Editor's note: this is an updated version of the original article which appeared in December 2015.
A few years ago I walked into the exam room to see a 14-month-old child who was new to our practice, for a regular check-up. The family had immigrated to the US about 9 months earlier and at 5 months of age the child had only received two doses of DTaP, Prevnar, HIB (type unknown), and IPV. Mom’s English was fair-to-good and she mentioned that she knew her son was behind on shots but wanted him to get everything he needed as soon as possible.
The easy part in dealing with children behind schedule on their vaccines is figuring out what they need that day. The tough part is knowing which vaccines will be needed and when their next visit should be scheduled.
I added up in my head the vaccines needed at this visit: MMR, Varivax, HIB, Prevnar, influenza, DTaP, hepatitis B, and IPV. I told mom that we had a lot of catch-up vaccines to do; I looked up from my notes and actually saw a big smile spread across her face. “Oh, doctor,” she began, “I am so glad you have ketchup vaccines because my son loves ketchup and I was so worried he was going to get a lot of needles today.” (Honest truth.)
After straightening out the confusion over the homonyms I had to tell mom when she should return for more vaccines and figure out what he would need then.
1. What should I have told her regarding the HIB vaccine?
A. Your son only needs one more HIB vaccine after the one today and the earliest we should do it is in 4 weeks
B. Your son only needs one more HIB vaccine after the one today and the earliest we should do it is in 8 weeks
C. Your son will be up to date after his HIB vaccine today.
D. Your son needs 2 more HIB vaccines after today’s dose since we have to assume he got the PRP-T (4 shot series)-type HIB. We can give the last in 8 weeks.
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Note: image is representation only, not the actual child in this case. :