ABSTRACT
Answer 1 First you find out that Nicholas has had all his routine immunizations. He received DPT (diphtheria, pertussis, and tetanus antigens) and oral live poliovirus vaccine at ages 3, 4, and 5 months, and a booster of both before entering kindergarten. He was also given MMR (mumps, measles, and rubella live vaccines) at 9 months of age. At the same time, he was given Hib vaccine (the conjugated capsular polysaccharide of Haemophilus influenzae, type b; Fig. A1.1). His growth and development have been normal. He suffered a middle ear infection (otitis media) at age 24 months. Other than that he has had no other illnesses, except for a common cold each winter. You feel comfortable that he is protected against infection with Haemophilus influenzae from the Hib vaccine. However, your concern about the possibility of pneumococcal infection leads you to advise the surgeon to immunize Nicholas against pneumococcal capsular poysaccharides by giving him conjugated pneumococcal polysaccharide vaccine. You also advise prophylactic antibiotics, to be taken at a low dose daily but at higher doses when Nicholas has any dental work done, or any invasive surgical procedure.
