Haroon Shaukat MD, Children’s National Hospital

The Case:
An unvaccinated 6-year-old male presents to the ED with pain and swelling to the left neck for one day. Exam showed tender swelling (~10 cm) over left lateral face/neck, spanning the mandible.

Here’s How You Answered Our Questions:

Discussion:

The most important branching point in this case for many of us was that the child was unvaccinated. Initial history obtained was that the child was fully immunized but upon further history by the physician it was found that this child was actually fully un-immunized. This changed the differential for us to include vaccine-preventable diseases such as Mumps. Strategies to ask if a child is immunized from the group included:

Presumptive Vs. Participatory Recommendations

AAP researchers found that pediatricians who provided a “presumptive recommendation” – informed parents that vaccines were due, rather than a “participatory recommendation” – asking what the parent thought about vaccines, were more likely to see parents accept vaccines.

Examples

Participatory:

• “Do you want to vaccinate your child today?”
• “What do you think about vaccines?”
• “Would you like to hear about the vaccines we offer for today’s visit?”

Presumptive:

• “Today your child is due for 2 vaccines. We will be giving MMR and Varicella.”
• “It’s time for an annual influenza vaccine. Your child is old enough to receive either the inactivated shot or the live nasal spray.”

Denouement:

Our institution did not have Mumps PCR available as a testing option so IgG and IgM were done. Mumps IgM and IgG results took about a week but were negative. In the interim the state health department had continued to follow the child and perform their own testing.

Opel, et al. The Architecture of Provider-Parent Vaccine Discussions at Health Supervision Visits. 2013. Pediatrics, 134, 139, 2013-2037.

Opel, et al. Impact of Childhood Vaccine Discussion Format Over Time on Immunization Status, Acad Pediatr. 2018 May-Jun;18(4):430-436. doi: 10.1016/j.acap.2017.12.009. Epub 2018 Jan 8.

CDC Mumps Strategies for Control

Laboratory Testing for Mumps

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