Measles Elimination — MCQs

10 questions

Which disease comes under International Surveillance?

What is the estimated mortality rate of measles in severely malnourished children in developing countries during major outbreaks with limited healthcare access?

Which of the following statements about measles is incorrect?

After the appearance of rash, prophylactic isolation of measles case is necessary for a minimum of:

Due to a measles outbreak in a community, a medical officer decided to immunize a child aged seven months with measles vaccine. When should the next measles vaccine be administered?

With regard to the Goals, Milestones and Targets for the Global Technical Strategy for Malaria (2016-2030), consider the following statements: 1. Compared to 2015, the target is to reduce the malaria mortality rates globally by at least 90% by year 2030 2. Compared to 2015, the target is to reduce malaria case incidence by 90% by year 2030 3. Eliminate malaria from at least 35 countries, where malaria was transmitted in 2015, by year 2030 Which of the above statements hold true?

All are correct about the vaccine shown except:

What is the death rate among cholera-affected individuals in a population of 5000, where 50 people are affected by cholera, and 10 of these individuals have died?

The "risk of a disease" is measured by the

Q10

Which is correct about the Vaccine Vial monitor shown in the image? (Recent NEET Pattern 2016-17)

Measles Elimination Indian Medical PG Practice Questions and MCQs

Question 1: Which disease comes under International Surveillance?

A. Typhoid fever (Correct Answer)
B. Chikungunya fever
C. Hepatitis B
D. Salmonellosis

Explanation: ***Typhoid fever*** - **Typhoid fever** is monitored by the **World Health Organization (WHO)** through global surveillance systems to track incidence, guide vaccination strategies, and implement control measures. - While **not on the mandatory notification list** under the International Health Regulations (IHR) 2005, typhoid is included in **WHO's global disease surveillance** programs due to its significant disease burden in endemic regions. - Among the given options, typhoid fever has the **strongest international surveillance framework** through WHO's Global Foodborne Infections Network and regional surveillance systems. - **Note:** Diseases under **mandatory IHR surveillance** include cholera, plague, yellow fever, smallpox, poliomyelitis, SARS, and novel influenza subtypes. *Chikungunya fever* - Chikungunya is primarily monitored through **national and regional surveillance** systems rather than comprehensive international surveillance frameworks. - WHO tracks outbreaks through epidemic intelligence but it is **not part of mandatory IHR notification**. - Surveillance focuses on **vector control** and outbreak detection at local levels. *Hepatitis B* - **Hepatitis B** surveillance is conducted primarily at **national levels** through prevalence studies, vaccination coverage monitoring, and chronic infection programs. - It is **not under mandatory international surveillance** per IHR, though WHO maintains global estimates and monitoring frameworks. - Focus is on **prevention through vaccination** and treatment of chronic infections. *Salmonellosis* - Non-typhoidal **salmonellosis** is monitored mainly through **national food safety** and public health surveillance systems. - **Not designated for mandatory international surveillance** under IHR 2005. - International coordination occurs through networks like WHO's Global Foodborne Infections Network for outbreak investigation.

Question 2: What is the estimated mortality rate of measles in severely malnourished children in developing countries during major outbreaks with limited healthcare access?

