MBBS OSCE · Paediatrics / Community Medicine

OSCE — vaccine counselling and catch-up planning

An 8-minute OSCE station testing the candidate's ability to take a vaccination history, identify true vs false contraindications, explain the schedule using plain language, address parental hesitancy, and produce a written catch-up plan. Marks for distinguishing live vs inactivated vaccines, the cold-chain check, the 15-minute observation rule, and the correct IM adrenaline dose if challenged.

8 min stationVerification in progress
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NEET-PGINICETUSMLEPLAB

Brief (to candidate)

A mother brings her 6-week-old son for the routine immunisation visit. The baby was born at 32 weeks gestation (4 weeks premature) and weighed 2.1 kg at birth. He is breastfed and today has a mild runny nose, with a temperature of 37.8 degrees C. The mother reports his older sister (now 5) developed a fever with the first DTaP dose and "had a febrile seizure at 18 months after MMR" — the sister is well and has no neurological diagnosis. The mother reads that vaccines can cause autism and wants to discuss whether to defer some vaccines, particularly MMR which is due in 6 months. She also asks about the new COVID-19 vaccine. You have 8 minutes to take a focused history, identify any true contraindications, explain the routine schedule in plain language, address the parental concern about autism, and agree the next vaccination plan for today and the next visit.

Candidate instructions

  1. Take a focused vaccine-relevant history from the mother (what matters for the decision).
  2. Identify any true contraindications present (be specific).
  3. State clearly which of the mother's concerns are NOT contraindications (with rationale).
  4. Outline the 6-week schedule due today, including which are live and which inactivated, the route, and the site.
  5. Address the MMR-autism concern with the evidence in plain language.
  6. State the observation period, what to advise on common expected reactions, and the paracetamol advice.
  7. Plan the next visit and any catch-up plan in the chart.

Examiner checklist (mark each domain / 10)

DomainKey actions expected
Vaccine-relevant historyAsks for: birth weight, prematurity, jaundice, prior doses, prior reactions, allergies, household immunocompromise, current illness, current medications, the sister's reaction in detail, the mother's pregnancy with MMR-autism concerns, source of her information
True vs false contraindicationsCorrectly identifies NONE true here — premature (vaccinate by chronological age, full dose), low-grade fever and mild URTI (NOT a contraindication), breastfeeding (NOT), family history of febrile seizure (NOT — give with antipyretic cover), maternal concern re MMR (NOT)[1]
6-week schedule due today(For UK) DTaP/IPV/Hib/HepB 6-in-1 IM anterolateral thigh + MenB (Bexsero) IM + rotavirus oral; (for India) pentavalent IM + OPV oral + rotavirus oral + PCV IM + fIPV intradermal. Live: rotavirus (and OPV in India). Inactivated: all others[5]
MMR-autism concernNames the myth; cites the Wakefield retraction; lists the disproving studies (Madsen 2002 NEJM, Hviid 2019 Ann Intern Med, Cochrane 2021); states MMR has NOT been shown to cause autism in over 7 million children studied; offers to give MMR on schedule at 12 months[4]
Observation, advice, safety net15-minute observation in clinic (30 minutes for high-risk); paracetamol 15 mg/kg q4–6h for fever or local reaction; cold compress for injection-site swelling; return if inconsolable crying over 3 hours, hypotonia, persistent fever over 39.5 degrees C beyond 48 hours, or any rash beyond the expected post-vaccination measles; written record given[1][6]
Cold chain / VVM checkNotes nurse MUST verify VVM (inner square not darker than outer) and that the vaccine has not been frozen (shake test for adsorbed vaccines); correct answer if asked
COVID-19 vaccine in the infantStates healthy 6-week-old is not currently in the priority group for COVID-19 vaccination in most national schedules; maternal vaccination in pregnancy and household vaccination protect the infant indirectly; do not give COVID-19 vaccine today[5]
Anaphylaxis preparednessConfirms that IM adrenaline 1:1000 is available and the team knows the dose (0.15 mg IM in the anterolateral thigh for under 6 years, repeat every 5 min)[1][6]
Communication styleAcknowledges concern, avoids confrontation, offers the strong personal recommendation, confirms consent, documents the discussion, leaves the door open
Catch-up / next-visit planSchedules the 10-week visit (UK: 6-in-1 + PCV + rotavirus; India: pentavalent + OPV + rotavirus + PCV + fIPV); documents the discussion and refusal pattern if any dose is deferred

