Let\'s look at the case of Michael, a bright high school senior whose family liv
ID: 81421 • Letter: L
Question
Let's look at the case of Michael, a bright high school senior whose family lives in a commune in western North Carolina. Michael's parents are believers in maintaining health "naturally" and have never immunized Michael. Now that Michael is planning to attend college in a nearby city and will live in a dormitory. the college health service is requesting to have some sense of his immune status respect to various communicable diseases. These inquiries from the college led Michael's parents to seek a consultation with a doctor. The doctor reviews Michael's medical record and notes that in kindergarten Michael was brought in to the office for evaluation of a skin rash which was confirmed to be chicken pox. How can we determine his vulnerabilities? What immunity does Michael already have? What immunizations will he need? What of the routine childhood immunizations have implications in adulthood? When Michael was five years old, during a visit to his grandparents. Michael was taken to their family doctor who gave him an immunization against measles, mumps and rubella. Does that offer Aim protection now that he is 18? How long does vaccine acquired immunity last? How long does natural immunity last? If Michael plans to travel to the Third World during the course of his studies: How can we best prepare him to safely come and go?Explanation / Answer
Answer:
1. The doctor reviewed Michael's medical record and notes that in kindergarten Michael was brought in to the office for evaluation of a skin rash which was confirmed to be chicken pox. So, we can safely assume that Varicella (the virus which causes chicken pox) is no longer on the list of vulnerabilities.
2. His immunity to Varicella should be intact. Because chicken pox is a commonly observed disease of childhood, most authorities would accept a history of infection as adequate evidence of host immunity.
3. In other diseases, however, the clinician would draw IgG levels to confirm a patient's immunity. If an individual has never had a rash consistent with chicken pox the IgG level can be obtained. If present, the patient can be considered protected from future infection related to exposure to that virus.
4. Most individuals began acquiring vaccine-induced immunity in early infancy. Diphtheria, Pertussis, Tetanus, Polio, Varicella, Measles, Mumps, Rubella, Varicella, Hemophilus Influenza B, Hepatitis B, are the current required vaccines for day care and school entry.
Fortunately for children, many of these immunizations are composed of combination vaccines, so that one injection can provide a dose that protects the individual from 2, 3 or even 4 diseases. Exemptions to school entry requirements are made based on parental preferences, religious practices, etc.
In addition, since some of these vaccines are composed of live virus, individuals who are immunocompromised, temporarily immunosuppressed, or have household contacts who are immunocompromised may be excluded from receiving them.
One rarely worries about diphtheria, pertussis, rotavirus, and hemophilus influenzae B beyond childhood. Although they can cause disease in adolescents and adults, the illness is not life-threatening, as it can be in early childhood. Measles, rubella, mumps, hepatitis A, hepatitis B, polio, tetanus, pneumococcus, meningococcus, typhoid, cholera, influenza, rabies, and yellow fever can cause devastating problems when they occur in any age group.
(Since there are multiple questions, the first 4 questions have been answered according to the rules of Chegg)
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