A. 1-3%
B. 10-12% (Correct Answer)
C. 5-7%
D. 15-20%

Explanation: ***10-12%*** - This is the **correct estimated mortality rate** for measles in severely malnourished children during major outbreaks with limited healthcare access in developing countries. - **Severe malnutrition** is the single most important risk factor for measles mortality, increasing the case fatality rate by **3-10 fold** compared to well-nourished children. - During outbreaks with limited healthcare access, mortality rates in this vulnerable population typically range from **10-25%**, with 10-12% being a conservative estimate within this range. - High mortality is primarily due to **severe complications** including pneumonia, diarrhea, encephalitis, and immune suppression, all of which are exacerbated by malnutrition. *1-3%* - This mortality rate is more characteristic of measles in **well-nourished populations with adequate healthcare access**. - It does not reflect the substantially elevated risk in severely malnourished children during outbreaks with limited medical resources. - This underestimates the true burden in the high-risk population described in the question. *5-7%* - While higher than the 1-3% rate, this still **underestimates** the mortality in severely malnourished children during major outbreaks. - This might represent mortality in moderately malnourished children or in settings with some healthcare access. - Not sufficient for the "severely malnourished" population specified in the question. *15-20%* - This represents the **upper end** of mortality estimates for measles in severely malnourished children. - Such rates may occur in **extreme humanitarian crises** with concurrent epidemics, complete healthcare system collapse, or vitamin A deficiency. - While possible, this is higher than the typical estimated range for the scenario described.

Question 3: Which of the following statements about measles is incorrect?

A. Secondary attack rate is 90%
B. Maximum incidence in 6 months to 3 years age group
C. Best age for immunization is 9-12 months
D. Secondary attack rate is 30% (Correct Answer)

Explanation: ***Secondary attack rate is 30%*** - Measles is highly contagious, and its **secondary attack rate** is much higher than 30%, often reaching **90% or more** among susceptible household contacts. - A 30% secondary attack rate would be exceptionally low for a disease with measles's known **high transmissibility**. *Maximum incidence in 6 months to 3 years age group* - This statement is correct as **maternal antibodies wane** around 6 months, making infants susceptible, and young children in this age range are often actively exposed in community settings. - Peak incidence occurs in this age group, particularly in **unvaccinated or under-vaccinated populations**. *Best age for immunization is 9-12 months* - This is the **recommended age** for measles vaccination under India's **Universal Immunization Programme (UIP)**. - Immunizing at this age ensures that waning maternal antibodies do not interfere with vaccine efficacy while providing timely protection during the high-risk period. *Secondary attack rate is 90%* - This statement is correct. Measles is one of the **most contagious infectious diseases**, with a secondary attack rate among susceptible household contacts often **exceeding 90%**. - Its high transmissibility is due to its **airborne spread** and long communicable period.

Question 4: After the appearance of rash, prophylactic isolation of measles case is necessary for a minimum of:

A. 2 days
B. 5 days (Correct Answer)
C. 7 days
D. 9 days

Explanation: ***5 days*** - Measles patients are infectious from **4 days before** to **4 days after** the rash appears, making them infectious for approximately 8-9 days total. - Standard isolation guidelines recommend isolation for **at least 4 days after rash onset**, and the 5-day option represents a **conservative approach** ensuring complete coverage of the infectious period. - This timeframe is crucial for controlling the spread of the **highly contagious measles virus** in community and healthcare settings, and the minimum of 5 days ensures no residual transmission risk. *2 days* - Isolating for only 2 days after the rash appears is **insufficient** as the patient remains infectious for at least 4 days post-rash. - This period does not cover the full duration of infectivity, leading to potential **onward transmission** and outbreak continuation. *7 days* - While 7 days would effectively cover the infectious period, it is **longer than medically necessary** for standard measles isolation after rash onset. - This extended isolation may impose **unnecessary burden** on patients, caregivers, and healthcare facilities without additional public health benefit. *9 days* - Isolating for 9 days is **excessive** and not required for measles, as the infectivity period after rash onset ends by day 4-5. - Prolonged isolation beyond the recommended period provides **no additional public health benefit** and can have significant social, psychological, and economic impacts on patients and families.

Question 5: Due to a measles outbreak in a community, a medical officer decided to immunize a child aged seven months with measles vaccine. When should the next measles vaccine be administered?

