Immunization and Vaccine-Preventable Diseases Practice Questions

Q: Which vaccine is contraindicated in pregnancy?

Varicella. ***Varicella (Correct Answer)*** - This is a **live attenuated vaccine** that is **contraindicated in pregnancy** due to the theoretical risk of causing congenital infection, such as **fetal varicella syndrome** - Vaccination should be postponed until the **postpartum period** - If an unprotected pregnant woman is exposed, **Varicella-Zoster Immune Globulin (VZIG)** may be indicated *Influenza (Incorrect)* - The **inactivated influenza vaccine** (injectable form) is **recommended and safe** for all pregnant women, regardless of the trimester - Vaccination protects both the mother and the newborn by reducing the risk of severe **influenza-related morbidity** in the mother - Provides passive antibody transfer to protect the infant during the first 6 months of life *Rabies (Incorrect)* - This is an **inactivated (non-live) vaccine** that is **safe to administer during pregnancy** if post-exposure prophylaxis (**PEP**) is indicated - The necessity of protection against a life-threatening disease like **rabies** outweighs the minimal risks associated with the inactivated vaccine - No contraindication in pregnancy when indicated *TDaP (Incorrect)* - TDaP (**Tetanus, Diphtheria, and acellular Pertussis**) is a **recommended non-live vaccine** given during *every* pregnancy - Ideally administered between **27-36 weeks of gestation** to ensure maximum maternal antibody transfer to the fetus - Provides passive immunity to the newborn against **pertussis** (whooping cough), protecting vulnerable infants

Q: A PLHIV came with multiple dog bites with a punctured wound. Choose the correct management:

Local Treatment + RIG + Vaccine. ***Local Treatment + RIG + Vaccine***- This regimen is mandatory for **Category III** rabies exposure, defined by single or multiple transdermal bites or scratches, which includes the described punctured wounds.- **Rabies Immunoglobulin (RIG)**, providing passive immediate protection, must be infiltrated into and around the wound, followed by the complete scheduled series of the Rabies **Vaccine** to establish long-term active immunity.*Local wound cleaning*- While immediate and thorough local wound cleaning with soap, water, and an antiseptic is the **most crucial first step**, it is insufficient alone for preventing rabies transmission in a Category III exposure.- Punctured wounds carry a high risk of deep inoculation, necessitating both passive (**RIG**) and active (**Vaccine**) immunization immediately.*Vaccine*- The **rabies vaccine** provides active immunity, but this protection takes several days to weeks to develop.- In high-risk, severe exposures (Category III), immediate passive immunity via **Rabies Immunoglobulin (RIG)** is essential to neutralize the virus before the vaccine takes effect.*Local Treatment + RIG*- This approach provides immediate passive neutralization through **RIG** and effective wound management, but it critically omits the **rabies vaccine**.- Omission of the vaccine prevents the development of necessary long-term protective active immunity, leaving the patient vulnerable after the short-term effect of RIG wanes.

Q: Which of the following is the schedule of the OPV vaccine?

6th week, 10th week and 14th week. ***6th week, 10th week and 14th week***- This schedule represents the **primary series** of Oral Polio Vaccine (OPV-1, OPV-2, and OPV-3) doses given in the National Immunization Schedule (NIS).- These doses are administered 4 weeks apart, starting at 6 weeks of age, and are crucial for developing robust immunity against the **poliovirus**.*6th week, 10th week & 9th month*- Although the 6th and 10th weeks are correct for the first two primary doses, the third dose should be administered at the **14th week**, not the 9th month.- The 9th month is the typical schedule point for the first dose of **Measles/MR vaccine** and **Vitamin A supplementation**, not a primary OPV dose.*6th week, 14th week & 9th month*- This schedule incorrectly misses the required **10th-week** dose, which interrupts the recommended 4-week spacing for the primary series of OPV.- Furthermore, the inclusion of the **9th month** timing incorrectly substitutes the proper 14th-week slot for the third primary dose.*6 to 12 weeks*- This describes a broad time window and is not the specific, thrice-repeated dosing schedule required for the **OPV primary series** (OPV-1, OPV-2, and OPV-3).- The standard schedule involves three distinct doses timed precisely at **6, 10, and 14 weeks** of age to achieve high seroconversion rates.

Q: A patient comes with a history of category 3 dog bites. He received prophylaxis for a monkey bite 6 months back. What is the next step in management?

