National Immunization Schedule — MCQs
Which vaccine is given at birth to provide protection against tuberculosis as per the National Immunization Schedule in India?
A mother brings her 9 month old child for vaccination. Which of the following statements is false regarding immunization of Japanese encephalitis?
A patient with the following feature shown in the image. The patient reports having another 3-year-old sibling at home, who is fully immunized as per the immunization schedule. What is the best measure to prevent diphtheria in the sibling of the child with diphtheria?
Neonatal tetanus prevention is best done by which antenatal measure?
At what age is the first dose of Measles vaccination given under the Universal Immunization Programme (UIP)?
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?
Smallpox eradication was not due to:
A 2-year-old child diagnosed provisionally with diphtheria and on examination she has greyish white membrane patch around her tonsils. The child has a 6-year-old sibling at home, who is fully immunized as per the schedule. What is the best measure to prevent disease in the sibling of the child?
Best means of giving hepatitis B vaccine is
A 9-month-old infant is brought to you for immunization. The infant has previously received the first dose of OPV and DPT. What will you do ?
National Immunization Schedule Indian Medical PG Practice Questions and MCQs
Question 1: Which vaccine is given at birth to provide protection against tuberculosis as per the National Immunization Schedule in India?
- A. Measles
- B. BCG (Correct Answer)
- C. OPV
- D. Hepatitis B
Explanation: ***Correct: BCG*** - The **BCG vaccine** (Bacille Calmette-Guérin) is the only vaccine given at birth specifically to protect against **tuberculosis** - It is administered at birth or as early as possible as part of the **National Immunization Schedule** - BCG is particularly important in India due to the high burden of tuberculosis *Incorrect: Measles* - The **measles vaccine** is given at **9 months of age**, not at birth - Early administration is less effective due to the presence of **maternal antibodies** that can interfere with vaccine response *Incorrect: OPV* - While **OPV zero dose (OPV0)** is also given at birth for early polio protection, it protects against **poliomyelitis**, not tuberculosis - OPV is followed by subsequent doses at 6, 10, and 14 weeks *Incorrect: Hepatitis B* - **Hepatitis B birth dose** is also given within 24 hours of birth to prevent **vertical transmission** - However, it protects against **Hepatitis B virus infection**, not tuberculosis
Question 2: A mother brings her 9 month old child for vaccination. Which of the following statements is false regarding immunization of Japanese encephalitis?
- A. Live vaccine SA 14-14-2 is administered intramuscularly (Correct Answer)
- B. 2 doses are recommended at age 9 months and 18 months
- C. The live attenuated vaccine can be given to adolescents
- D. The strain used for live vaccine is JE strain SA 14-14-2
Explanation: ***Live vaccine SA 14-14-2 is administered intramuscularly*** - The live attenuated **JE vaccine SA 14-14-2** is approved for subcutaneous (SC) administration, not intramuscular (IM). - While some vaccines are given IM, the specific instructions for this live JE vaccine specify the **subcutaneous route**. *2 doses are recommended at age 9 months and 18 months* - This statement is **true** for the live attenuated Japanese Encephalitis vaccine, as two doses at 9 and 18 months provide good long-term protection. - This schedule is commonly adopted in JE-endemic regions for comprehensive immunization. *The live attenuated vaccine can be given to adolescents* - This statement is **true**, as the live attenuated JE vaccine is approved for use across a wide age range, including adolescents, for primary immunization or as a booster. - The vaccine is generally well-tolerated and effective in this age group. *The strain used for live vaccine is JE strain SA 14-14-2* - This statement is **true**; the **SA 14-14-2 strain** is the most widely used and well-characterized live attenuated Japanese Encephalitis vaccine globally. - It has demonstrated high efficacy and a good safety profile in preventing JE caused by various genotypes.
Question 3: A patient with the following feature shown in the image. The patient reports having another 3-year-old sibling at home, who is fully immunized as per the immunization schedule. What is the best measure to prevent diphtheria in the sibling of the child with diphtheria?