A. Not required
B. When the child completes nine months of age (Correct Answer)
C. When the child completes fifteen months of age
D. After four weeks

Explanation: ***When the child completes nine months of age*** - A measles vaccine given at **seven months during an outbreak** is considered a **zero-dose** or **early dose** and does NOT replace the routine immunization schedule. - According to the **Indian National Immunization Schedule**, the routine first dose of measles vaccine (MR vaccine) is given at **9 months of age**, regardless of whether an earlier outbreak dose was administered. - Vaccines given before 9 months have **reduced efficacy** due to interference from maternal antibodies, making the 9-month dose essential for adequate seroconversion. - After the 9-month dose, a second dose is given at **16-24 months** as per routine schedule. *When the child completes fifteen months of age* - While 15-18 months is appropriate timing for the **second dose** of measles vaccine in the routine schedule, it is not the immediate next dose after a 7-month outbreak vaccination. - The child still requires the **routine 9-month dose first**, followed by the second dose at 16-24 months. - Skipping the 9-month dose and going directly to 15 months would leave a prolonged gap without adequate protection. *Not required* - This is **incorrect** because early doses given before 9 months are considered zero-doses and do not provide reliable long-term immunity. - The routine schedule **must still be followed** to ensure proper immunization, starting with the 9-month dose. *After four weeks* - A four-week interval after the 7-month dose is **too short** and not recommended in immunization guidelines. - There is **no indication** for such an early repeat dose; the child should wait until the routine 9-month schedule for the next dose.

Question 6: With regard to the Goals, Milestones and Targets for the Global Technical Strategy for Malaria (2016-2030), consider the following statements: 1. Compared to 2015, the target is to reduce the malaria mortality rates globally by at least 90% by year 2030 2. Compared to 2015, the target is to reduce malaria case incidence by 90% by year 2030 3. Eliminate malaria from at least 35 countries, where malaria was transmitted in 2015, by year 2030 Which of the above statements hold true?

A. 1 and 3 only
B. 1 and 2 only
C. 2 and 3 only
D. 1, 2 and 3 (Correct Answer)

Explanation: ***1, 2 and 3*** - All three statements accurately reflect the **core targets** set by the Global Technical Strategy for Malaria (2016-2030). - These ambitious goals aim to achieve significant reductions in malaria burden and eventual eradication in many regions. *1 and 3 only* - This option is incorrect because it omits statement 2, which is a verified goal for **reducing malaria case incidence**. - All three statements are indeed part of the strategy's published objectives. *1 and 2 only* - This option is incorrect as it excludes statement 3 regarding the **elimination of malaria** from at least 35 countries. - The strategy encompasses all three stated objectives for global malaria control. *2 and 3 only* - This option is incorrect because it fails to include statement 1, which specifies the target for **reducing malaria mortality rates**. - The strategy explicitly addresses all three aspects: mortality, incidence, and country-level elimination.

Question 7: All are correct about the vaccine shown except:

A. Bivalent
B. Recombinant vaccine
C. Recommended in all women in age group 25-45 years (Correct Answer)
D. 3 dosages

Explanation: ***Recommended in all women in age group 25-45 years*** - While Cervarix (HPV vaccine) is important for preventing **cervical cancer**, routine vaccination is primarily recommended for adolescents and young adults (up to age 26). - Catch-up vaccination for women aged 27-45 years is a shared clinical decision, not a universal recommendation for "all women" in that age group. *Bivalent* - **Cervarix** is a **bivalent vaccine**, meaning it protects against two HPV types: HPV-16 and HPV-18. - These two types are responsible for the majority of **cervical cancers**. *Recombinant vaccine* - HPV vaccines, including Cervarix, are **recombinant vaccines**. - They are specifically **virus-like particle (VLP) vaccines**, which means they contain no viral DNA and cannot cause infection. *3 dosages* - When initially introduced, Cervarix was administered in a **3-dose schedule** (0, 1-2, and 6 months). - For adolescents initiating vaccination before age 15, a 2-dose schedule is now often recommended, but a 3-dose schedule remains standard for older individuals or those with certain immunocompromising conditions.

Question 8: What is the death rate among cholera-affected individuals in a population of 5000, where 50 people are affected by cholera, and 10 of these individuals have died?