Wound cleaning+ rabies vaccine on day 0 & 3. ***Wound cleaning+ rabies vaccine on day 0 & 3***- Since the patient received prophylaxis 6 months ago, they are considered **previously immunized**, meaning **Rabies Immunoglobulin (RIG)** is *not* required, even for a **Category 3 bite**.- For a previously immunized individual with a Category III exposure, the required management is a **booster regimen** consisting of the rabies vaccine given on **Day 0** and **Day 3** (two doses). *Wound cleaning only*- This action is inadequate for managing a **Category 3 bite**, which involves severe exposure like deep puncture wounds or mucosal contamination.- Even in previously vaccinated individuals, a **booster dose** is necessary to ensure adequate and rapid protective antibody levels against the high viral load typical of a severe animal bite. *Wound cleaning+rabies vaccine on day 0,3 & 7*- While this 3-dose schedule is sometimes used, the **standard recommended booster regimen** for previously immunized individuals with a new Category III exposure is the **2-dose schedule** (Day 0 and Day 3) as per WHO and IAPSM guidelines.- The 2-dose booster is sufficient to rapidly achieve protective antibody titers in individuals who have received complete prior vaccination. *Wound cleaning+IM vaccine +RIG*- The administration of **Rabies Immunoglobulin (RIG)** is unnecessary and contraindicated in patients who have been **previously immunized** with a full course of the rabies vaccine.- RIG is reserved for **unvaccinated** patients with Category II or III exposures to provide immediate passive immunity before the active immune response develops.

Q: Which of the following vials, as shown in the image, can be used for administering vaccines?

1,2. ***Correct: 1,2*** - Vials 1 and 2 show the inner square of the **Vaccine Vial Monitor (VVM)** is lighter than the outer circle, indicating that the vaccine has **not been damaged by heat** and is **safe for administration** (VVM Stages 1 and 2). - The VVM is designed to change color permanently upon exposure to heat, signaling irreversible thermal damage. - According to WHO guidelines, vaccines are usable as long as the inner square is **lighter than the outer ring**. *Incorrect: Only 1* - While Vial 1 (inner square much lighter than the ring) is clearly usable (VVM Stage 1), this option incorrectly excludes Vial 2. - Vial 2 is also **usable** as the inner square is still lighter than the outer ring (VVM Stage 2). - Vaccines remain usable until the inner square reaches the same color intensity as the outer ring. *Incorrect: 1,2,3,4* - Vials 3 and 4 must be **discarded** because their VVMs indicate heat exposure has darkened the inner square. - A vaccine is considered spoilt and unusable if the inner square is the **same color as or darker** than the outer circle. - Including all vials would risk administering heat-damaged vaccines. *Incorrect: 2,4* - Vial 4 is **unusable and must be discarded** because its inner square is clearly much **darker than the outer ring** (VVM Stage 4). - This option incorrectly includes an unusable vial and excludes Vial 1, which is clearly usable.

Q: The accompanying portrait is an unverified artistic illustration for a museum display about the 1796 experiment in which material from a cowpox lesion was used to protect against smallpox. Which historical figure should the display identify as the investigator who performed this experiment?

Edward Jenner. Edward Jenner is correct. In 1796, Jenner inoculated James Phipps with material obtained from a cowpox lesion and later demonstrated protection against smallpox. This work is widely regarded as the first scientifically documented successful vaccination and helped establish vaccination as a method of disease prevention. The portrait should not be used as a verified likeness; the historical description identifies the answer. Louis Pasteur later advanced germ theory and developed vaccines against diseases including anthrax and rabies. James Lind conducted an early controlled trial showing that citrus fruit prevented and treated scurvy. William Harvey accurately described systemic circulation and the heart's role in pumping blood; he was not associated with vaccine development.

Q: All are correct regarding the live attenuated intranasal influenza vaccine (LAIV) except:

It can be administered to immunocompromised individuals. ***It can be administered to immunocompromised individuals*** - LAIV is a **live attenuated vaccine** and is therefore **contraindicated** in immunocompromised individuals (e.g., those with HIV, receiving immunosuppressive therapy, or with primary immunodeficiency). Live vaccines carry a risk of causing disease in immunocompromised hosts due to uncontrolled viral replication. Inactivated influenza vaccines (IIV) are the preferred option for these patients. *Induces both systemic and mucosal immunity* - **LAIV**, as a live attenuated intranasal vaccine, effectively stimulates both **nasopharyngeal mucosal immunity** and **systemic immunity**. - The local nasopharyngeal immune response is crucial for preventing infection and transmission, while systemic antibodies provide broader protection. *Immunity induced at Waldeyer ring* - The **Waldeyer's ring** (tonsils and adenoids) is a collection of lymphoid tissues in the pharynx, which is a key site for initiating immune responses to intranasally administered antigens, including LAIV. - This anatomical location plays an important role in the early immune recognition and processing of intranasal vaccines. *Higher compliance* - Intranasal vaccine administration (e.g., LAIV) is generally **easier and less invasive** than injections, making it more acceptable to children and their parents, leading to **higher compliance rates**. - This ease of administration is particularly beneficial in mass vaccination campaigns.

