
- Effective in infants <2 years old.
- Variants: PCV10, PCV13, PCV15.
PPSV23 (T-cell independent):
- For high-risk individuals >2 years old and the elderly.
- Wider serotype coverage but no immunologic memory.

⭐ NIS Schedule: PCV was introduced in 2017. The universal schedule is 2 primary doses (6, 14 weeks) + 1 booster (9 months).

Rotavirus Vaccine - Gut Guard Gala

Oral rotavirus vaccine administration to an infant

Type: Live attenuated, oral vaccine.
NIS Schedule: 6, 10, & 14 weeks. Cannot be initiated after 1 year of age.
Products & Doses:
- - Rotavac (116E): 5 drops
- - Rotasiil (Pentavalent): 2.5 mL
- - RotaTeq (Pentavalent): 2 mL
⚠️ Key Contraindication: History of intussusception.

⭐ Vaccine-associated intussusception risk is highest within 7 days post-1st dose, though the absolute risk remains very low.

JE Vaccine - Brain Fever Blockade

Type: Live Attenuated Vaccine (LAV), using the SA 14-14-2 strain in India's Universal Immunization Programme (UIP).
Dose & Route: 0.5 mL, Subcutaneous (SC), typically over the left upper arm.
Schedule (UIP):
- 1st Dose: At 9 completed months.
- 2nd Dose: At 16-24 months.

⭐ The JE vaccine can be co-administered with the Measles-Rubella (MR) vaccine at 9 months, but must be given using separate syringes at different anatomical sites.

HPV Vaccine - Cervix Sentinel Saga

Mechanism: Virus-Like Particle (VLP) vaccines; non-infectious and non-oncogenic.
Types & Coverage:
- Bivalent (Cervarix): HPV 16, 18.
- Quadrivalent (Gardasil, CERVAVAC): HPV 6, 11, 16, 18.
- Nonavalent (Gardasil-9): Adds 31, 33, 45, 52, 58.
Schedule (IAP 2024):
- 9-14 years: 2 doses (0, 6 months).
- ≥15 years / Immunocompromised: 3 doses (0, 1-2, 6 months).

⭐ Recommended for both girls and boys. Primarily prevents cervical cancer, but also vaginal, vulvar, anal, and oropharyngeal cancers.

Future Vaccines - Tomorrow's Tiny Troopers

Malaria: RTS,S/AS01 & the more effective R21/Matrix-M vaccine.
Dengue: New tetravalent vaccines (e.g., Qdenga) targeting all serotypes.
Chikungunya: Single-dose live-attenuated vaccines in late-stage development.
RSV: Maternal vaccines and long-acting monoclonal antibodies (Nirsevimab) for infant protection.
Platform Tech: mRNA vaccines being developed for influenza, Zika, and cancer.

⭐ The R21/Matrix-M malaria vaccine (developed by Oxford-SII) is the first to meet the WHO's 75% efficacy goal.

High‑Yield Points - ⚡ Biggest Takeaways

Dengvaxia (Dengue vaccine) is a live attenuated tetravalent vaccine, recommended only for seropositive individuals aged 9-45 years due to risk of severe disease in seronegatives.

RTS,S/AS01 (Mosquirix) is the first recombinant protein malaria vaccine; the newer R21/Matrix-M shows higher efficacy.

HPV nonavalent vaccine protects against 9 serotypes, offering broader coverage than the quadrivalent vaccine.

Typhoid Conjugate Vaccine (TCV) is immunogenic from 6 months of age, a key advantage.

PCV-13 is now part of the National Immunization Schedule, protecting against 13 pneumococcal serotypes.

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