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Immunization Encounter 2013 Case Studies

These two case studies are covered in the "Immunization Encounter: Critical Issues 2013" education course.

Case Study 1: Emily

Emily is 18 years old and has been in your practice since birth. She is in your facility in May for a routine health visit and vaccinations. She was recently accepted to the state university and will be living in a dormitory when she starts her freshman year in the fall.

Vaccination history:

The immunization registry indicates that Emily completed her childhood vaccines at age 5 years. The only adolescent vaccines she has received are 2 doses of HPV vaccine. Her second dose was administered 1 year ago. She is currently healthy and has no chronic medical conditions.

Emily reports she experienced a syncopal, or fainting, episode after receiving her second dose of HPV vaccine. She was evaluated in the Emergency Department, recovered and discharged without need for treatment.

Your office stocks all routine childhood vaccines as well as T-dap and meningococcal conjugate vaccine. Your plan for today is to administer the last dose of the HPV series and catch up Emily with the other adolescent vaccines, MCV4 and T-dap.

If you are viewing this program with a group we suggest you pause the program now and discuss it among yourselves. We will return in a moment to discuss it with you.

Questions:

Should a pregnancy test be done prior to administering HPV vaccine?

Is Emily’s previous history of syncope a contraindication to the vaccines she needs today?

Should HPV vaccine be administered first as a pain management strategy?

Answers to the case study will be discussed during the Immunization Encounters program.

February 2013

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Case Study 2: Jason

Jason is a 9 month old who is new to your practice. He is in your facility in November for a routine health visit and vaccinations.

Vaccine history:

The immunization history in the registry shows that he received hepatitis B vaccine at birth. At 4 months of age he received DTAP, IPV and Hib vaccines. He has not received any additional vaccines since then.

His mother reports he was a full-term baby and there were no problems at delivery. Jason is currently healthy and has no chronic medical conditions.

You plan to administer DTaP, IPV, Hep B, Hib, PCV13 and influenza vaccines at this visit. To decrease the number of injections, you want to use a combination vaccine. You have all the routinely recommended pediatric vaccines in your inventory. This particular facility stocks Pentacel- a combination vaccine that includes DTAP, IPV and Hib.

Questions:

Can you use a combination vaccine to catch up Jason since he is behind schedule for several vaccines?

Can you switch from individual vaccines to a combination vaccine?

How should combination vaccines be documented?

Answers to the case study will be discussed during the Immunization Encounters program.

February 2013

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