Immunization in Children - Pediatric OSCE Stations

A Guide for OSCE Question asked commonly on Pediatric immunizations, vaccines, vaccine schedule and procedure to store and procedure for vaccinating childrens

Answer 1

DTaP:

Preferably be avoided in primary vaccination series (at 6, 10 and 14 weeks)

IPV:

Instead of OPV at 6, 10, 14 weeks and 15 months, So OPV only at birth, 6 months, 9 months and 5 years

Hepatitis B vaccine:

The final (third or fourth) dose in the Hepatitis B vaccine series should be administered no earlier than age 24 weeks and at least 16 weeks after the first dose

MMR vaccine:

At 9 months and 15 months, No need for booster at 5 years

Typhoid conjugate vaccine:

(TypBar) given at 9 to 12 months, with a booster at 2 years of age

Hepatitis A:

Single dose for live attenuated H2-strain Hep-A vaccine
Two doses for all killed Hep-A vaccines are recommended at 12 months and 18 months

HPV:

Only 2 doses of either of the two HPV vaccines for adolescent/pre-adolescent girls aged 9-14 years
For girls 15 years and older, and immunocompromised individuals 3 doses are recommended
For two-dose schedule, the minimum interval between doses should be 6 months.
For 3 dose schedule, the doses can be administered at 0, 1-2 and 6 months

Answer: 2

High-risk category of children:

1. Congenital or acquired immunodeficiency (including HIV)
2. Chronic cardiac, pulmonary, hematologic, renal and liver disease
3. Children on long term steroids, salicylates, immunosuppressive or radiation therapy
4. Diabetes mellitus, CSF leak, Cochlear implant, Malignancies
5. Children with functional/ anatomic asplenia/ hyposplenia
6. Laboratory personnel and healthcare workers
7. Travelers

IAP recommended vaccines for High-risk children

1. Influenza Vaccine
2. Meningococcal Vaccine
3. Japanese Encephalitis Vaccine
4. Cholera Vaccine
5. Rabies Vaccine
6. Yellow Fever Vaccine
7. Pneumococcal vaccine (PPSV 23)

Answer: 3

1. Children having pets in home
2. Children perceived with higher threat of being bitten by dogs such as hostellers, risk of stray dog menace while going outdoor
3. Veterinarians, those who work with animals
4. Three doses are recommended to be given intramuscularly on days 0, 7 and 28

Advantage:

In case of bite,
Two doses are to be given on days 0 and 3. Rabies immunoglobulin (RIG) are not needed in these children.

Answer: 4

1. TDaP vaccine- single dose
2. MMR- 2 doses at 4-8 weeks gap
3. Hep B- 3 doses at 0,1 and 6 months
4. Hepatitis A- 2 doses at 0, 6 months
5. Typhoid- 1 dose every 3 years
6. Varicella- 2 doses at 4-8 weeks

Answers: 5

Types

Trivalent inactivated vaccines (TIV) and Live Attenuated Influenza vaccines (LAIV).
LAIV not recommended below 2 years of age, in high-risk individuals and in pregnant women.
(1-Highest priority, 4-Lowest priority)

1.Elderly (> 65 years) / nursing-home residents
2.HIV/AIDS, and pregnant women (especially to protect infants 0–6 months)
3.Other groups: Health care workers, asthmatics, and children from ages 6 months to 2 years.
4.Children aged 2–5 years and 6–18 years, and healthy young adults.



Answers: 6

A.During disease outbreaks
B. Vaccination of persons with high-risk conditions/situations

1. Complement component deficiencies
2. Functional/anatomic asplenia/hyposplenia
3. HIV
4. Healthcare workers exposed routinely to Neisseria meningitides
5. Adjunct to chemoprophylaxis

C. International travellers – Study abroad/ Hajj/ Sub-Sahara Africa

Answer: 7

1. No
2. Yes – if IPV not affordable
3. Yes, if CD4+ count > 15%

Answer: 8

1. Normal saline
2. A wheal of 5 mm at injection site
3. A papule develops by 2-3 weeks, increases to size of 4-8mm by 5-6 weeks, ulcerates and heals with scarring by 6-12 weeks
4. Toxic shock syndrome

1.

a) Dropping immunization coverage
b) High population densities
c) Tropical conditions
d) previous eradication of wild polio virus

2.

VAPP – Type 2
VDPV – Type 3

Answer: 12






Answer: 13

AEFI is adverse Event Following immunization
An AEFI will be considered serious, if it:

Results in death
Is life-threatening
Requires in-patient hospitalization or prolongation of existing hospitalization
Results in persistent or significant disability/incapacity
Is a congenital anomaly/birth defect or
Requires intervention to prevent permanent impairment or damage.

Types of AEFI:

1. Vaccine reaction:
Event caused by the vaccine or precipitated by the vaccine when given correctly eg. VAPP after OPV

2. Programme error:
Event caused by an error in vaccine preparation, handling, or administration. Egs- TSS after measles vaccine due to improper storage

3. Injection reaction:
Event from anxiety about, or pain from the INJECTION, rather than vaccine. Eg abscesses

4. Coincidental:
Event that happens after immunization, but NOT caused by it. Eg SIDS

5. Unknown:
The cause of the event cannot be determined.



Answer: 14

1. Varicella : 30 mins (and protect from light)
2. MMRV: 30 mins (and protect from light)
3. Yellow fever: 1 hour
4. MEASLES/MMR : 4 to 6 hours
5. Meningococcal PS vaccine: 30 mins
6. DTaP/Hib combination: 30 mins

Answer: 15

1. Freezer: OPV
2. Top shelf: BCG, Measles, MMR
3. Middle shelf: T- vaccines, IPV, Hib, Combination vaccines, HPV, Typhoid, Hep A, PCV, influenza, rota virus
4. Lower: Varicella

Answer: 16

Contraindication:
A condition in a recipient which greatly increases chances of a serious adverse reaction. Egs- severe allergic reactions


Precaution:
A Condition in recipient which might increase chance or severity of a serious adverse reaction or might compromise ability of vaccine to produce immunity







Answer: 17

Small vial of red liquid attached to a white card and covered in plastic.
Vial breaks if temperature drops below 0 Celsius for >1 hour
Useful for T vaccine
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