Comprehensive Nursing Pharmacology Q 280
A 13-month-old child recently arrived in the United States from a foreign country with his parents and needs childhood immunizations. His mother reports that he is allergic to eggs. Upon further questioning, you determine that the allergy to eggs is anaphylaxis. Which of the following vaccines should he not receive?
A. Hepatitis B.
B. inactivated polio.
C. diphtheria, acellular pertussis, tetanus (DTaP).
D. mumps, measles, rubella (MMR).
Correct Answer: D. mumps, measles, rubella (MMR)
The measles portion of the MMR vaccine is grown in chick embryo cells. The current MMR vaccine does not contain a significant amount of egg proteins, and even children with dramatic egg allergies are extremely unlikely to have an anaphylactic reaction. However, patients that do respond to egg contact with anaphylaxis should be in a medically controlled setting where full resuscitation efforts can be administered if anaphylaxis results. The vaccines in options a,b and c do not contain egg protein.
Option A: People who have had an allergic reaction after a previous dose or any component of a hepatitis B vaccine, have had an allergic reaction to yeast, and have had an allergic reaction to neomycin (contraindication for Twinrix) should not be vaccinated.
Option B: People who have had severe allergic (anaphylactic) reactions after a previous dose of inactivated polio vaccine (IPV) or after taking streptomycin, polymyxin B, or neomycin should not receive IPV. IPV contains trace amounts of streptomycin, polymyxin B, and neomycin, and people who are sensitive to these antibiotics can also have hypersensitivity reactions to IPV. No serious adverse events related to the use of enhanced-potency IPV have been documented.
Option C: People with a contraindication for MMR or MMRV vaccine should not receive the vaccine, including anyone who had a severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component; has a known severe immunodeficiency (e.g., from hematologic and solid tumors, receipt of chemotherapy, congenital immunodeficiency, or long-term immunosuppressive therapy or patients with human immunodeficiency virus [HIV] infection who are severely immunocompromised); is pregnant, and has a history of anaphylactic reactions to neomycin.