Model key actions

  • Confirm no true contraindication in this child. Prematurity (by chronological age, full dose), mild URTI / low-grade fever (<38.5 degrees C), breastfeeding, and family history of febrile seizure are all NOT contraindications.[1]
  • Vaccinate today with the 6-week schedule appropriate to the country (UK 6-in-1 + MenB + rotavirus; India pentavalent + OPV + rotavirus + PCV + fIPV). Document batch, lot, site, date, giver.
  • Address MMR-autism concern by naming the myth, citing the 1998 Wakefield retraction as fraudulent, summarising the disproving studies (Madsen 2002 NEJM, Taylor 1999 Lancet, Smeeth 2004 Lancet, Hviid 2019 Ann Intern Med, Cochrane 2021), and stating the 2-dose MMR schedule on time at 12 to 15 months then 3y4m (UK) / 4 to 6y (US).[4]
  • 15-minute observation in clinic; advise on common expected reactions and paracetamol 15 mg/kg q4–6h (prophylactic around DTaP reduces fever and local reaction).
  • Confirm adrenaline 1:1000 available (0.15 mg IM for under 6y, repeat every 5 min); confirm VVM safe and that the vaccine has not been frozen.
  • Schedule the next visit and document the discussion; plan catch-up only if any dose is missed.

Common errors

  • Deferring vaccination because the child has a cold — the commonest cause of under-vaccination globally; mild URTI is NOT a contraindication.[1]
  • Reducing the dose or correcting for prematurity — premature babies get the FULL dose on the CHRONOLOGICAL schedule.
  • Withholding MMR because of family history of autism — a false contraindication rooted in the retracted Wakefield paper.
  • Failing to name the MMR-autism myth explicitly — vague reassurance without naming the myth fails to address the parent's actual concern.
  • Recommending COVID-19 vaccine today in this 6-week-old — outside the current priority indication; offer reassurance and maternal/household vaccination as the indirect protection.
  • Omitting the cold-chain / VVM check — a programmatic pitfall that fails the patient silently (the vaccine may be useless); the candidate who mentions it scores above their peer group.
  • Failing to document the discussion — if the parent refuses any vaccine, the discussion and the refusal must be in the record; "no" is not a contraindication for future visits.
References6Show
  1. [1]Kroger AT, Atkinson WL, Marcuse EK, Pickering LK; ACIP. General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep, 2006.PMID 17136024
  2. [2]Schillie S, Vellozzi C, Reingold A, Harris A, Haber P, Ward JW, Nelson NP. Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the ACIP. MMWR Recomm Rep, 2018.PMID 29939980
  3. [3]Meites E, Szilagyi PG, Chesson HW, Unger ER, Romero JR, Markowitz LE; CDC. Human Papillomavirus Vaccination for Adults: Updated Recommendations of the ACIP. MMWR Morb Mortal Wkly Rep, 2019.PMID 31415491
  4. [4]Gerber JS, Offit PA. Vaccines and autism: a tale of shifting hypotheses. Clin Infect Dis, 2009.PMID 19128068
  5. [5]Wodi AP, Murthy N, McNally VV, et al. Advisory Committee on Immunization Practices Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger — United States, 2024. MMWR Morb Mortal Wkly Rep, 2024.PMID 38206855
  6. [6]Varricchio F, Iskander J, Destefano F, et al. Understanding vaccine safety information from the Vaccine Adverse Event Reporting System. Pediatr Infect Dis J, 2004.PMID 15071280
OSCE — vaccine counselling and catch-up planning · MBBS OSCE · NeetVellum