A 2-year-old child is receiving chemotherapy for neuroblastoma. The older sibling is due to receive a poliovirus vaccine before starting kindergarten. The appropriate action is:

A 2-year-old child is receiving chemotherapy for neuroblastoma. The older sibling is due to receive a poliovirus vaccine before starting kindergarten. The appropriate action is:

• A. Give IPV
• B. Withhold IPV, and give it 1 year after the sibling completes chemotherapy
• C. Withhold IPV, and give it as soon as the sibling completes chemotherapy
• D. Give oral poliovirus (OPV)

Answer: (A)

The key concept is that a child who is immunocompromised from chemotherapy is at risk from live vaccines given to people in close contact. Live vaccines can shed virus, and that shed virus could potentially infect someone with a weakened immune system. In contrast, inactivated vaccines do not shed and are safe around immunocompromised individuals. Polio vaccination options illustrate this: the inactivated polio vaccine is given as an injection and cannot replicate or shed virus, so it's safe for household contacts of an immunocompromised child. The oral polio vaccine, however, is a live attenuated vaccine and is shed in stool for a period after vaccination; this could pose a risk to the child undergoing chemotherapy. Therefore, the older sibling should receive the inactivated polio vaccine (IPV) rather than the oral version. This protects the sibling from polio while minimizing risk to the immunocompromised patient.

The key concept is that a child who is immunocompromised from chemotherapy is at risk from live vaccines given to people in close contact. Live vaccines can shed virus, and that shed virus could potentially infect someone with a weakened immune system. In contrast, inactivated vaccines do not shed and are safe around immunocompromised individuals.

Polio vaccination options illustrate this: the inactivated polio vaccine is given as an injection and cannot replicate or shed virus, so it's safe for household contacts of an immunocompromised child. The oral polio vaccine, however, is a live attenuated vaccine and is shed in stool for a period after vaccination; this could pose a risk to the child undergoing chemotherapy.

Therefore, the older sibling should receive the inactivated polio vaccine (IPV) rather than the oral version. This protects the sibling from polio while minimizing risk to the immunocompromised patient.