APHA Contraindications & Precautions 2 — Questions and Answers
Question 1: A child is receiving long-term systemic corticosteroids (2 mg/kg/day prednisone for >14 days). Which vaccine should be deferred until at least 1 month after therapy ends?
- Inactivated influenza vaccine
- MMR vaccine (Correct answer)
- Hepatitis B vaccine
- Meningococcal conjugate vaccine
Correct answer: MMR vaccine
Live vaccines like MMR are contraindicated in persons receiving high-dose systemic corticosteroids for ≥14 days; defer until at least 1 month after cessation.
Question 2: Which of the following is a TRUE contraindication to receiving the yellow fever vaccine?
- Travel to a non-endemic country
- Age 6–8 months in a high-risk situation
- Thymus disorder associated with abnormal immune function (Correct answer)
- Prior receipt of MMR 25 days ago
Correct answer: Thymus disorder associated with abnormal immune function
Thymus disorder associated with abnormal immune function is a contraindication to yellow fever vaccine due to risk of vaccine-associated viscerotropic disease.
Question 3: An adolescent received a tetanus-containing vaccine 3 years ago. She now presents for a Tdap booster. Is her recent vaccination history a contraindication?
- Yes, Tdap is contraindicated within 5 years of a prior tetanus dose
- No, 3 years is an adequate interval and she may receive Tdap (Correct answer)
- Yes, she must wait until 10 years have passed
- No, but she should receive Td instead of Tdap
Correct answer: No, 3 years is an adequate interval and she may receive Tdap
ACIP recommends a minimum 2-year interval between tetanus-containing vaccines, so 3 years is acceptable for Tdap administration.
Question 4: A 70-year-old patient reports a previous episode of Guillain-Barré syndrome (GBS) 6 weeks after receiving influenza vaccine. What is the appropriate action?
- GBS history is an absolute contraindication; no influenza vaccine should ever be given
- GBS within 6 weeks of prior influenza vaccine is a precaution; weigh risks and benefits (Correct answer)
- Administer the vaccine without restriction since GBS resolves
- Switch to live attenuated influenza vaccine (LAIV) as an alternative
Correct answer: GBS within 6 weeks of prior influenza vaccine is a precaution; weigh risks and benefits
GBS within 6 weeks of a prior influenza vaccine is classified as a precaution, not a contraindication; clinicians should weigh individual risk versus benefit.
Question 5: Which condition is considered a PRECAUTION (not a contraindication) for the varicella vaccine?
- Known severe immunodeficiency
- Recent receipt of antibody-containing blood product (Correct answer)
- Anaphylaxis to gelatin
- Pregnancy
Correct answer: Recent receipt of antibody-containing blood product
Recent receipt of antibody-containing blood products is a precaution for varicella vaccine because passively acquired antibodies may interfere with the immune response.
Question 6: A breastfeeding mother asks about receiving the live attenuated influenza vaccine (LAIV). Which statement is correct?
- LAIV is contraindicated in breastfeeding women
- LAIV is not recommended in breastfeeding women but is not contraindicated (Correct answer)
- LAIV is the preferred influenza vaccine for breastfeeding women
- Breastfeeding is a precaution but not a reason to defer LAIV
Correct answer: LAIV is not recommended in breastfeeding women but is not contraindicated
LAIV is not recommended for breastfeeding women due to theoretical risk, but it is not classified as a contraindication; inactivated influenza vaccine is preferred.
Question 7: A patient has a latex allergy causing urticaria after latex glove contact. Which action is most appropriate when administering a vaccine packaged with a latex-containing vial stopper?
- Administer the vaccine in a standard setting since urticaria is mild
- Administer with caution; latex urticaria allergy is a precaution, not a contraindication (Correct answer)
- Withhold vaccine entirely as any latex allergy is an absolute contraindication
- Replace with LAIV which has no latex components
Correct answer: Administer with caution; latex urticaria allergy is a precaution, not a contraindication
Contact urticaria from latex is a precaution; only anaphylactic reaction to latex contraindicates use of vaccines in latex-containing packaging.
APHA Contraindications & Precautions 2
A child is receiving long-term systemic corticosteroids (2 mg/kg/day prednisone for >14 days).
Which vaccine should be deferred until at least 1 month after therapy ends?