- A. Give diphtheria toxoid booster
- B. Give a full course of DPT vaccine
- C. Give prophylactic erythromycin (Correct Answer)
- D. Nothing is required to be done
Explanation: ***Correct: Give prophylactic erythromycin*** - Erythromycin is the **recommended antimicrobial prophylaxis** for close contacts of diphtheria patients to eradicate *Corynebacterium diphtheriae* carriage. - This prevents asymptomatic carriers from transmitting the bacteria, even if vaccinated, as vaccination provides immunity against the toxin, not necessarily against carriage. *Incorrect: Give diphtheria toxoid booster* - While immunization reduces the risk of symptomatic diphtheria disease by inducing **antitoxin immunity**, it does not reliably prevent nasal or pharyngeal carriage of the bacteria. - A booster might be considered if the last dose was more than 5 years ago, but it is not the primary immediate measure to prevent transmission from a known contact. *Incorrect: Give a full course of DPT vaccine* - The patient's sibling is already reported to be **fully immunized**, implying they have received the appropriate doses of the DPT vaccine according to the immunization schedule. - Giving a full course when already immunized would be redundant and ineffective to prevent immediate exposure and potential carriage. *Incorrect: Nothing is required to be done* - Close contacts of diphtheria cases are at **high risk of acquiring and transmitting the infection**, even if they are fully immunized, as immunization protects against the toxin but not necessarily carriage. - Failure to intervene would allow potential colonization and transmission, posing a risk to the community and the contact themselves.
Question 4: Neonatal tetanus prevention is best done by which antenatal measure?
- A. Tetanus toxoid (Correct Answer)
- B. Tetanus immunoglobulin
- C. Antibiotics (e.g., Penicillin)
- D. Antibiotics (e.g., Metronidazole)
Explanation: ***Tetanus toxoid*** - **Tetanus toxoid vaccination** of pregnant women stimulates **active immunity** in the mother, leading to production of protective antibodies. - These maternal IgG antibodies cross the placenta and provide **passive immunity** to the fetus/neonate, protecting against neonatal tetanus. - Neonatal tetanus is often acquired through umbilical stump infection with *Clostridium tetani* spores in unhygienic delivery conditions. - **WHO recommends** at least 2 doses of TT during pregnancy for prevention of neonatal tetanus. *Tetanus immunoglobulin* - **Tetanus immunoglobulin (TIG)** provides immediate **passive immunity**, but its effect is short-lived (3-4 weeks). - It's used for **post-exposure prophylaxis** or treatment in individuals who are unimmunized or inadequately immunized. - Not practical or recommended for routine antenatal prevention due to short duration, high cost, and need for repeated administration. *Antibiotics (e.g., Penicillin)* - While penicillin can be used as part of **tetanus treatment** to kill *Clostridium tetani* bacteria, it does not provide **preventive immunity** to the fetus. - Antibiotics do not neutralize the tetanus toxin or provide antibodies for passive immunity. - They have no role in antenatal prevention of neonatal tetanus. *Antibiotics (e.g., Metronidazole)* - **Metronidazole** is another antibiotic used to treat *Clostridium tetani* infection. - Like penicillin, it does not confer **immunity** (active or passive) to the neonate. - Not an effective antenatal measure for preventing neonatal tetanus.
Question 5: At what age is the first dose of Measles vaccination given under the Universal Immunization Programme (UIP)?
- A. 10 weeks
- B. 9 months (Correct Answer)
- C. 14 weeks
- D. 6 months
Explanation: ***9 months*** - The first dose of the **Measles-Rubella (MR) vaccine** is given at **9 months of age** as per India's Universal Immunization Programme (UIP). - This timing is chosen because **maternal antibodies** against measles, which can interfere with vaccine effectiveness, generally wane by this age. - A second dose is given at **16-24 months** to ensure adequate protection (Note: Some countries use MMR vaccine which includes mumps component as well). *10 weeks* - This age is associated with the administration of other routine vaccinations like **Pentavalent vaccine (DPT-HepB-Hib)** and **OPV/IPV**, not measles. - Administering the measles vaccine too early, when **maternal antibodies** are still high, leads to suboptimal immune response. *14 weeks* - This is when the **third dose of Pentavalent vaccine and OPV/IPV** are given as part of the routine immunization schedule. - This age is not the standard recommendation for initial measles vaccination. *6 months* - While specific high-risk situations (e.g., outbreaks or travel to endemic areas) might warrant an additional measles vaccine dose at 6 months, it is **not the routine recommended age** for the first dose. - At 6 months, there may still be sufficient **maternal antibodies** to interfere with vaccine efficacy, leading to poorer immune response compared to vaccination at 9 months. - If given at 6 months during outbreaks, the child still receives routine doses at 9 months and 16-24 months.
Question 6: 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 7: Smallpox eradication was not due to:
- A. Highly effective vaccine
- B. Cross-immunity with animal pox virus (Correct Answer)
- C. Subclinical infections do not transmit the disease
- D. Life long immunity
Explanation: ***Cross-immunity with animal pox virus*** - While cowpox provided the basis for the smallpox vaccine, **cross-immunity with naturally circulating animal pox viruses** did not contribute to the eradication of smallpox itself. - The eradication was achieved through targeted vaccination campaigns with a **human-specific vaccine**, not by incidental cross-protection from wildlife. *Highly effective vaccine* - The smallpox vaccine was highly effective, providing **strong and long-lasting immunity** against the Variola virus. - This effectiveness was crucial for establishing herd immunity and breaking the chains of transmission. *Subclinical infections do not transmit the disease* - Individuals infected with smallpox either developed **symptomatic disease** or were **immune/resistant** to infection. - The absence of asymptomatic carriers who could silently transmit the virus made it feasible to interrupt transmission through targeted vaccination and surveillance. *Life long immunity* - Both natural infection and successful vaccination provided **long-lasting, often lifelong immunity** to smallpox. - This durable immunity prevented reinfection and helped sustain the protection achieved through vaccination campaigns over time.
