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Certification Review for the Ortho PA

Beck, David MPAS, PA‐C

JBJS Journal of Orthopaedics for Physician Assistants: Fall 2016 - Volume 4 - Issue 4 - p 14
doi: 10.2106/JBJS.JOPA.16.00021
Articles

1University of Pittsburgh Physician Assistant Studies Program, Pittsburgh, Pennsylvania

Disclosure: The author indicated that no external funding was received for any aspect of this work.

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Question

A 4‐month‐old girl who was born in Tennessee and has no noteworthy medical history or history of foreign travel is brought to your clinic for a well‐child visit while you are moonlighting at a local pediatrics office in the United States. Upon review of the patient's immunization history, you note the following:

* At birth: monovalent hepatitis B vaccine

* At age 5 weeks: monovalent hepatitis B vaccine

* At age 10 weeks: rotavirus vaccine, live, oral, pentavalent (RV5); diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine; Haemophilus influenzae type b (Hib) conjugate vaccine; pneumococcal conjugate vaccine (PCV13)

Which of the following is an appropriate vaccination plan for today's visit?

A. Administer the first dose of inactivated poliovirus vaccine

B. Administer the third dose of monovalent hepatitis B vaccine

C. Administer the final dose of rotavirus vaccine, live, oral, pentavalent (RV5)

D. Do not administer the next dose of diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine because the patient is younger than 24 weeks of age

E. Administer the first dose of inactivated hepatitis A vaccine

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Discussion

According to the “Recommended Immunization Schedules for Persons Aged 0 Through 18 Years—United States, 2016,” this patient has received all immunizations on schedule, with the exception of not receiving the first dose of the inactivated poliovirus vaccine at 2 months of age. The appropriate action is to administer this first dose today. Future doses are to be administered according to the following schedule: the second dose is due in 4 weeks, the third dose is due in 8 weeks, and the fourth (and final) dose should be administered at least 6 months from now and when the patient is at least 4 years of age.

The third dose of monovalent hepatitis B vaccine is due at a minimum age of 24 weeks. This dose cannot be given until 8 weeks after the second dose, and at least 16 weeks after the first dose.

The rotavirus vaccination options include either rotavirus vaccine, live, oral (RV1) or rotavirus vaccine, live, oral, pentavalent (RV5). According to the patient's vaccination history with the RV5 vaccine, the most appropriate next step is to administer the second dose today and administer the third and final dose at 6 months of age. (The RV1 vaccine is given in a 2‐dose series at 2 and 4 months of age.)

Administration of the second dose of diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine is indicated today. Future doses include a third dose at 6 months of age, a fourth dose between 15 and 18 months of age, and a final dose between 4 and 6 years of age. The hepatitis A vaccination is not indicated for today's visit. The first dose of this 2‐dose series should be administered at the age of 12 months, and the second dose should be administered 6 to 18 months later.

Answer: A

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Suggested Reading

Robinson CL; Advisory Committee on Immunization Practices (ACIP), ACIP Child/Adolescent Immunization Work Group. Advisory Committee on Immunization Practices recommended immunization schedules for persons aged 0 through 18 years—United States, 2016. MMWR Morb Mortal Wkly Rep. 2016 Feb 05;65(4):86-7.
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