A 4 -year-old child who has been receiving high-dose systemic glucocorticoids for several months comes to a clinic for school immunizations, which usually include the DTaP vaccine;
varicella virus vaccine (Varivax); the measles, mumps, and rubella virus (MMR) vaccine; and the inactivated poliovirus vaccine (IPV). The clinic nurse will expect to administer which vaccines to this child?
a. All four school immunizations
b. DTaP and IPV only
c. DTaP, OPV, and Varivax only
d. DTaP and IPV, along with immunoglobulins
ANS: B
Children who are immunocompromised should not receive live virus vaccines, including the MMR vaccine and Varivax. Children taking high-dose systemic glucocorticoids are immunocompromised and should not receive the vaccine until therapy is stopped and normal glucocorticoid production returns. The oral polio vaccine (OPV) contains live virus and is contraindicated. Immunoglobulins are not indicated unless children are exposed to the diseases themselves.
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