Vaccines

Vaccines US Medical PG Question 1: A 34-year-old female medical professional who works for a non-governmental organization visits her primary care provider for a routine health check-up. She made a recent trip to Sub-Saharan Africa where she participated in a humanitarian medical project. Her medical history and physical examination are unremarkable. A chest radiograph and a tuberculin skin test (PPD) are ordered. The chest radiograph is performed at the side and the PPD reaction measures 12 mm after 72 hours. Which of the following mechanisms is involved in the skin test reaction?

• A. Complement activation
• B. Formation of immune complexes
• C. Th1-mediated delayed-type hypersensitivity (Correct Answer)
• D. IgE cross-linking

Vaccines Explanation: ***Th1-mediated delayed-type hypersensitivity*** - The **tuberculin skin test (PPD)** is a classic example of a **Type IV hypersensitivity reaction**, which is mediated by **T-helper 1 (Th1) cells** [3]. - Upon re-exposure to mycobacterial antigens (tuberculin), previously sensitized Th1 cells release **cytokines** that recruit and activate **macrophages**, leading to the characteristic induration and erythema [3]. *Complement activation* - This mechanism is primarily involved in host defense against microbial infections and in **Type II** and **Type III hypersensitivity reactions**, not Delayed-Type Hypersensitivity [2]. - Activation of the complement system leads to cell lysis, opsonization, and inflammation, but it does not directly drive the PPD skin test response [2]. *Formation of immune complexes* - This describes a **Type III hypersensitivity reaction**, where **antigen-antibody complexes** deposit in tissues, leading to inflammation and tissue damage [1]. - Examples include serum sickness and Arthus reaction, which are distinct from the cell-mediated PPD response [1]. *IgE cross-linking* - This mechanism is characteristic of **Type I (immediate) hypersensitivity reactions**, commonly known as allergies [4]. - **IgE antibodies** bind to mast cells and basophils; subsequent cross-linking by antigens triggers the release of mediators like histamine, leading to rapid allergic symptoms [4].

Vaccines US Medical PG Question 2: A research team develops a new monoclonal antibody checkpoint inhibitor for advanced melanoma that has shown promise in animal studies as well as high efficacy and low toxicity in early phase human clinical trials. The research team would now like to compare this drug to existing standard of care immunotherapy for advanced melanoma. The research team decides to conduct a non-randomized study where the novel drug will be offered to patients who are deemed to be at risk for toxicity with the current standard of care immunotherapy, while patients without such risk factors will receive the standard treatment. Which of the following best describes the level of evidence that this study can offer?

• A. Level 1
• B. Level 3 (Correct Answer)
• C. Level 5
• D. Level 4
• E. Level 2

Vaccines Explanation: ***Level 3*** - A **non-randomized controlled trial** like the one described, where patient assignment to treatment groups is based on specific characteristics (risk of toxicity), falls into Level 3 evidence. - This level typically includes **non-randomized controlled trials** and **well-designed cohort studies** with comparison groups, which are prone to selection bias and confounding. - The study compares two treatments but lacks randomization, making it Level 3 evidence. *Level 1* - Level 1 evidence is the **highest level of evidence**, derived from **systematic reviews and meta-analyses** of multiple well-designed randomized controlled trials or large, high-quality randomized controlled trials. - The described study is explicitly stated as non-randomized, ruling out Level 1. *Level 2* - Level 2 evidence involves at least one **well-designed randomized controlled trial** (RCT) or **systematic reviews** of randomized trials. - The current study is *non-randomized*, which means it cannot be classified as Level 2 evidence, as randomization is a key criterion for this level. *Level 4* - Level 4 evidence includes **case series**, **case-control studies**, and **poorly designed cohort or case-control studies**. - While the study is non-randomized, it is a controlled comparative trial rather than a case series or retrospective case-control study, placing it at Level 3. *Level 5* - Level 5 evidence is the **lowest level of evidence**, typically consisting of **expert opinion** without explicit critical appraisal, or based on physiology, bench research, or animal studies. - While the drug was initially tested in animal studies, the current human comparative study offers a higher level of evidence than expert opinion or preclinical data.

Vaccines US Medical PG Question 3: A 40-year-old pregnant woman, G4 P3, visits your office at week 30 of gestation. She is very excited about her pregnancy and wants to be the healthiest she can be in preparation for labor and for her baby. What vaccination should she receive at this visit?

