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: Identify person shown in the image below:

Edward Jenner. ***Edward Jenner*** - Edward Jenner is widely recognized as the pioneer of the **smallpox vaccine**, a foundational discovery in immunology and public health. - His work in the late 18th century involved inoculating individuals with material from **cowpox lesions** to confer immunity against smallpox. *Louis Pasteur* - Louis Pasteur is renowned for his groundbreaking work on **germ theory**, showing that microbes cause diseases. - He developed vaccines for **rabies and anthrax**, and invented the process of pasteurization. *James Lind* - James Lind is famous for his work on **scurvy**, demonstrating in one of the first controlled clinical trials that citrus fruits could prevent and cure it. - His legacy is primarily in nutritional science and epidemiology, not vaccination. *William Harvey* - William Harvey was an English physician who was the first to describe accurately how **blood is pumped around the body by the heart** and proposed that the heart is crucial for the circulation of blood. - His contributions are central to cardiology and understanding the circulatory system but are unrelated to immunology or vaccination.

Q: All are correct regarding the following route of vaccine administration except:

Higher antigenic dose. ***Higher antigenic dose*** - The image depicts the **oral route of vaccine administration**, often used for vaccines like the oral polio vaccine (OPV). This route typically involves a **lower antigenic dose** compared to inactivated parenteral vaccines. - Oral vaccines are designed to replicate in the gut (live attenuated vaccines), generating a robust immune response despite a smaller initial dose. *Induces both systemic and mucosal immunity* - **Oral vaccines**, particularly live attenuated ones such as OPV, effectively stimulate both **mucosal immunity** in the gut and **systemic immunity**. - The local intestinal 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 orally administered antigens, including vaccines. - This anatomical location plays an important role in the early immune recognition and processing of oral vaccines. *Higher compliance* - Oral vaccine administration 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: A child has developed this complication after vaccination. Which is the vaccine responsible?

BCG. ***BCG*** - The image shows **regional lymphadenopathy** (BCG adenitis/lymphadenitis) in a child, likely involving the **ipsilateral axillary lymph nodes**, indicated by the swelling in the shoulder/axillary region. This is a well-recognized complication of the **BCG vaccine**. - BCG vaccine, especially in infants, can cause localized reactions including **lymphadenitis** in the ipsilateral axilla or supraclavicular regions (occurs in **0.1-4.3%** of vaccinated infants). - Typically appears **2-6 months post-vaccination** and may progress to **suppuration, caseous necrosis**, and occasionally sinus/fistula formation. - **Management:** Most cases resolve spontaneously with observation; aspiration (not incision) may be needed for large fluctuant nodes; antitubercular therapy reserved for severe cases. *MMR* - The MMR vaccine (Measles, Mumps, Rubella) is a **live attenuated vaccine** but does not typically cause regional lymphadenopathy as a common complication. - Common side effects of MMR include **fever** (5-15 days post-vaccination), **transient rash**, and **arthralgia/arthritis** (especially in adult women), not the significant localized lymphatic swelling seen in the image. *DPT* - The DPT vaccine (Diphtheria, Pertussis, Tetanus) is an **inactivated vaccine** known for **local reactions at the injection site**, such as redness, swelling, and pain. - May cause fever and irritability, but does not commonly cause **regional lymphadenopathy** distal to the injection site, nor the type of persistent nodal swelling depicted. *Hepatitis B* - The Hepatitis B vaccine is an **inactivated recombinant subunit vaccine**. Its side effects are generally mild and localized. - Local side effects include **pain, swelling, and redness at the injection site**, but it is not associated with significant **regional lymphadenopathy** or suppurative lymphadenitis.

Q: All are correct about the vaccine shown except:

Recommended in all women in age group 25-45 years. ***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.

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 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.

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

Identify person shown in the image below:

Accepted Answer

Edward Jenner

Answer

Louis Pasteur

Answer

James Lind

Answer

William Harvey

Question 7

All are correct regarding the following route of vaccine administration except:

Accepted Answer

Higher antigenic dose

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:

Accepted Answer

Recommended in all women in age group 25-45 years

Answer

Bivalent

Answer

Recombinant vaccine

Answer

3 dosages

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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