Q: All are correct about the vaccine shown except (per CDC/ACIP guidelines):

Recommended for all women aged 25–45 years.. ***Recommended for all women aged 25–45 years*** - This statement is incorrect. CDC/ACIP recommends routine HPV vaccination at ages 11–12 years, although vaccination may begin at age 9. - Catch-up vaccination is recommended for everyone through age 26 if not adequately vaccinated earlier. - For adults aged 27–45 years, HPV vaccination is not universally recommended; it may be offered based on shared clinical decision-making. *Bivalent* - Cervarix is a bivalent HPV vaccine that protects against HPV types 16 and 18. - These two types cause the majority of cervical cancers. *Recombinant vaccine* - Cervarix is a recombinant virus-like particle vaccine. It contains no viral DNA and cannot cause HPV infection. *Three doses when vaccination is initiated at age 15 years or older* - Under CDC/ACIP guidelines, a three-dose HPV vaccine schedule is used when the series is initiated at age 15 years or older. - Cervarix historically used a three-dose schedule at 0, 1, and 6 months. - A three-dose schedule is also recommended for immunocompromised persons who initiate vaccination at ages 9–26 years. - Immunocompetent adolescents who initiate vaccination before age 15 generally receive a two-dose schedule.

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

Vaccine cannot be used, irrespective of expiry date. ***Vaccine cannot be used, irrespective of expiry date*** - The image shows a **darker inner square** compared to the outer circle, indicating that the vaccine is **beyond the discard point** and has been exposed to detrimental cumulative heat. - A VVM reading beyond the discard point signifies that cumulative heat exposure has reached or exceeded the discard threshold, and the vaccine should not be administered, regardless of the expiry date. The VVM measures cumulative heat exposure and triggers discard rather than directly proving loss of potency. *Vaccine can be used, if expiry date not passed* - This statement is incorrect because the VVM clearly indicates that **cumulative heat exposure** has exceeded the discard threshold, making it unsuitable for use. - The VVM overrides the expiry date when it shows the vaccine is beyond the discard point, as the heat exposure threshold has been breached even if the vaccine is 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* - The image depicts a VVM that is **beyond the discard point** (inner square darker than outer circle), not merely 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.

Question 1

Which vaccine is contraindicated in pregnancy?

Accepted Answer

Varicella

Answer

TDaP

Answer

Rabies

Answer

Influenza

Question 2

A PLHIV came with multiple dog bites with a punctured wound. Choose the correct management:

Accepted Answer

Local Treatment + RIG + Vaccine

Answer

Local wound cleaning

Answer

Local Treatment + RIG

Answer

Vaccine

Question 3

Which of the following is the schedule of the OPV vaccine?

Accepted Answer

6th week, 10th week and 14th week

Answer

6 to 12 weeks

Answer

6th week, 10th week & 9th month

Answer

6th week, 14th week & 9th month

Question 4

A patient comes with a history of category 3 dog bites. He received prophylaxis for a monkey bite 6 months back. What is the next step in management?

Accepted Answer

Wound cleaning+ rabies vaccine on day 0 & 3

Answer

Wound cleaning only

Answer

Wound cleaning+IM vaccine +RIG

Answer

Wound cleaning+rabies vaccine on day 0,3 & 7

Question 5

Which of the following vials, as shown in the image, can be used for administering vaccines?

Accepted Answer

1,2

Answer

Only 1

Answer

1,2,3,4

Answer

2,4

Question 6

The accompanying portrait is an unverified artistic illustration for a museum display about the 1796 experiment in which material from a cowpox lesion was used to protect against smallpox. Which historical figure should the display identify as the investigator who performed this experiment?

Accepted Answer

Edward Jenner

Answer

Louis Pasteur

Answer

James Lind

Answer

William Harvey

Question 7

All are correct regarding the live attenuated intranasal influenza vaccine (LAIV) except:

Accepted Answer

It can be administered to immunocompromised individuals

Answer

Induces both systemic and mucosal immunity

Answer

Immunity induced at Waldeyer ring

Answer

Higher compliance

Question 8

A child has developed this complication after vaccination. Which is the vaccine responsible?

Accepted Answer

BCG

Answer

MMR

Answer

DPT

Answer

Hepatitis B

Question 9

All are correct about the vaccine shown except (per CDC/ACIP guidelines):

Accepted Answer

Recommended for all women aged 25–45 years.

Answer

Three doses when vaccination is initiated at age 15 years or older

Answer

Recombinant vaccine

Answer

Bivalent

Question 10

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

Accepted Answer

Vaccine cannot be used, irrespective of expiry date

Answer

Vaccine can be used, if expiry date not passed

Answer

Vaccine can be used, after expiry date

Answer

Vaccine is at discard point, consult supervisor

Immunization and Vaccine-Preventable Diseases — MCQs

Immunization and Vaccine-Preventable Diseases — MCQs

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