Counsel a family on deferring live vaccines while SCID is excluded — OSCE

OSCE communication and shared decision-making station: explaining to a frightened family why the four-month-old's routine live vaccines must be deferred while a combined T-cell defect is excluded, what the tests involve, why inactivated vaccines will still go ahead, how the household can cocoon the infant, and what the likely outcome is — while addressing fear and the temptation to 'just get the needles over with'.

osce communication and shared decision-making2 min readVerification in progress

Prompt

The parents of a four-month-old boy born overseas have brought him for his routine immunisations. His maternal uncle died in infancy. He has persistent oral thrush and faltering growth, and no newborn SCID screen result is available. You have decided to defer the live vaccines (BCG, rotavirus, MMR, varicella) while you exclude a combined T-cell defect. The parents are frightened that 'something is wrong with his immune system', anxious that deferring needles leaves him unprotected, and keen to 'just get them done today'. Counsel them.

Task

Counsel the parents. You have five minutes. Demonstrate an organised, empathic, and safety-focused explanation that addresses the four questions a fellowship communication station rewards: why the live vaccines must wait, what will happen next, what will still go ahead today, and what the family can do. The framework and the live-vaccine contraindications follow the 2013 IDSA guideline. ^[1]

References4Show

[1]Rubin LG, Levin MJ, Ljungman P, et al. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin Infect Dis, 2014.PMID 24421306
[2]National Center for Immunization and Respiratory Diseases. General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep, 2011.PMID 21293327
[5]Gennery AR. Severe combined immunodeficiency: newborn screening and the BCG vaccination. Arch Dis Child, 2022.PMID 35973752
[7]Bakare N, Menschik D, Tiernan R, et al. Severe combined immunodeficiency (SCID) and rotavirus vaccination: reports to the Vaccine Adverse Events Reporting System (VAERS). Vaccine, 2010.PMID 20674876

Counsel a family on deferring live vaccines while SCID is excluded — OSCE

osce communication and shared decision-making2 min readVerification in progress

Task

References4Show

[1]Rubin LG, Levin MJ, Ljungman P, et al. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin Infect Dis, 2014.PMID 24421306
[2]National Center for Immunization and Respiratory Diseases. General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep, 2011.PMID 21293327
[5]Gennery AR. Severe combined immunodeficiency: newborn screening and the BCG vaccination. Arch Dis Child, 2022.PMID 35973752
[7]Bakare N, Menschik D, Tiernan R, et al. Severe combined immunodeficiency (SCID) and rotavirus vaccination: reports to the Vaccine Adverse Events Reporting System (VAERS). Vaccine, 2010.PMID 20674876