• A. Measles, mumps, and rubella (MMR)
• B. Varicella vaccine
• C. Herpes zoster vaccine
• D. Live attenuated influenza vaccine
• E. Tetanus, diphtheria, and acellular pertussis (Tdap) (Correct Answer)

Vaccines Explanation: ***Tetanus, diphtheria, and acellular pertussis (Tdap)*** - The Tdap vaccine is recommended during each pregnancy, preferably between **27 and 36 weeks of gestation**, to maximize maternal antibody response and passive antibody transfer to the fetus. - This provides critical protection against **pertussis (whooping cough)** for the newborn, who is too young to be vaccinated. *Measles, mumps, and rubella (MMR)* - The **MMR vaccine is a live vaccine** and is **contraindicated during pregnancy** due to the theoretical risk of congenital rubella syndrome, although no cases have been reported. - It should be administered **postpartum** if the mother is not immune to rubella. *Varicella vaccine* - The **varicella vaccine is a live vaccine** and is **contraindicated during pregnancy** due to the theoretical risk of congenital varicella syndrome. - Like MMR, it should be offered in the **postpartum period** if the woman is not immune. *Herpes zoster vaccine* - The herpes zoster vaccine is typically recommended for **older adults** (50 years and older) for shingles prevention. - It is **not routinely recommended during pregnancy**, and its safety and efficacy in this population have not been sufficiently established. *Live attenuated influenza vaccine* - The **live attenuated influenza vaccine (LAIV)** is **contraindicated during pregnancy** due to its live virus content. - Pregnant women should receive the **inactivated influenza vaccine (IIV)**, which is safe and recommended during any trimester.

Vaccines US Medical PG Question 4: A 21-year-old woman is diagnosed with a rare subtype of anti-NMDA encephalitis. During the diagnostic workup, she was found to have an ovarian teratoma. Her physician is curious about the association between anti-NMDA encephalitis and ovarian teratomas. A causal relationship between this subtype of anti-NMDA encephalitis and ovarian teratomas is suspected. The physician aims to identify patients with anti-NMDA encephalitis and subsequently evaluate them for the presence of ovarian teratomas. Which type of study design would be the most appropriate?

• A. Case-control study
• B. Retrospective cohort study (Correct Answer)
• C. Cross-sectional study
• D. Case series
• E. Randomized controlled trial

Vaccines Explanation: ***Retrospective cohort study*** - This is the **most appropriate design** because the physician starts with a defined group of patients **with anti-NMDA encephalitis** (the exposure/condition) and then evaluates them for the **presence of ovarian teratomas** (the outcome). - A **cohort study** follows this directional approach: identify individuals with a specific exposure or condition, then assess the frequency or presence of an outcome within that group. - **Retrospective** cohort studies use **existing medical records** to identify the exposed cohort and determine outcome status, making this practical for studying a rare condition like anti-NMDA encephalitis. - This design allows calculation of the **prevalence** of ovarian teratomas among anti-NMDA encephalitis patients and can suggest an association between the two conditions. *Cross-sectional study* - Cross-sectional studies assess **both exposure and outcome simultaneously** at a single point in time in a population, rather than starting with one condition and looking for another. - This design would be appropriate if the physician surveyed a population and assessed both anti-NMDA encephalitis and ovarian teratomas at the same time, but the question describes a **directional evaluation** (first identify encephalitis patients, then evaluate for teratomas). - While cross-sectional studies can identify associations, they do not follow the sequential approach described in the clinical scenario. *Case series* - A **case series** is a descriptive study that reports characteristics or outcomes in a group of patients with a particular condition but lacks a comparison group and does not systematically evaluate associations. - While it could describe ovarian teratoma findings in anti-NMDA encephalitis patients, it does not provide the structured framework for assessing prevalence or association that a cohort study offers. *Case-control study* - **Case-control studies** work in the **opposite direction**: they start with the outcome (e.g., ovarian teratoma cases) and look backward for the exposure (e.g., anti-NMDA encephalitis). - The physician's approach starts with the **exposure first** (anti-NMDA encephalitis), making a case-control design inappropriate. - Case-control studies are efficient for studying rare outcomes but are not aligned with the described study plan. *Randomized controlled trial* - **RCTs** are experimental studies that randomly assign participants to different interventions to evaluate treatment efficacy or causation. - This is an **observational research question** about naturally occurring associations, not an intervention study, making RCTs inappropriate and unethical for this scenario.

