Name that Vaccine: Which One Could Have Prevented Each of 2 Patient Scenarios?

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“Name that Vaccine" is a take on the TV show popular in the 1950s called "Name that Tune." The game has been modified by Patient Care contributor Terry Brenneman, MD, who has substituted a clinical vignette for the music and asks you to name the vaccine that could have prevented the disease presented in the 2 cases that follow. Are you game?

Assume neither of the following patients has received any immunizations and all have normal immune systems.

1. A mother is awoken in the middle of the night by the noisy, raspy breathing of her 18-month-old child. She calls her pediatrician and tells him that its sounds exactly like her older child did when he had bad croup last winter; he had a barky cough and sounded like “Darth Vader” when breathing. It is the middle of flu season, and her 18-month-old does have some minimal cough, a and runny nose, and his temperature is 102°F. and attends a home day care. Mom mentions that he seems to be making more saliva since he is drooling a little. He seemed to be fine when she put him to bed.

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2. A 40-year-old woman presents to your office in the middle of flu season with the acute onset of pain over her right rib cage. She reports a sometimes productive, worsening cough of about 4 weeks duration that has been waking her at night and she has even had a few episodes of post-tussive emesis. She says it started like a mild cold. She never had any fever. She denies any “whoop” sounds, but once she starts coughing it seems to go on and on and she has been frightened a few times by the inability to take a breath in.

She is on a PPI prescribed a week ago by a provider at an urgent care center for “reflux” after results of a chest x-ray returned negative and she has not noticed any improvement. On examination, her lungs are clear. She has no tenderness over her facial sinuses. She does have point tenderness over an anterior rib. Abdominal examination is normal.