A 4-year-old is brought in for a preschool physical. Immunization records show that DTaP, IPV, and MMR are due. The child had Kawasaki syndrome treated with IVIG 9 months ago. Which immunizations should be administered today?

A 4-year-old is brought in for a preschool physical. Immunization records show that DTaP, IPV, and MMR are due. The child had Kawasaki syndrome treated with IVIG 9 months ago. Which immunizations should be administered today?

• A. Only MMR
• B. DTaP, IPV, and MMR
• C. None (immunizations should be given at the school physical examination next year)
• D. DTaP and IPV (the parent should be instructed to schedule an appointment in 2 months for the MMR)

Answer: (B)

The key idea is how IVIG affects live vaccines and when it’s safe to give them. IVIG can neutralize or interfere with the replication of live vaccines like MMR, so these vaccines are typically delayed after IVIG receipt for a period (usually several months, depending on the IVIG dose). In this child, IVIG was given 9 months ago, which means passively acquired antibodies should have waned enough by now, making MMR safe to administer. DTaP and IPV are inactivated vaccines and can be given at any time, including after IVIG, so they can be administered today as well. Kawasaki disease itself does not contraindicate vaccination. Therefore, administering all three vaccines today is appropriate and keeps the child on schedule. Delaying MMR or giving only some vaccines would leave the child under-immunized.

The key idea is how IVIG affects live vaccines and when it’s safe to give them. IVIG can neutralize or interfere with the replication of live vaccines like MMR, so these vaccines are typically delayed after IVIG receipt for a period (usually several months, depending on the IVIG dose). In this child, IVIG was given 9 months ago, which means passively acquired antibodies should have waned enough by now, making MMR safe to administer.

DTaP and IPV are inactivated vaccines and can be given at any time, including after IVIG, so they can be administered today as well. Kawasaki disease itself does not contraindicate vaccination.

Therefore, administering all three vaccines today is appropriate and keeps the child on schedule. Delaying MMR or giving only some vaccines would leave the child under-immunized.