Vaccines US Medical PG Question 5: A 12-month-old girl is brought to her pediatrician for a checkup and vaccines. The patient’s mother wants to send her to daycare but is worried about exposure to unvaccinated children and other potential sources of infection. The toddler was born at 39 weeks gestation via spontaneous vaginal delivery. She is up to date on all vaccines. She does not walk yet but stands in place and can say a few words. The toddler drinks formula and eats a mixture of soft vegetables and pureed meals. She has no current medications. On physical exam, the vital signs include: temperature 37.0°C (98.6°F), blood pressure 95/50 mm Hg, pulse 130/min, and respiratory rate 28/min. The patient is alert and responsive. The remainder of the exam is unremarkable. Which of the following is most appropriate for this patient at this visit?

• A. Meningococcal vaccine
• B. Gross motor workup and evaluation
• C. Rotavirus vaccine
• D. Referral for speech pathology
• E. MMR vaccine (Correct Answer)

Vaccines Explanation: ***MMR vaccine*** - The **measles, mumps, and rubella (MMR) vaccine** is recommended for administration at **12-15 months of age**. - This timing offers protection against these common childhood diseases, which is especially important for children attending **daycare**. *Meningococcal vaccine* - The routine **meningococcal vaccine (MenACWY)** is typically recommended for adolescents at **11-12 years of age**, with a booster at 16 years. - While there are specific circumstances for earlier vaccination (e.g., high-risk conditions), it is **not routine** for a 12-month-old. *Gross motor workup and evaluation* - The patient's motor development, standing in place but not yet walking, is **within the normal range** for a 12-month-old. - A definitive **gross motor workup** would generally be considered if there were more significant delays or regressions. *Rotavirus vaccine* - The **rotavirus vaccine** series is typically given at **2, 4, and 6 months of age**, with the final dose administered no later than **8 months of age**. - A 12-month-old is **outside the recommended age range** for initiating or completing this vaccine series. *Referral for speech pathology* - Saying "a few words" at 12 months is **within the normal developmental milestone** for expressive language at this age. - A referral for **speech pathology** would generally be indicated for more significant language delays.

Vaccines US Medical PG Question 6: A young man about to leave for his freshman year of college visits his physician in order to ensure that his immunizations are up-to-date. Because he is living in a college dormitory, his physician gives him a vaccine that prevents meningococcal disease. What type of vaccine did this patient likely receive?

• A. Live, attenuated
• B. Killed, attenuated
• C. Toxoid
• D. Conjugated polysaccharide (Correct Answer)
• E. Killed, inactivated

Vaccines Explanation: ***Conjugated polysaccharide*** - The **meningococcal vaccine** commonly administered to college students is a **polysaccharide vaccine** wherein the polysaccharide antigens are conjugated to a protein carrier. - This **conjugation** improves the immune response by converting a T-independent antigen into a T-dependent one, inducing better memory responses and allowing for vaccination of infants. *Live, attenuated* - Live, attenuated vaccines contain a **weakened form of the pathogen** that can replicate but does not cause disease, such as the MMR or varicella vaccine. - While they elicit strong, long-lasting immunity, the meningococcal vaccine is not typically of this type due to the risk of opportunistic infection, especially in immunocompromised individuals. *Killed, attenuated* - This term is a **contradiction**; vaccines are either **killed (inactivated)** or **live (attenuated)**, but not both. - Attenuation implies weakening, for which the organism would still be alive. *Toxoid* - **Toxoid vaccines** are made from inactivated bacterial toxins, used to protect against diseases where the toxin, not the bacterium itself, causes the disease, such as diphtheria and tetanus. - Meningococcal disease is primarily caused by **direct bacterial invasion and inflammation**, not solely by a toxin. *Killed, inactivated* - **Killed, inactivated vaccines** contain whole pathogens that have been killed and cannot replicate, such as the inactivated poliovirus vaccine. - While there are inactivated meningococcal vaccines, the most common type for broad use, especially in college settings, is the conjugated polysaccharide vaccine, which elicits a stronger and more long-lasting immune response against multiple serotypes compared to plain inactivated whole-cell vaccines.

