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Highlight doc Day 3 - imm
#ir #peds
  1. 2DTaP-IPV-HibPneu-C-13Rot-1
    15 Var
    4-6Tdap-IPV MMRV
    Gr 7Men-C-ACYWHPV-4HB
    Yr Infl
    Live (MMR + V)àSC
    Td q10y >24, Pneu q5y, shingles >65
    1. IMMUNIZATIONS (know Ontario immunization schedule)
      1. All IM excl MMR & V (SC) & Rota (oral)
  • “Do vaccines cause ASD?” How do you advise the parents? Discuss
    how you would calm mom's fear of autism in a child receiving MMR.
  • Understand concern: worries, understanding of dz risks &
Vaccine benefits & risks, validate why may have belief
  • if concerned re: ASD, discuss how original info was fraud &
no evidence to support link; give anecdotes of children
affected by vaccine-preventable dz’s
  • stick to msg: vaccines are safe & effective & serious dz can
be prevented w/ imm
  • vaccine benefits & risks, herd protection not 100% (tetanus from soil), ‘wait and see’ not good b/c many need mult doses & take time to protect
  • vaccine safety system: held to higher safety standard than drugs, usually approved in Canada after use in other countries
  • address pain assc w/ imm
  • don’t dismiss from practice if parents refuse: majority of parents accept when concerns addressed
  • Adverse reaction of MMR vaccine? (give 3)
  • MMR: measles rash (7-14d), ITP, parotitis, febrile seizure
    • Local: induration, tenderness, redness, swelling
    • Allergic: urticaria, rhinitis, anaphylaxis
    • Systemic: ↑T, rash, irritability, lymphadenopathy, arthr/myalgia, arthritis
    • CIs: moderate/severe illness ± fever (not mild URTI), component allergy
  • During a 6mo ♀ wellness visit, which diseases is the child being inoculated against (3 marks; there are five diseases, which opens up the possibility that I am wrong)? Name the AEs of such a vaccine (3 marks).
  • Diphtheria, tetanus, pertussis (whooping cough), polio, Haemophilus influenzae type B (Hib)
  • AEs: serious s/e rare. Mild pain, swelling, redness x few days at site. Some get fever/rash/lose appetite/fussy/drowsy x1-2d after shot (acetaminophen to prevent pain & fever).
  • Mother being counselled about HPV vaccine. Which of the following are correct?
  • protects against genital warts T (not 100%)
  • HPV causes cervical and anal cancer T (HPV 16,18)
  • most of us will get the infection and clear it on our own F (10% incidence)
  • injection at 0, 2, 6 months T (0, 1-2, 6)
  • side effects are common F
  • protects against four high-risk subtypes F (not HPV 6,11)
  • doesn’t require yearly paps T (q3y)
  • average time from acquiring high-risk genotype to cancer is 30-40 y F (15y)
  • Which vaccination should an 11yo ♀ get before leaving for summer school?
  • I answered DTaP booster. Hepatitis B, and meningococcal C
  • 15mo well-baby visit: which vaccinations/route? Anticipatory guidance on safety (3 marks)
  • Varicella SC
  • Anticipatory guidance: 1) tantrums 2) nutrition 3) dentition 4) safety 5) language
  • What are the immunizations necessary for a 7yo ♂ not from Canada?
  • Depends on his immunization and country of origin/exposure Hx
    DTap-IPV x 5, Hib x 4, Pneu-C-13 x 3, Men-C, MMR x 2, V x 2
  • Just give everything he’s missed till now?
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