A. 10 per 1000
B. 20 per 100 (Correct Answer)
C. 1 per 1000
D. 5 per 1000

Explanation: ***20 per 100*** - The death rate among cholera-affected individuals is also known as the **case fatality rate (CFR)**. - This is calculated as (number of deaths / number of *affected* individuals) × 100 = (10 / 50) × 100 = **20% (or 20 per 100)**. - CFR measures the severity of disease among those who contract it. *1 per 1000* - This would represent a case fatality rate of 0.1%, which is far lower than the actual rate. - This is an incorrect calculation that doesn't match the given data. *5 per 1000* - This would represent a case fatality rate of 0.5%, which is also incorrect. - This calculation does not reflect the proportion of deaths among cholera-affected individuals. *10 per 1000* - This appears to confuse the number of deaths (10) with a rate expression. - The actual **mortality rate** (deaths per total population) would be (10 / 5000) × 1000 = **2 per 1000**, not 10 per 1000. - The question specifically asks for death rate among *affected* individuals (CFR), not the population mortality rate.

Question 9: The "risk of a disease" is measured by the

A. Prevalence Rate
B. Incidence Rate (Correct Answer)
C. Case Fatality Rate
D. Communicability Rate

Explanation: ***Incidence Rate*** - The **incidence rate** directly measures the frequency of **new cases** of a disease in a population over a specified period. - It is used to estimate the **risk** or probability of developing a disease, as it quantifies how quickly people are contracting the disease within the at-risk population. - **Formula:** (Number of new cases during time period / Population at risk) × multiplier - This is the epidemiologically correct measure of disease risk. *Prevalence Rate* - The **prevalence rate** measures the **total number of existing cases** (both new and old) of a disease in a population at a specific point in time or over a period. - It reflects the **burden** of a disease, not the risk of acquiring it, as it includes individuals who may have developed the disease much earlier. - Prevalence = Incidence × Duration of disease. *Case Fatality Rate* - The **case fatality rate** (CFR) measures the **proportion of individuals diagnosed with a disease who die from that disease** within a specified period. - It reflects the **severity** or lethality of a disease among those affected, not the risk of developing the disease in the first place. - CFR is a measure of disease outcome, not disease occurrence. *Communicability Rate* - There is no standard epidemiological term exactly defined as "communicability rate"; however, related concepts include the **basic reproduction number (R₀)** and **secondary attack rate**. - These concepts describe the **spread or transmissibility of an infectious disease**, not the risk of contracting a disease from a general population perspective. - This measures transmission dynamics rather than individual risk.

Question 10: Which is correct about the Vaccine Vial monitor shown in the image? (Recent NEET Pattern 2016-17)

A. Vaccine can be used, if expiry date not passed
B. Vaccine can be used, after expiry date
C. Vaccine cannot be used, irrespective of expiry date (Correct Answer)
D. Vaccine is at discard point, consult supervisor

Explanation: ***Vaccine cannot be used, irrespective of expiry date*** - The image shows a **darker inner square** compared to the outer circle, indicating that the vaccine has been exposed to detrimental heat. - A VVM turning dark signifies that the vaccine has lost its **potency** and should not be administered, regardless of the expiry date. *Vaccine can be used, if expiry date not passed* - This statement is incorrect because the VVM clearly indicates **heat exposure** has compromised vaccine quality, making it unsuitable for use. - The VVM overrides the expiry date when it shows significant heat damage, as vaccine potency is reduced even if not expired. *Vaccine can be used, after expiry date* - This is incorrect as a vaccine should never be used **after its expiry date**, irrespective of the VVM status, as sterility and potency cannot be guaranteed. - Using expired vaccines poses a **health risk** and may not provide adequate protection. *Vaccine is at discard point, consult supervisor* - While it is at the discard point, consulting a supervisor is not the primary instruction; the vaccine is simply **unsuitable for use**. - The VVM is designed to be a **clear indicator** for immediate action, not necessarily requiring further consultation for the general health worker.

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