Vaccines US Medical PG Question 7: A 27-year-old man presents to the family medicine clinic for a routine check-up. The patient recently accepted a new job at a childcare center and the employer is requesting his vaccination history. After checking the records from the patient’s childhood, the physician realizes that the patient never had the varicella vaccine. The patient is unsure if he had chickenpox as a child, and there is no record of him having had the disease in the medical record. There is no significant medical history, and the patient takes no current medications. The patient’s heart rate is 82/min, respiratory rate is 14/min, temperature is 37.5°C (99.5°F), and blood pressure is 120/72 mm Hg. The patient appears alert and oriented. Auscultation of the heart reveals no murmurs, rubs, or gallops. The lungs are clear to auscultation bilaterally. With regard to the varicella vaccine, which of the following is recommended for the patient at this time?

• A. Two doses of vaccine (Correct Answer)
• B. One dose of the vaccine
• C. Wait until patient turns 50
• D. Serology then administer the vaccine (2 doses)
• E. Serology then administer the vaccine (1 dose)

Vaccines Explanation: ***Two doses of vaccine*** - According to **CDC/ACIP guidelines**, adults without evidence of immunity to varicella should receive **two doses of varicella vaccine** (4-8 weeks apart) without prior serologic testing. - The patient has no documentation of vaccination or prior disease, and works in a **high-risk setting (childcare center)** with frequent exposure to children. - **Routine serologic testing is NOT recommended** before vaccination as it delays protection, is cost-ineffective, and the vaccine is safe even if the person is already immune. - Two doses provide **97% protection** against varicella and significant protection against breakthrough disease. *Serology then administer the vaccine (2 doses)* - While the two-dose schedule is correct, obtaining serology first is **not recommended by CDC** for routine adult varicella vaccination. - Serologic testing delays protection and is cost-ineffective; the vaccine is safe to give even if immunity already exists. - Serology may be considered in special circumstances (e.g., for healthcare workers when cost-benefit analysis favors testing), but not routinely. *One dose of the vaccine* - A single dose provides only **80-85% protection** and is insufficient for adults. - **Two doses are required** for optimal immunity in adults without evidence of immunity. *Wait until patient turns 50* - This confuses the **varicella (chickenpox) vaccine** with the **herpes zoster (shingles) vaccine** (Shingrix), which is recommended at age 50. - The patient needs immediate protection due to high-risk occupational exposure and current susceptibility. *Serology then administer the vaccine (1 dose)* - This option is incorrect for two reasons: serology is not routinely recommended, and one dose is insufficient for adult vaccination. - Adults require a **two-dose series** for adequate protection against varicella.

Vaccines US Medical PG Question 8: A 15-month-old girl is brought to her primary care physician for a follow-up visit to receive the 4th dose of her DTaP vaccine. She is up-to-date on her vaccinations. She received her 1st dose of MMR, 1st dose of varicella, 3rd dose of HiB, 4th dose of PCV13, and 3rd dose of polio vaccine 3 months ago. Thirteen days after receiving these vaccinations, the child developed a fever up to 40.5°C (104.9°F) and had one generalized seizure that lasted for 2 minutes. She was taken to the emergency department. The girl was sent home after workup for the seizure was unremarkable and her temperature subsided with acetaminophen therapy. She has not had any other symptoms since then. She has no history of serious illness and takes no medications. Her mother is concerned about receiving further vaccinations because she is afraid of the girl having more seizures. Her vital signs are within normal limits. Examination shows no abnormalities. Which of the following is the most appropriate recommendation at this time?

• A. Administration of the DTaP vaccine as scheduled (Correct Answer)
• B. Administration of the DTaP vaccine with valproic acid
• C. Administration of a reduced-dose DTaP vaccine
• D. Refrain from administration of the DTaP vaccine
• E. Administration of the DTaP vaccine with prophylactic aspirin

