Immunization and Vaccine-Preventable Diseases Practice Questions

Q: Consider the following statements regarding Vaccine Vial Monitor (VVM) on the vial of oral polio vaccine : The vaccine is not potent and should be discarded 1. if the colour of the small square within the circle is lighter in colour than that of the circle 2. if the small square within the circle is of the same colour as the circle 3. if the small square within the circle is darker in colour than the colour of the circle Which of the statements given above is/are correct?

2 and 3. ***2 and 3*** - A vaccine vial is considered **not potent and should be discarded** if the inner square is the **same color as or darker than** the outer circle, as this indicates **heat exposure** reducing vaccine efficacy. - **Statement 2** (same color) indicates the vaccine has reached the **discard point** due to cumulative heat exposure, and **statement 3** (darker color) indicates the vaccine is **beyond the discard point**, both requiring immediate disposal. - VVMs are crucial for ensuring **cold chain integrity**; the color change of the inner square relative to the outer circle signifies cumulative heat damage and loss of potency. *2 only* - While statement 2 correctly identifies that a vaccine should be discarded when the inner square is the **same color** as the outer circle, this option **omits statement 3**. - Statement 3 (darker inner square) also correctly indicates the vaccine should be discarded, making this option **incomplete**. *1 only* - This statement is **incorrect** because a **lighter inner square** compared to the outer circle indicates that the vaccine has been exposed to **minimal heat**, meaning the vaccine is **still potent and safe to use**. - A lighter inner square is the **ideal state** for a VVM, signifying a correctly maintained cold chain; the vaccine should **NOT be discarded** in this scenario. *1 and 2* - Statement 1 is **incorrect** because when the inner square is **lighter** than the outer circle, the vaccine remains **potent and should continue to be used**, not discarded. - Only statement 2 is correct in this combination, but statement 3 is also correct and should be included, making this option wrong.

Q: Which one of the following is an absolute contraindication for administration of killed vaccine?

Severe reaction to a previous dose. ***Severe reaction to a previous dose*** * A **severe allergic reaction** (e.g., **anaphylaxis**) to a previous dose of any vaccine or its components is an **absolute contraindication** to further doses of that vaccine. * This is due to the potential for a life-threatening anaphylactic response upon re-exposure to the allergen. *Hodgkin's disease* * While Hodgkin's disease is a **malignancy** that can affect the immune system, it is generally considered a **precaution** or a reason to defer live vaccines, not an absolute contraindication for killed vaccines. * **Killed vaccines** are generally safe in immunocompromised patients, though their efficacy may be reduced. *Pregnancy* * **Pregnancy** is a contraindication for certain **live attenuated vaccines** (e.g., MMR, varicella) due to the theoretical risk of fetal infection. * However, most **killed vaccines** (e.g., inactivated influenza, tetanus, diphtheria, acellular pertussis) are **safe and often recommended** during pregnancy for maternal and fetal protection. *Immunodeficiency* * **Immunodeficiency** (e.g., HIV/AIDS, chemotherapy) is primarily a contraindication for **live attenuated vaccines**, as these can cause disseminated infection in immunocompromised individuals. * **Killed vaccines** are generally safe in immunocompromised individuals, although the **immune response may be suboptimal**, and repeat doses or higher doses may be necessary.

Q: Match List-I with List-II and select the correct answer using the code given below the Lists:

A→4 B→3 C→1 D→2. ***A→4 B→3 C→1 D→2*** - **Oral polio vaccine (OPV)** is a live attenuated vaccine, and a rare but serious adverse effect is vaccine-associated paralytic poliomyelitis (VAPP), which manifests as **paralysis**. - **BCG vaccine** (Bacillus Calmette-Guérin) is used against tuberculosis. A known adverse effect, particularly in immunocompromised individuals, is **suppurative lymphadenitis**, where regional lymph nodes become inflamed and may form abscesses. - **Pertussis vaccine** (whole-cell DTP) can cause reactions such as persistent inconsolable screaming, high fever, and, very rarely, encephalopathy. **Persistent inconsolable screaming** is a recognized adverse reaction to the pertussis component. - **Measles vaccine** is a live attenuated vaccine. While generally safe, rare severe adverse effects include **encephalopathy** (or encephalitis). *A→3 B→4 C→1 D→2* - This option incorrectly associates oral polio vaccine with suppurative lymphadenitis and BCG with paralysis, contradicting established vaccine adverse effects. - Oral polio has a risk of paralysis, not lymphadenitis, whereas BCG can cause lymphadenitis. *A→2 B→1 C→4 D→3* - This option incorrectly links oral polio to encephalopathy and BCG to persistent inconsolable screaming. - Encephalopathy is associated with measles or pertussis, and persistent screaming with pertussis, not oral polio or BCG. *A→1 B→2 C→3 D→4* - This option incorrectly attributes persistent inconsolable screaming to oral polio and encephalopathy to BCG. - Paralysis is a known complication of oral polio, and suppurative lymphadenitis is a key adverse effect of BCG.

Q: Which of the following vaccines has NOT been introduced in the Universal Immunization Programme in India?

Cervical cancer vaccine. ***Cervical cancer vaccine (HPV vaccine)*** ✓ **Correct Answer (as of 2017)** - At the time of this examination (UPSC-CMS 2017), the **HPV vaccine** had NOT been introduced into the Universal Immunization Programme (UIP) in India. - While pilot studies were conducted, nationwide rollout had not occurred. - **Update**: India officially introduced HPV vaccination in the UIP in 2024 for girls aged 9-14 years, but this question reflects the 2017 status. *Injectable polio vaccine (IPV)* - The **Injectable Polio Vaccine (IPV)** was introduced into the UIP in **2015** in a phased manner. - IPV was added alongside the oral polio vaccine (OPV) to provide additional protection and prevent **vaccine-derived poliovirus** cases. - Essential for maintaining India's polio-free status achieved in 2014. *MR vaccine (incorrectly listed as MMR)* - India's UIP includes the **MR vaccine (Measles-Rubella)**, NOT MMR. - **Measles vaccine** was part of UIP since its inception; **Rubella** was added in phased campaigns starting 2017. - **Mumps vaccine is NOT part of routine UIP** - it's only available privately. - The option should technically say "MR vaccine" for accuracy, but MMR was listed in the original question. *Pentavalent vaccine* - The **pentavalent vaccine** was introduced in UIP starting **2011** (phased) and nationwide by 2015. - Protects against five diseases: **Diphtheria, Pertussis, Tetanus, Hepatitis B, and Haemophilus influenzae type b (Hib)**. - Replaced the earlier DPT + Hepatitis B + Hib schedule, reducing injection burden.

Q: With reference to Vaccine Vial Monitors (VVM) being used on vaccine vials, which of the following statements is/are correct? 1. It gives information about heat exposure over a period of time 2. It directly indicates vaccine potency Select the correct answer using the code given below:

1 only. ***1 only*** - **Vaccine Vial Monitors (VVMs)** are designed to show **cumulative heat exposure** over time, indicating whether a vaccine has been stored within an acceptable temperature range throughout its shelf life. - The color change of the VVM helps healthcare workers determine if a vaccine has been exposed to excessive heat, which can compromise its quality. - VVMs are time-temperature indicators that change color progressively based on both duration and degree of heat exposure. *2 only* - VVMs do **not directly measure vaccine potency**. While excessive heat exposure indicated by a VVM can *imply* reduced potency, the VVM itself does not provide a quantitative measure of a vaccine's effectiveness. - Vaccine potency can only be accurately assessed through specific laboratory tests, not by a visual indicator on the vial. - The VVM is an **indirect indicator** of potential potency loss through monitoring storage conditions. *Neither 1 nor 2* - This is incorrect because statement 1 is accurate - VVMs do provide information about cumulative heat exposure over time. - VVMs are crucial tools in cold chain management for monitoring vaccine storage conditions. *Both 1 and 2* - This is incorrect because while VVMs do indicate heat exposure (statement 1 is correct), they do **not directly** indicate vaccine potency (statement 2 is incorrect). - It's important to differentiate between an indicator of proper storage conditions and a direct measure of efficacy.

