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Safely Navigating Vaccine Contraindications in Children & Teens for MSRA

Updated: 23 hours ago

Q1. A 2-month-old infant is due for routine vaccinations. He was diagnosed with severe combined immunodeficiency (SCID) at birth. Which of the following vaccines is contraindicated?

Choose the answer

  • A. 6-in-1 (DTaP/IPV/Hib/HepB)

  • B. PCV13 (pneumococcal conjugate)

  • C. Rotavirus (oral)

  • D. Hepatitis B


✅ Answer: C

 Explanation: Rotavirus is a live oral vaccine contraindicated in SCID. All others are inactivated/subunit and safe.



Q2. A 5-year-old child with a history of anaphylaxis to gelatin is due for MMR. What is the most appropriate management?

Choose the correct answer

  • A. Give MMR with antihistamine cover

  • B. Specialist allergy testing referral before administration

  • C. Give MMR vaccine as normal

  • D. Delay vaccination until adolescence


✅ Answer: B 

Explanation: Gelatin is a known excipient in MMR. Anaphylaxis to gelatin is a contraindication. Refer before re-administering.



Q3. A 12-year-old girl with severe asthma is on daily high-dose oral steroids. Her school offers the nasal flu vaccine (LAIV). What should you do?

Choose the correct answer

  • A. Administer LAIV with steroid cover

  • B. Defer vaccination until asthma improves

  • C. Give inactivated flu vaccine instead

  • D. LAIV is safe in asthma


✅ Answer: C

 Explanation: LAIV is contraindicated in patients with severe asthma or current oral steroid use. Use inactivated flu vaccine instead.



Q4. Which of the following is a contraindication to BCG vaccination?

Choose the correct answer

  • A. Travel to high TB incidence area

  • B. Asplenia

  • C. Positive Mantoux (tuberculin skin test)

  • D. Age under 1 month


✅ Answer: C

 Explanation: A positive Mantoux suggests latent TB. BCG is contraindicated due to risk of local ulceration.



Q5. A 10-month-old baby is due for their rotavirus vaccine. Which of the following is the best approach?

Choose the correct answer

  • A. Administer immediately

  • B. Defer and give at 12 months

  • C. Do not give—contraindicated due to age

  • D. Replace with inactivated oral rotavirus vaccine


✅ Answer: C

 Explanation: Rotavirus vaccine is contraindicated after 8 months of age due to increased risk of intussusception.



Q6. Which child must not receive the oral typhoid vaccine?

Choose the correct answer

  • A. Healthy 8-year-old travelling to India

  • B. 6-year-old on methotrexate for juvenile arthritis

  • C. 12-year-old with mild asthma

  • D. 10-year-old with egg allergy


✅ Answer: B

 Explanation: Oral typhoid is a live vaccine contraindicated in immunosuppressed patients (e.g., on methotrexate).



Q7. Which of the following individuals should not receive the Yellow Fever vaccine?

Choose the correct answer

  • A. 35-year-old healthy traveller to sub-Saharan Africa

  • B. 10-month-old baby travelling to an endemic area

  • C. 27-year-old with HIV and CD4 of 620

  • D. 29-year-old woman who is 8 weeks pregnant


✅ Answer: D 

Explanation: Yellow Fever is a live vaccine contraindicated in pregnancy, unless high-risk travel and no alternatives.



Q8. A 14-year-old girl is due for the HPV vaccine. She has a known severe yeast allergy. What is the best course of action?

Choose the correct answer

  • A. Give HPV as scheduled

  • B. Switch to live HPV vaccine

  • C. Refer to specialist for risk assessment

  • D. Delay until adulthood


✅ Answer: C

 Explanation: The HPV vaccine is produced in yeast cells → refer for assessment if there is a severe yeast allergy.



Q9. A 25-year-old man is being assessed for catch-up MMR. He is HIV-positive with a CD4 count of 250 and on antiretroviral therapy. What is the correct approach?

Choose the correct answer

  • A. MMR contraindicated—do not vaccinate

  • B. Administer MMR vaccine

  • C. Wait until CD4 rises above 500

  • D. Give MMR with immune globulin cover


✅ Answer: B

 Explanation: MMR is safe in HIV patients if CD4 >200 and patient is clinically stable/on ART.



Q10. Which of the following is not a contraindication to MMR?

