APHA Contraindications & Precautions 3 — Questions and Answers
Question 1: A 2-year-old with a history of intussusception at age 8 months presents for routine vaccination. Which vaccine carries a contraindication related to this history?
- DTaP
- Rotavirus vaccine (Correct answer)
- PCV15
- Hepatitis A vaccine
Correct answer: Rotavirus vaccine
Rotavirus vaccine is contraindicated in children with a history of intussusception due to the association between the condition and the vaccine.
Question 2: Which of the following correctly differentiates a contraindication from a precaution?
- A contraindication increases the vaccine's efficacy, while a precaution decreases it
- A contraindication means the vaccine should generally never be given; a precaution means carefully weigh risks and benefits (Correct answer)
- A contraindication applies only to live vaccines; a precaution applies only to inactivated vaccines
- A precaution is permanent, while a contraindication may be temporary
Correct answer: A contraindication means the vaccine should generally never be given; a precaution means carefully weigh risks and benefits
A contraindication indicates that a vaccine should not be administered, while a precaution signals a condition that might increase risk or reduce efficacy, requiring individualized clinical judgment.
Question 3: A 35-year-old pregnant woman is in her first trimester. Which vaccine is ABSOLUTELY contraindicated during pregnancy?
- Inactivated influenza vaccine
- Tdap vaccine
- Varicella vaccine (Correct answer)
- Hepatitis B vaccine
Correct answer: Varicella vaccine
Varicella vaccine is a live attenuated vaccine and is absolutely contraindicated during pregnancy due to potential fetal harm.
Question 4: A patient who received IVIG 3 months ago needs MMR vaccination. What should the provider do?
- Administer MMR immediately since 3 months is sufficient
- Defer MMR based on the dose of IVIG received, following ACIP's recommended intervals (Correct answer)
- Administer varicella instead of MMR to avoid the interaction
- No deferral is needed because IVIG only affects inactivated vaccines
Correct answer: Defer MMR based on the dose of IVIG received, following ACIP's recommended intervals
The required interval after IVIG before giving MMR depends on the IVIG dose, ranging from 3 to 11 months per ACIP guidelines.
Question 5: Which of the following is NOT a valid contraindication to DTaP vaccination?
- Encephalopathy within 7 days of a prior DTaP dose
- Anaphylaxis after a prior DTaP dose
- Temperature of 40.5°C (105°F) within 48 hours of a prior DTaP dose (Correct answer)
- Anaphylaxis to a vaccine component
Correct answer: Temperature of 40.5°C (105°F) within 48 hours of a prior DTaP dose
Temperature of ≥40.5°C within 48 hours of a prior DTaP dose is classified as a precaution, not a contraindication, for subsequent doses.
Question 6: A patient with well-controlled HIV and a CD4 count of 350 cells/mm³ needs vaccination. Which statement about MMR is correct?
- MMR is contraindicated for all HIV-positive individuals
- MMR may be given to HIV-positive persons who are not severely immunocompromised (CD4 ≥200 cells/mm³) (Correct answer)
- MMR can only be given if HIV viral load is undetectable
- MMR is contraindicated when CD4 count is below 500 cells/mm³
Correct answer: MMR may be given to HIV-positive persons who are not severely immunocompromised (CD4 ≥200 cells/mm³)
ACIP recommends MMR for HIV-infected persons who are not severely immunocompromised, defined as CD4 count ≥200 cells/mm³ in adults.
Question 7: Which of the following is an example of an INVALID contraindication often cited incorrectly?
- Anaphylaxis to a previous dose of the same vaccine
- Current mild illness without fever (Correct answer)
- Pregnancy (for live vaccines)
- Severe combined immunodeficiency (SCID)
Correct answer: Current mild illness without fever
Mild illness without fever is NOT a valid contraindication; vaccines may be safely administered to persons with minor illnesses.
APHA Contraindications & Precautions 3
A 2-year-old with a history of intussusception at age 8 months presents for routine vaccination.
Which vaccine carries a contraindication related to this history?