Chapter 22: Immunizations

Garzon Maaks: Burns’ Pediatric Primary Care, 7th Edition

MULTIPLE RESPONSE

1. What new vaccine delivery systems are being investigated? (Select all that apply.)
a. Skin-patch
b. Edible
c. Nasal
d. Rectal
e. Topical
ANS: A, B, C
New vaccine delivery systems are being investigated that include skin-patch vaccines, edible
vaccines, additional applications for nasal delivery, and needle-free injections.

2. What reasons are commonly given by parents and caregivers for failing to have their children
vaccinated? (Select all that apply.)
a. Religious beliefs
b. Distrust of government agencies
c. Immunizations are too expensive
d. Believed connection to the development of autism
e. Inoculation is too physically and emotionally traumatic
ANS: A, B, D, E
Parents commonly express concerns that vaccines are not safe and may cause autism, overload
or are traumatic for children. Others distrust government agencies or have personal religious
beliefs against immunization. Cost is not a commonly expressed concern.

3. The National Academy of Medicine has determined, after a comprehensive review,

determined there is no substantiated evidence of a causal relationship between thimerosal-
containing vaccines or measles, mumps, rubella (MMR) vaccine and what disorders? (Select
all that apply.)
a. Childhood schizophrenia
b. Autism
c. Asperger syndrome
d. Attention-deficit/hyperactive disorder (AD/HD)
e. Pett syndrome
ANS: B, E
After a comprehensive review of adverse events, the Institute of Medicine (IOM) (now called
the National Academy of Medicine) determined there is no substantiated evidence of a causal
relationship between thimerosal-containing vaccines or measles, mumps, rubella (MMR)
vaccine and autism, attention-deficit/hyperactivity disorder (ADHD), speech/language delays,
childhood-disintegrative disorder, Asperger syndrome, or Rett syndrome.

MULTIPLE CHOICE
1. Which PCP question, posed to a parent, best demonstrates participatory care when addressing
the topic of childhood immunizations?
a. “Do you want to hold your child while I give the shots due today?”
b. “What are your feelings about childhood vaccinations?”
c. “What shots do you want your child to receive at this visit?”
d. “Do you have any questions about the shots that are due at this visit?”
ANS: C
Providers who are presumptive (e.g., “these shots are due today”) rather than participatory
(e.g., “what shots do you want your child to receive today”) in their discussion of childhood
vaccines had fewer refusals by vaccine-hesitant parents even within the context of initial
vaccine resistance on the part of the parent. The remaining options all present with the
assumption that the vaccinations will be given.

2. Which statement is not supported by the ACIP general vaccination guidelines?

a. If two live virus parenteral vaccines are given less than 28 days apart, the vaccine
given second should be disregarded; repeat this second vaccine at least 4 weeks
later.
b. In some circumstances (e.g., imminent travel, country epidemics, delayed
immunizations) an accelerated schedule is available from the ACIP.
c. When multiple vaccines are given on the same extremity, the sites of injection
should be at least 1 inch apart; the anterolateral aspect of the thigh is preferred.
d. While written, dated records are preferred, parent or guardian recollection of a
child’s immunization status may be accepted if source is considered reliable.
ANS: D
Use only written, dated records. Parent or guardian recollection of a child’s immunization
status may not be reliable. All the other options are true statements.