Choose the correct answer

  • A. Pregnancy

  • B. Anaphylaxis to neomycin

  • C. Immunosuppression due to chemotherapy

  • D. Breastfeeding


✅ Answer: D

 Explanation: Breastfeeding is NOT a contraindication to MMR. All others are true contraindications.



Q11. A 9-year-old child is offered a nasal spray flu vaccine at school. She has mild asthma, uses a salbutamol inhaler once a week, and has no recent exacerbations. What is the appropriate action?

Choose the correct answer

  • A. Withhold LAIV and give inactivated flu vaccine

  • B. Give LAIV at school as scheduled

  • C. Defer all flu vaccination

  • D. LAIV contraindicated in all asthmatics


✅ Answer: B 

Explanation: LAIV is safe in mild, well-controlled asthma. It's only contraindicated in severe asthma or recent wheeze.



Q12. A 3-year-old boy is due for his annual flu vaccine. He is on long-term aspirin therapy following Kawasaki disease. What is the most appropriate next step?

Choose the correct answer

  • A. Give LAIV with monitoring

  • B. Do not vaccinate due to aspirin use

  • C. Give inactivated flu vaccine instead

  • D. LAIV is preferred in this age group


✅ Answer: C

 Explanation: LAIV is contraindicated in children on aspirin due to the risk of Reye’s syndrome. Use inactivated vaccine.



Q13. Which of the following is a contraindication to giving LAIV?

Choose the correct answer

  • A. Age 12 years

  • B. Breastfeeding mother

  • C. Egg allergy with mild rash

  • D. History of SCID (Severe Combined Immunodeficiency)


✅ Answer: D

 Explanation: SCID is an absolute contraindication to all live vaccines, including LAIV. Mild egg allergy is not a contraindication.



Q14. A 2-year-old child is attending for their first LAIV dose. Parents ask why the child may need a second dose. What’s the correct explanation?

Choose the correct answer

  • A. It boosts protection against pneumonia

  • B. First dose only protects against one flu strain

  • C. Two doses ensure better immunity in first-time recipients

  • D. Second dose is needed only if missed last year


✅ Answer: C

 Explanation: Children under 9 receiving LAIV for the first time need two doses (4 weeks apart) to prime their immune system and ensure optimal protection. In subsequent years, only one dose is needed annually.



Q15. A 14-year-old boy has recently completed chemotherapy for leukemia and is now in remission. He is immunocompromised but clinically well. Which flu vaccine should he receive?

Choose the correct answer

  • A. LAIV

  • B. No vaccine needed

  • C. Wait 12 months, then give LAIV

  • D. Give inactivated flu vaccine


✅ Answer: D

 Explanation: LAIV is contraindicated in immunocompromised individuals. Give inactivated flu vaccine instead.



Q16. A healthy 6-year-old has a known anaphylactic allergy to egg. What is the best course of action regarding flu vaccination?

Choose the correct answer

  • A. LAIV is contraindicated; do not vaccinate

  • B. Give inactivated flu vaccine in a hospital setting

  • C. LAIV is safe in mild egg allergy but not anaphylaxis

  • D. Refer to allergy specialist before vaccinating


✅ Answer: B

 Explanation: For severe egg allergy, LAIV is contraindicated, but inactivated flu vaccine can be safely given under supervision.



Q17. Which of the following children is most suitable for LAIV?

Choose the correct answer

  • A. 1-year-old child with no comorbidities

  • B. 3-year-old with well-controlled asthma

  • C. 6-year-old on methotrexate for juvenile arthritis

  • D. 13-year-old on aspirin for rheumatic fever


✅ Answer: B 

Explanation: LAIV is appropriate for children aged 2–17, if they are not immunosuppressed, not on aspirin, and have no recent wheeze.



Q18. Why is the influenza vaccine (including LAIV) administered annually?

Choose the correct answer

  • A. It contains live viruses that provide only short-term pro

  • B. Antigenic shift results in new pandemics each year

  • C. The LAIV causes antibodies to wane faster than others

  • D. Antigenic drift changes flu strains, and immunity fades


✅ Correct Answer: D

Explanation:

  • Antigenic drift = minor mutations in influenza virus surface proteins (hemagglutinin and neuraminidase)

  • These changes reduce the immune system’s ability to recognize the virus from the previous year.

  • Additionally, vaccine-induced immunity wanes over months, particularly in older adults and young children.

  • Therefore, the flu vaccine must be updated and re-administered every year to match circulating strains and maintain protection.

🔄 This is why annual influenza vaccination is recommended globally — including with LAIV for children aged 2–17 in the UK.

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