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Flu Vaccine Counseling:: Attempt 1:: A PLAB 2 Mock

Summary:

This station involves counseling a parent about the seasonal flu vaccine for their child. The scenario focuses on explaining the nature, benefits, risks, contraindications, and misconceptions associated with the influenza vaccine, especially the live attenuated nasal spray version given to children aged 2–17.



Key Points:


Vaccine Type and Composition

  • Live attenuated influenza vaccine (LAIV), administered as a nasal spray.

  • Provides immunity against 2 strains of Influenza A and 2 strains of Influenza B.

  • Given annually due to frequent antigenic drift and shift in flu virus strains.


Reasons for Annual Administration

  • Flu viruses mutate rapidly; yearly updates ensure vaccine matches circulating strains.

  • Each year, the vaccine is reformulated based on current viral surveillance data.


Important Considerations:

  • Contraindications:

    • Immunocompromised individuals (e.g., on steroids or immunosuppressants).

    • Pregnant individuals.

    • Current use of aspirin (e.g., in Kawasaki disease) due to risk of Reye’s syndrome.

    • Severe egg allergy, gelatin allergy, or neomycin allergy.

  • Precautions:

    • Relative caution in children with asthma or recurrent wheeze (may increase bronchospasms).

    • Delay vaccination if the child is acutely unwell.


Diagnostic Approach:

  • Confirm child’s identity, age, and prior flu vaccination history.

  • Elicit detailed past medical history (especially respiratory or immune-related issues).

  • Ask about current medications (aspirin/steroids).

  • Screen for allergies (egg, gelatin, neomycin).

  • Check developmental milestones, feeding habits, growth, and general well-being.



Management:


Explanation of Vaccine:

  • Administered as nasal spray, easy and painless.

  • Side effects: mild fever, runny nose, headache lasting 2–3 days.

  • Highly effective and recommended annually for ages 2–17.


Benefits:

  • Prevents flu-related complications: pneumonia, bronchitis, otitis media, febrile seizures.


Safety Measures:

  • Do not vaccinate during acute illness.

  • Contraindicated with specific allergies or medications.


Post-Vaccine Monitoring:

  • Offer safety netting: advise parents to seek medical help if severe symptoms occur post-vaccine.


Communication Skills:

  • Use simple language (e.g., "weakened virus" instead of "live attenuated").

  • Reassure about vaccine safety and lack of evidence linking vaccines to seizures.

  • Acknowledge and address parental concerns empathetically.

  • Normalize concerns and explain common myths vs. facts.


Ethical Considerations:

  • Respect autonomy: vaccination is not mandatory but highly advised.

  • Avoid jargon and ensure informed consent through clear explanation.

  • Do not over-promise outcomes or resources.


Additional Resources:

  • NHS Flu vaccine guidance for children

  • Public Health England leaflet: "Protecting your child against flu"

  • GMC Good Medical Practice guidelines on patient safety and communication

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