week 8 disc 1 reply to Neeli M
A healthy 2-month-old child was brought to your clinic by her parents. The child is a full-term infant with no concerns. Her exam is normal, and she received her Hep B #1 in the nursery.
Q1. What vaccines does she get? What combinations are available at your clinic?
According to CDC recommended schedule, 2 months of age, the child should receive the following vaccines: (CDC 2023)
– DTaP (Diphtheria, Tetanus, Pertussis)
– Hib (Haemophilus influenzae type b)
– IPV (Polio)
– PCV13 (Pneumococcal conjugate)
– RV (Rotavirus)
– Hepatitis B (if not already received in the nursery)
Combinations of these vaccines may be available at your clinic in the form of combination vaccines such as Pediarix (DTaP-Hepatitis B-IPV) or Pentacel (DTaP-IPV/Hib).
Q2. The child returns at 12 months after completing her primary series of vaccines at 2, 4, and 6 months of age. Her vaccines are right on schedule, her parents have no concerns, she is developing normally, and her exam is normal. What vaccines can she get today?
At 12 months of age, the child can receive the following vaccines: (CDC 2023)
– MMR (Measles, Mumps, Rubella)
– Varicella (Chickenpox)
– Hepatitis A
These vaccines are typically given around 12 months of age, so the child can receive them if she has completed her primary series of vaccines at 2, 4, and 6 months of age.
- Q3. Which groups of patients are at higher risk for pneumococcal disease, and need PPSV23 early starting at 2-years old?
Groups of patients at higher risk for pneumococcal disease and who should receive the PPSV23 vaccine early starting at 2 years old include: (CDC 2023)
– Children with certain underlying medical conditions such as asplenia (absence of spleen), sickle cell disease, HIV infection, or chronic heart, lung, or liver disease.
– Children with cochlear implants.
– Children with cerebrospinal fluid leaks.
– Children with immunocompromising conditions or undergoing immunosuppressive therapy.
– Children with chronic renal failure or nephrotic syndrome.
These children are at higher risk for severe pneumococcal disease and may need additional protection provided by the PPSV23 vaccine.
A 25-year-old woman comes to your office asking for oral contraceptive refills. She stated that she was feeling depressed and heard about St. John’s wort used in depression which she started taking a week ago.
- Q4. How might concomitant administration of St. John’s wort affect the efficacy of drugs this patient is taking such as the oral contraceptives? Discuss another example of a possible drug interaction that might occur with St. John’s wort?
St. John’s wort can potentially decrease the efficacy of oral contraceptives when taken concomitantly. St. John’s wort is known to induce certain liver enzymes, particularly cytochrome P450 enzymes, which can lead to increased metabolism and decreased blood levels of estrogen and progestin components of oral contraceptives (Loughren et al., 2020). This can reduce the effectiveness of the birth control pill and increase the risk of unintended pregnancy. Therefore, it is important for patients using oral contraceptives to be cautious when taking St. John’s wort and to use alternative or additional contraceptive methods (Loughren et al., 2020).
Another example of a possible drug interaction with St. John’s wort is its interaction with certain antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) (Loughren et al., 2020). St. John’s wort can increase the levels of serotonin in the brain and may potentially lead to serotonin syndrome when combined with these medications. Serotonin syndrome is a serious condition that can cause symptoms such as confusion, hallucinations, seizures, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea (Loughren et al., 2020).
It is essential for patients to inform their healthcare providers about all medications, including over-the-counter supplements like St. John’s wort, to avoid potentially harmful drug interactions (Loughren et al., 2020).
The 25-year-old woman stated that her 4-year-old child has been coughing and sounds congested. She wants to know if echinacea might help her child.
Q5. What is echinacea used for and how is it taken?
Echinacea is an herbal supplement that is commonly used for its purported immune-boosting properties. It is often taken to help prevent or reduce the symptoms of the common cold or other respiratory infections. Echinacea is available in various forms, including capsules, tablets, liquid extracts, and teas. It is typically taken orally (Burlou et al., 2022).
Q6. Is it safe for this mother to give her child echinacea?
The use of echinacea in children, especially young children like a 4-year-old, is a topic of debate and caution. While some people believe that echinacea can help boost the immune system and alleviate symptoms of colds, there is limited scientific evidence to support these claims, particularly in children (Burlou et al., 2022).
The safety and efficacy of echinacea in children, especially in young children, have not been well established through rigorous scientific studies. Due to the lack of definitive evidence and potential risks, it is generally recommended to exercise caution when giving echinacea to children (Burlou et al., 2022).
In this case, it would be best for the mother to consult with her child’s healthcare provider before giving echinacea to her 4-year-old child. The healthcare provider can provide guidance on the appropriate course of action and recommend safe and effective treatments for the child’s cough and congestion (Burlou et al., 2022).
Reference
Burlou-Nagy C, B?nic? F, Jurca T, Vica? LG, Marian E, Muresan ME, Bácskay I, Kiss R, Fehér P, Pallag A. Echinacea purpurea (L.) Moench: Biological and Pharmacological Properties. A Review. Plants (Basel). 2022 May 5;11(9):1244.
Centers for Disease Control and Prevention. (2023, November 16). Birth-18 years immunization schedule – healthcare providers. Centers for Disease Control and Prevention.https://www.cdc.gov/vaccines/schedules/hcp/imz/chi…
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