Vaccination of immunocompromised children — branching viva

Primary care clinic: a four-month-old boy born overseas is due his routine immunisations. There is no newborn SCID screen on file; his maternal uncle died in infancy; he has persistent oral thrush and faltering growth. The examiner asks: what is your framework, what is the single most important safety decision today, which vaccines are at risk, how will you confirm or exclude the relevant defect, and what will you do about the inactivated vaccines and the household — then branches to a seven-year-old two years post-haematopoietic stem cell transplant, well and off immunosuppression, and asks you to justify rebuilding her entire schedule on evidence of reconstitution rather than her old record.