Vaccines Explanation: ***Administration of the DTaP vaccine as scheduled*** - The seizure experienced by the child was a **febrile seizure**, triggered by a fever following vaccination, and not a contraindication to future DTaP doses. - The timing of the seizure (**13 days post-vaccination**) suggests it was most likely related to the **MMR vaccine**, which commonly causes delayed fever (5-12 days) and febrile seizures, rather than the pertussis component or other vaccines given simultaneously. - Since the child did **not receive DTaP** at the visit when the febrile seizure occurred, there is no evidence that pertussis-containing vaccines trigger seizures in this patient. - The **unremarkable workup** and the child's return to normal health indicate the seizure was benign and not indicative of an underlying seizure disorder or severe adverse reaction. - **Simple febrile seizures are not a contraindication** to DTaP vaccination per CDC/ACIP guidelines. *Administration of the DTaP vaccine with valproic acid* - **Valproic acid** is an anti-epileptic drug and is not indicated for the prevention of simple febrile seizures following vaccination. - Prophylactic use of anti-epileptic drugs for vaccination-related febrile seizures is generally not recommended due to potential side effects and lack of clear benefit. *Administration of a reduced-dose DTaP vaccine* - There is **no such thing as a reduced-dose DTaP vaccine** for standard administration in children of this age. - Reducing the vaccine dose would compromise its efficacy and protective immunity. *Refrain from administration of the DTaP vaccine* - **Febrile seizures are not a contraindication** to receiving further DTaP vaccination. - Withholding the vaccine would leave the child unprotected against **diphtheria, tetanus, and pertussis**, which are serious and potentially life-threatening diseases. *Administration of the DTaP vaccine with prophylactic aspirin* - **Aspirin is contraindicated in children** due to the risk of **Reye's syndrome**, especially during viral illnesses or when fever is present. - It should not be used as a prophylactic measure for vaccination-related fever or seizures.

Vaccines US Medical PG Question 9: A parent presents to her pediatrician requesting information about immunizations for her newborn. The pediatrician explains about basic principles of immunization, types of vaccines, possible adverse effects, and the immunization schedule. Regarding how immunizations work, the pediatrician explains that there are mainly 2 types of vaccines. The first type of vaccine provides stronger and more lasting immunity as it induces both cellular and humoral immune responses. The second type of vaccine produces mainly a humoral response only, and its overall efficacy is less as compared to the first type. Which of the following vaccines belongs to the first type of vaccine that the pediatrician is talking about?

• A. Hepatitis A vaccine
• B. Polio vaccine (Salk)
• C. Yellow fever vaccine (Correct Answer)
• D. Rabies vaccine
• E. Hepatitis B vaccine

Vaccines Explanation: ***Yellow fever vaccine*** - The Yellow fever vaccine is a **live-attenuated vaccine**, which mimics natural infection and effectively stimulates both **cellular and humoral immune responses**, leading to strong and long-lasting immunity. - Live-attenuated vaccines contain a weakened form of the pathogen, allowing for replication within the host and robust immune system activation. *Hepatitis A vaccine* - The Hepatitis A vaccine is an **inactivated vaccine**, which primarily induces a **humoral (antibody-mediated) immune response**. - Inactivated vaccines generally do not stimulate a strong cellular immune response and often require booster doses to maintain protective immunity. *Polio vaccine (Salk)* - The Salk polio vaccine is an **inactivated polio vaccine (IPV)**, meaning it contains killed viral particles. - As an inactivated vaccine, it mainly elicits a **humoral immune response** producing circulating antibodies but less mucosal or cellular immunity. *Rabies vaccine* - The Rabies vaccine is an **inactivated vaccine** given after exposure or for pre-exposure prophylaxis. - It primarily induces a **humoral antibody response** rather than a strong cellular immune response. *Hepatitis B vaccine* - The Hepatitis B vaccine is a **recombinant vaccine**, containing only a portion of the viral antigen (HBsAg). - This type of vaccine primarily stimulates a **humoral immune response** leading to antibody production, which is effective but does not typically induce a strong cellular response like live vaccines.

Vaccines US Medical PG Question 10: A 13-month-old girl is brought to the physician because of a pruritic rash for 2 days. The girl's mother says she noticed a few isolated skin lesions on her trunk two days ago that appear to be itching. The girl received her routine immunizations 18 days ago. Her mother has been giving her ibuprofen for her symptoms. The patient has no known sick contacts. She is at the 71st percentile for height and the 64th percentile for weight. She is in no acute distress. Her temperature is 38.1°C (100.6°F), pulse is 120/min, and respirations are 26/min. Examination shows a few maculopapular and pustular lesions distributed over the face and trunk. There are some excoriation marks and crusted lesions as well. Which of the following is the most likely explanation for these findings?

