Hurry up!
: : Get The Offer
Unlimited Access Step ( one, two and three ).
Priority Access To New Features.
Free Lifetime Updates Facility.
Dedicated Support.
1
Question:

An 18-year-old man seeks travel advice before going to central Africa.  He was diagnosed with Crohn disease 3 years ago but currently feels well and has been asymptomatic on azathioprine and adalimumab for the last year.  A review of medical records shows documentation of meningococcal polysaccharide conjugate vaccine at age 11.  The patient has had no vaccines since then but received all the recommended childhood vaccinations prior to that.  His vital signs and physical examination are normal.  Which of the following vaccines is recommended for this patient?

Hurry up!
: : Get The Offer
Unlimited Access Step ( one, two and three ).
Priority Access To New Features.
Free Lifetime Updates Facility.
Dedicated Support.


Explanation:

There are many explanatory sources, such as pictures, videos, and audio clips to explain these explanations and questions and explain the answers, but you must subscribe first so that you can enjoy all these advantages. We have many subscription plans at the lowest prices. Don't miss today's offer. Subscribe

Meningococcal vaccination

Routine schedule

  • Age 11-12: primary vaccination
  • Age 16: booster

High-risk patients

(vaccinate if age ≥2 months)

  • Complement deficiency
  • Asplenia
  • College students in residential housing (age ≤21)
  • Military recruits
  • Travel to endemic area
  • Exposure to community outbreaks

Neisseria meningitidis meningitis is a rapidly progressive and potentially fatal infection with incidence that has significantly declined since the introduction of meningococcal vaccine (MCV).  The quadrivalent (serotypes A, C, Y, W135) conjugate MCV is recommended for all adolescents at age 11-12.  A booster dose should be given at age 16 due to waning immunity and increased risk of N meningitidis meningitis in older teenagers and young adults.  In addition, vaccination against N meningitidis serotype B should be considered for adolescents age 16-18.

MCV is also recommended prior to travel to an endemic region, such as most of sub-Saharan Africa and the Muslim hajj pilgrimage to Mecca, Saudi Arabia.  In addition, young adults in large groups who live in close quarters (eg, military recruits, college students in dormitories) should be immunized due to increased risk of infection.  Finally, vaccination should be provided to those with complement deficiency or functional or anatomic asplenia due to increased risk of infection by encapsulated organisms, including N meningitidis.

This patient did not receive MCV at age 16 and has upcoming travel to central Africa; a booster dose of MCV is recommended.  He should also be offered the intramuscular, inactivated typhoid vaccine due to risk of transmission via contaminated food and water in central Africa.  In addition, the patient should receive the inactivated influenza vaccination annually.

(Choices A, B, D, and E)  Intranasal influenza; measles, mumps, and rubella; oral typhoid; and varicella vaccines are live-attenuated vaccines.  Live vaccines have a potential to cause disseminated disease in those who are immunocompromised (eg, severe combined immunodeficiency) or immunosuppressed, such as this patient who is receiving tumor necrosis factor antagonists (eg, adalimumab), and should be avoided.

Educational objective:
Meningococcal vaccine is recommended for adolescents age 11-12 with a booster at age 16.  Additional indications include those with complement deficiency or asplenia, college students living in dormitories, and travelers to endemic regions.  Live-attenuated vaccines should be avoided in patients receiving immunosuppressants (eg, tumor necrosis factor antagonists).