Answer to Question 1
B
Routine immunizations are appropriate. CD4+ cells are monitored when deciding whether to provide live virus vaccines. If the child is severely immunocompromised, the MMR vaccine is not given. The varicella vaccine can be considered on the basis of the child's CD4+ counts. Only inactivated polio (IPV) should be used for HIV-infected children. Immunizations are given to infants who are HIV positive. The pertussis vaccination is not eliminated for an infant who is HIV positive.
Answer to Question 2
A
Perinatal transmission accounts for the highest percentage of HIV infections in children. Infected women can transmit the virus to their infants across the placenta during pregnancy, at delivery, and through breast-feeding. Cases of HIV infection from sexual abuse have been reported; however, perinatal transmission accounts for most pediatric HIV infections. Although in the past some children became infected with HIV through blood transfusions, improved laboratory screening has significantly reduced the probability of contracting HIV from blood products. Poor hand washing is not an etiology of HIV infection.
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