Case Study 1: Aidan
Aidan is an established patient in your practice. He is in your
office in May for a routine visit.
Aidan is 20 months old. He received MMR #1, varicella #1, DTaP
#4, Hib #4, PCV #4 and hepatitis A #1 at 14 months of age. His
mother reports a temperature of 101o F for 2 days, about 9 days
after these vaccines, with no other symptoms.
At 17 months of age Aidan was diagnosed with a neuropathy
which caused weakness of his left leg. The condition was treated
with a 2-week course of prednisone and ibuprofen. He still has
some residual weakness in the leg. He has no other medical
Was the fever caused by the vaccines? If so, which vaccine was
Was the neuropathy caused by the vaccines?
Should the fever and neuropathy be reported to the Vaccine
Adverse Event Reporting System (VAERS)?
Case Study 2: Michelle
Michelle is 27 years old and is beginning nursing school. She has mild
asthma, which is controlled with the occasional use of an albuterol inhaler.
She was told by her parents that she had chickenpox at age 5 years but
has no documentation of this.
Michelle has a written record of having received 5 doses of DTP, 5 doses
of OPV, and 2 doses of MMR in childhood, and a 3-dose series hepatitis B
vaccine at 12 years of age. The nursing school requires serologic proof of
hepatitis B immunity. Her anti-HBs test drawn 1 month ago is negative.
What vaccine or vaccines should Michelle receive today?
What, if any, serologic testing should be done at today’s visit?
When should Michelle return, and what vaccine or vaccines
should she receive at that visit?
Case Study 3: Hank
Hank is a 65-year-old retired aerospace engineer beginning a second
career as an aide in a children’s hospital. He has a history of psoriatic
arthritis diagnosed 6 months ago. The arthritis is being treated with
etanercept (Enbrel®) twice a week.
Hank had severe varicella at age 22, that was complicated by varicella
pneumonia and required hospitalization. He also reports a mumps outbreak
in the community served by the hospital. Several children with mumps have
recently been admitted to the hospital where he works.
Childhood vaccination records lost
One month ago:
-inactivated influenza vaccine
-3rd dose of hepatitis B vaccine
One year ago:
-Td (only documented dose)
-MMR (only documented dose)
What vaccine or vaccines does Hank need today?
Are there any contraindications for the vaccine(s) he needs
Is any serologic testing indicated?