RN Nursing · Immunizations · Practice question
A nurse is preparing to administer the DTaP vaccine to a 3-month-old infant during a well-child visit. Which finding should lead the nurse to delay the administration of the vaccine?
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The infant has a history of eczema but no current skin infection or symptoms.
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The infant's developmental assessment shows mild delay in reaching motor milestones.
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The infant has a current fever of 38.9°C (102°F) with signs of respiratory distress.
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The infant's weight and length are at the 10th percentile but stable over time.
Answer & explanation
Correct: The infant has a current fever of 38.9°C (102°F) with signs of respiratory distress.
Current guidelines from the CDC and the Advisory Committee on Immunization Practices (ACIP) indicate that vaccines, including DTaP, should be deferred when a child has a moderate to severe acute illness, with or without fever. An infant presenting with a current fever of 38.9°C (102°F) accompanied by signs of respiratory distress represents a moderate to severe acute illness. Administering a vaccine in this setting makes it difficult to attribute any subsequent symptoms to the vaccine versus the underlying illness, and the immune response may be suboptimal. Therefore, this finding should lead the nurse to delay DTaP administration until the infant has recovered. A history of eczema without current skin infection or symptoms is not a contraindication to DTaP. Mild developmental delay in reaching motor milestones is not a contraindication; vaccines are still recommended on schedule. Weight and length at the 10th percentile but stable over time reflects normal variation and is not a reason to delay vaccination. The key principle is that mild illness such as a low-grade fever or minor upper respiratory symptoms do not warrant delay, but moderate-to-severe illness does, particularly when accompanied by respiratory distress in an infant.
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