A 6-week-old infant is scheduled for the first dose of pentavalent vaccine (DTwP-HepB-Hib). The mother mentions that the previous child had persistent inconsolable screaming for 4 hours after the second dose of DTwP. The most appropriate decision is:

• A Administer the full pentavalent vaccine as planned
• B Omit the pertussis component and give DT with HepB and Hib separately
• C Substitute DTaP (acellular pertussis) for all remaining pertussis-containing vaccines in this infant ✓
• D Delay all immunizations until 12 weeks and monitor for reaction

Explanation

Persistent inconsolable screaming (high-pitched cry) for 3 or more hours after a pertussis-containing vaccine is a precaution (not a contraindication) to further whole-cell pertussis vaccination. For this sibling, the adverse event in the family is relevant; the preferred strategy per IAP is to substitute with DTaP (acellular pertussis) which has a significantly lower rate of local and systemic reactions including persistent crying. Withholding all pertussis vaccination would leave the child unprotected.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.