Question 8: A 2-year-old child diagnosed provisionally with diphtheria and on examination she has greyish white membrane patch around her tonsils. The child has a 6-year-old sibling at home, who is fully immunized as per the schedule. What is the best measure to prevent disease in the sibling of the child?
- A. Prophylactic erythromycin to be given (Correct Answer)
- B. Nothing is required to be done
- C. Full course of DPT
- D. Booster dose of DPT
Explanation: ***Prophylactic erythromycin to be given*** - All **close contacts** of a diphtheria patient, regardless of their immunization status, should receive **antibiotic prophylaxis** to eliminate carriage of *C. diphtheriae*. - **Erythromycin** is a commonly recommended antibiotic for this purpose, given its effectiveness against the bacteria. *Nothing is required to be done* - This is incorrect because, even if immunized, a close contact can still be a **carrier** of *C. diphtheriae* and transmit the infection to others. - **Diphtheria toxin** can still be produced by carriers, posing a risk of disease development if not cleared. *Full course of DPT* - This is unnecessary for a fully immunized child; a full course is typically for **unimmunized** or **incompletely immunized** - **Antibiotic prophylaxis** is the immediate priority for preventing illness in contacts. *Booster dose of DPT* - A booster dose offers **active immunity** but does not immediately address potential asymptomatic carriage of *C. diphtheriae*. - The primary goal for a contact is to eliminate the bacteria, which antibiotics can achieve more rapidly.
Question 9: Best means of giving hepatitis B vaccine is
- A. Intramuscular deltoid (Correct Answer)
- B. Intradermal
- C. Subcutaneous
- D. Intramuscular gluteal
Explanation: ***Intramuscular deltoid*** - The **deltoid muscle** is the recommended site for hepatitis B vaccine administration in adults and older children due to its muscle mass and distance from major nerves and vessels. - This route ensures proper absorption and immunogenicity, leading to an optimal **antibody response**. *Intradermal* - This route is typically reserved for vaccines that require a small dose and a localized immune response, such as the **BCG vaccine**. - It's not recommended for hepatitis B vaccine as it can lead to reduced efficacy and a less robust immune response. *Subcutaneous* - **Subcutaneous administration** might be considered in individuals with bleeding disorders, but it generally leads to a less consistent and potentially weaker immune response for hepatitis B vaccination. - It's a second-line route when intramuscular injection is contraindicated, not the primary method. *Intramuscular gluteal* - The **gluteal muscle** is not the preferred site for vaccines due to the risk of injury to the **sciatic nerve** and the potential for injection into adipose tissue rather than muscle, which can compromise vaccine efficacy. - While intramuscular, absorption can be less predictable compared to the deltoid, especially in adults.
Question 10: A 9-month-old infant is brought to you for immunization. The infant has previously received the first dose of OPV and DPT. What will you do ?
- A. Give the infant second dose of DPT/OPV (Correct Answer)
- B. Give the infant DT/OPV
- C. Repeat the first dose counting afresh
- D. Give the infant a booster dose of DPT/Polio
Explanation: ***Give the infant second dose of DPT/OPV*** - As per the **Expanded Programme on Immunization (EPI)** guidelines, even if there's a delay, one should **continue the vaccination schedule** from where it left off, rather than restarting. - The 9-month-old is due for the **second dose of DPT and OPV**, as the first dose has already been administered. *Give the infant DT/OPV* - **DT (Diphtheria and Tetanus)** vaccine is generally given to older children who have contraindications to the pertussis component of DPT or as part of a different schedule. - At 9 months, the infant still requires the **pertussis component** for protection against whooping cough. *Repeat the first dose counting afresh* - There is **no clinical or immunological basis** for restarting the vaccination schedule (counting afresh) simply because of a delay. - Antibodies from the first dose are still present and contribute to the immune response upon subsequent doses; hence, previous doses are **considered valid**. *Give the infant a booster dose of DPT/Polio* - A **booster dose** is typically given much later in childhood (e.g., at 18 months or 5 years) to enhance and prolong immunity after the primary series is completed. - The infant first needs to **complete the primary series** of DPT and OPV, which involves a second and third dose.
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