Measles (Rubeola): The Daily PANCE Blueprint
The measles-mumps-rubella (MMR) vaccine is CONTRAINDICATED in which of the following groups of patients?
A. A 2-year-old with egg allergy who developed hives after eating scrambled eggs
B. A 15-month-old receiving long-term aspirin therapy for Kawasaki disease
C. A 12-month-old who is being treated with high-dose corticosteroids for nephrotic syndrome
D. A 4-year-old who developed a localized rash after their first MMR dose
E. A 6-year-old with HIV infection and a CD4 count of 600 cells/μL
Answer and topic summary
The answer is A 12-month-old who is being treated with high-dose corticosteroids for nephrotic syndrome
Explanation for correct answer: High-dose systemic corticosteroids (≥2 mg/kg/day or ≥20 mg/day of prednisone for ≥2 weeks) are a contraindication for MMR vaccination because they cause significant immunosuppression. Live vaccines like MMR should be delayed until at least 1 month after discontinuation of high-dose steroid therapy. This is because immunosuppression increases the risk of vaccine strain viral replication and potential disease.
Live vaccines are contraindicated in:
- Patients on high-dose steroids (delay 1 month after discontinuation)
- Severe immunodeficiency (primary or acquired)
- Pregnancy (delay 1 month before conception)
- Active untreated TB
- Recent blood product administration (delay 3-11 months)
- Chemotherapy recipients (delay 3 months post-completion)
- Transplant recipients on immunosuppression
- CD4 count <200 cells/μL in HIV patients
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Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint Dermatology ⇒ Exanthems ⇒ Measles
Also covered as part of the Pediatric EOR topic lists