• A. Antigen contact with presensitized T-lymphocytes
• B. Reactivation of virus dormant in dorsal root ganglion
• C. Immune complex formation and deposition
• D. Crosslinking of preformed IgE antibodies
• E. Replication of the attenuated vaccine strain (Correct Answer)

Vaccines Explanation: ***Replication of the attenuated vaccine strain*** - The presentation of a **pruritic rash with maculopapular and pustular lesions**, along with crusted lesions, describes the classic **polymorphic rash** of **varicella (chickenpox)**. - The timing of the rash, appearing **18 days after routine immunizations** (which commonly include the attenuated **MMRV vaccine** at 12-15 months), strongly suggests a vaccine-induced varicella rash due to the replication of the live attenuated virus. *Antigen contact with presensitized T-lymphocytes* - This mechanism describes a **Type IV hypersensitivity reaction** (delayed-type hypersensitivity), such as **contact dermatitis** or a **tuberculin skin test**. - While it can cause a rash, it typically presents differently (e.g., vesicles in contact dermatitis) and the timeline of 18 days post-vaccination is less consistent with a primary contact-mediated reaction causing widespread varicella-like lesions. *Reactivation of virus dormant in dorsal root ganglion* - This process describes the pathogenesis of **herpes zoster (shingles)**, which occurs due to the reactivation of the **latent varicella-zoster virus (VZV)** from the dorsal root ganglia. - Shingles typically presents with a **dermatomal rash** in older individuals or immunocompromised patients, not a widespread polymorphic rash in an otherwise healthy toddler. *Immune complex formation and deposition* - This mechanism describes a **Type III hypersensitivity reaction**, where antigen-antibody complexes deposit in tissues, leading to inflammation. - Conditions like **serum sickness**, **lupus**, or some forms of **vasculitis** are examples, which present with fever, arthralgia, and urticarial or purpuric rashes, differing from the described varicella-like lesions. *Crosslinking of preformed IgE antibodies* - This mechanism describes a **Type I hypersensitivity reaction**, commonly known as an **allergic reaction**. - It typically results in **urticaria (hives)**, angioedema, or anaphylaxis, which are acute reactions characterized by wheals and pruritus, rather than the polymorphic rash with pustules and crusts seen here.

Vaccines Flashcard 1 of 9

Question: What is the best interventional strategy for prevention of neonatal tetanus?_____

Answer: Maternal vaccination w/ toxoid vaccine

Vaccines Flashcard 2 of 9

Question: Which form of poliovirus vaccine provides group immunity with person-to-person contact? _____

Answer: Sabin

Extra Information:   Watch Poliovirus (PicoRNAviridae) [https://dashboard.sketchy.com/study/medical/courses/medical-microbiology/units/medical-microbiology-viruses/videos/medical-microbiology-viruses-rna-viruses-positive-sense-poliovirus-picornaviridae?utm_source=anki&utm_medium=partnership&utm_campaign=february_update&utm_content=medical]Watch associated Bootcamp video [https://app.bootcamp.com/med-school/immunology/videos/vaccinations?index=4] https://onlinemeded.org/spa/pediatrics/vaccinations/acquire?ref=anki 

Vaccines Flashcard 3 of 9

Question: What strain of Haemophilus influenzae is a vaccine available for?_____

Answer: Type B (meningitis causing)

Vaccines Flashcard 4 of 9

Question: Meningococcal vaccine is given between _____

Answer: 11-18 yo

Extra Information:  https://onlinemeded.org?ref=anki 

Vaccines Flashcard 5 of 9

Question: What is the likely diagnosis in a child who recently received the VZV vaccine and developed a maculopapular/vesicular rash with few lesions? _____

Answer: Replication of the vaccine-strain VZV

Extra Information:  https://onlinemeded.org?ref=anki 

Vaccines Flashcard 6 of 9

Question: MMR and varicella vaccines first due at _____

Answer: 1 year

Extra Information:  https://onlinemeded.org/spa/pediatrics/vaccinations/acquire?ref=anki 

Vaccines Flashcard 7 of 9

Question: Mother is Hep B (+) = _____ Mother is Hep B (unknown) = _____

Answer: give Hep B vaccine and HepB IVIg

Extra Information:  https://onlinemeded.org/spa/pediatrics/vaccinations/acquire?ref=anki 

Vaccines Flashcard 8 of 9

Question: What cause of viral gastroenteritis is more commonly seen in unvaccinated children? _____

Answer: Rotavirus

Extra Information:  https://onlinemeded.org/spa/infectious-disease?ref=anki 

Vaccines Flashcard 9 of 9

Question: What is the most common cause of viral gastroenteritis in developing countries? _____

Answer: Rotavirus

Extra Information:  https://onlinemeded.org/spa/infectious-disease?ref=anki