Review Question - QID 213830

This 12-year-old boy should receive the meningococcal conjugate vaccine, which is routinely given at age 11-12 years, with a booster at 16 years.

The bacterium Neisseria meningitidis causes meningococcal meningitis, a severe (and often rapidly fatal) illness that often affects otherwise healthy adolescents and adults, causing epidemics in densely populated living spaces (such as college dormitories or military barracks). The initial presentation is often nonspecific, but classic meningitis symptoms of fever, headache, and nuchal pain and rigidity rapidly follow. Meningococcemia (i.e., bacteremia) may also develop with diffuse petechial rash and/or organ failure. Both forms of illness are treated with IV antibiotics (usually ceftriaxone) but can be prevented with routine vaccination.

Incorrect Answers:
Answer 1: The Haemophilus influenza type B (HiB) vaccine, which protects against the most virulent type of H. influenza (type B, the most likely to cause meningitis and epiglottitis), is given 4 times in infancy (ages 2, 4, 6 and 12-15 months). This patient has presumably already been vaccinated. There is no vaccine against other H. influenza types, which commonly cause non-invasive mucosal infections (e.g. otitis media, sinusitis, and pneumonia).

Answer 2: The human papillomavirus (HPV) vaccine is given twice at age 11-12 years to help prevent HPV, a sexually transmitted virus with strains that cause cervical (and less often, penile or oropharyngeal) cancer and strains that cause papillomas or warts. This patient has already received the first HPV vaccine and should receive the second dose 6 months later (i.e., 3 months from now).

Answer 4: The pneumococcal polysaccharide vaccine (PPSV23), along with the pneumococcal conjugate vaccine (PCV13), helps protect against invasive infection with the bacterium Streptococcus pneumoniae. PPSV23 is recommended for all adults > 65 years old, as well as children and adolescents with predisposing conditions (such as immunocompromising conditions or asplenia); none of which are present in this patient.

Answer 5: The varicella-zoster vaccine is given twice (at age 12-15 months and again at 4-6 years) to prevent primary varicella-zoster infection (chickenpox, which characterized by diffuse, pruritic, vesicular rash) and its complications. Patients who have had chickenpox (such as this patient) develop immunity, do not require this vaccine, though they should receive the herpes zoster vaccine at age 60 to prevent reactivation of the virus later (i.e., shingles).

Bullet Summary:
The meningococcal vaccine (a conjugated vaccine against Neisseria meningitidis) should first be given to all children aged 11-12 years, with a booster at age 16 years to help prevent meningococcal meningitis and meningococcemia.