Preventive Measure for an Unvaccinated 11-Year-Old with Family History of Asthma
The most appropriate preventive measure is vaccination, specifically starting with inactivated influenza vaccine (TIV), as this child is at increased risk for influenza complications due to the family history of asthma and should receive catch-up immunizations immediately. None of the listed options (urine analysis, lipids profile, chest radiograph, or CBC) represent appropriate preventive measures for this clinical scenario.
Why Vaccination is the Priority
This unvaccinated child requires urgent catch-up immunization, with influenza vaccine being particularly critical given the family history of asthma. 1
Influenza Vaccination Recommendations
All children aged 6 months through 18 years should receive annual influenza vaccination, with particular emphasis on children with family history of asthma who may be at higher risk for respiratory complications 1
For this 11-year-old, inactivated influenza vaccine (TIV) is the appropriate choice rather than live attenuated influenza vaccine (LAIV), as LAIV is contraindicated in children with asthma or family history suggesting potential asthma risk 1
The child should receive 0.5 mL of TIV intramuscularly into the deltoid muscle 1
Why the Listed Options Are Inappropriate
Urine analysis (Option A): Not a preventive measure for asthma or general health screening in this age group without specific clinical indication 1
Lipids profile (Option B): Not routinely recommended as preventive screening in healthy 11-year-olds without risk factors for cardiovascular disease 1
Chest radiograph (Option C): Not indicated as a preventive measure in asymptomatic children, even with family history of asthma; chest X-rays do not prevent disease and are only diagnostic tools 1
CBC (Option D): Not a preventive measure and not routinely indicated for asymptomatic children without clinical suspicion of hematologic abnormality 1
Comprehensive Catch-Up Immunization Strategy
Beyond influenza vaccine, this completely unvaccinated 11-year-old requires a full catch-up immunization schedule:
All routine childhood vaccines should be administered according to catch-up schedules, including measles-mumps-rubella (MMR), varicella, hepatitis B, diphtheria-tetanus-pertussis, polio, and meningococcal vaccines 1, 2
Haemophilus influenzae type b (Hib) and pneumococcal conjugate vaccines should be considered based on age-appropriate catch-up schedules 2
Multiple vaccines can be administered simultaneously at different injection sites to accelerate catch-up immunization 1
Special Considerations for Family History of Asthma
Family history of asthma does NOT contraindicate any standard childhood vaccines 1
The only asthma-related vaccine precaution is avoiding LAIV in children with diagnosed asthma or recent wheezing episodes 1
Childhood vaccines, including inactivated influenza vaccine, are safe and do not increase asthma risk 3, 4
The risks of not vaccinating far outweigh any theoretical concerns about vaccine-related asthma exacerbations 3
Common Pitfalls to Avoid
Do not delay vaccination while ordering unnecessary screening tests like those listed in the options; vaccination is the immediate priority 1
Do not withhold vaccines from children with family history of asthma; this is not a contraindication to any standard immunization 1
Do not give LAIV to this child if there is any concern about potential asthma development; use TIV instead 1
Ensure proper screening before LAIV administration by asking: "In the past 12 months, has a health care professional ever told you that your child had wheezing?" If yes, use TIV instead 1