Q: At the end of an immunization session, you found that a reconstituted BCG vaccine vial has around two doses left in it. What should be done in such a situation?

Discard the vial in a red coloured bin. ***Discard the vial in a red coloured bin*** - **Reconstituted BCG vaccine must be discarded at the end of the immunization session** or after **4 hours of reconstitution**, whichever comes first, as per WHO and India's Universal Immunization Programme (UIP) guidelines - This is because reconstituted BCG is **highly susceptible to bacterial contamination** and loses potency over time - **Red coloured bin** is used for **contaminated waste** including discarded vaccine vials in the biomedical waste management system (though yellow bins are sometimes used for pharmaceutical waste) - The multi-dose vial policy based on VVM status applies to **unopened/non-reconstituted vaccines**, not to already reconstituted vaccines *Take decision depending upon the Vaccine Vial Monitor (VVM) status* - VVM status is checked **before opening or reconstituting** the vaccine vial, not after reconstitution - For **reconstituted vaccines** like BCG, the time limit (4 hours or end of session) takes precedence over VVM considerations - VVM-based multi-dose vial policy does not apply to already reconstituted vaccines *Can reuse the remaining two doses during the next immunization session* - This is **completely incorrect** and dangerous - Reconstituted BCG must be discarded after **4 hours** or at the **end of the session**, whichever is earlier - Reusing reconstituted BCG poses serious risks of **bacterial contamination** and **loss of vaccine potency** *Discard the vial in a black coloured bin* - Black bins are used for **general non-hazardous waste**, not for biomedical waste - Vaccine vials must be disposed of as **biomedical waste** in red or yellow bins, not black bins

Q: Which is the first step in carrying out an Adverse Event Following Immunization (AEFI)?

Confirm information in report. ***Confirm information in report*** - The initial and crucial step is to **verify the accuracy and completeness of the reported information** to ensure reliable data for further investigation. - This involves checking details such as the **patient's demographics, vaccine administered, date of vaccination, and the reported adverse event** itself. *Collect data about the suspected vaccine* - While essential for an AEFI investigation, **collecting specific vaccine data comes after confirming the initial report**, as you first need a verified event to investigate. - This step focuses on the **vaccine's batch number, expiry date, and manufacturer**, which are vital for causality assessment but not the very first action. *Observe the immunization service in action* - **Observing the immunization service** is a step that might be taken later in an investigation if a program error or procedural issue is suspected, not the immediate first step for an individual AEFI. - This helps identify **potential programmatic errors** in vaccine administration or storage, which is a downstream investigative measure. *Formulate a working hypothesis* - **Formulating a working hypothesis** is part of the analytical phase of an AEFI investigation, which occurs after initial data collection and confirmation, not as the very first step. - A hypothesis guides further investigation into potential causes but requires **initial confirmed data** to be meaningful.

Q: 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?

When the child completes nine months of age. ***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.

Q: Which of the following vaccines are given through the intramuscular route? 1. BCG vaccine 2. Hepatitis B vaccine 3. Pentavalent vaccine 4. Inactivated Polio vaccine

2, 3 and 4. ***2, 3 and 4*** - The **Hepatitis B vaccine**, **Pentavalent vaccine** (DPT-Hib-HepB), and **Inactivated Polio Vaccine (IPV)** are all administered via the **intramuscular (IM)** route to ensure proper absorption and immune response. - Intramuscular injection is preferred for these vaccines to deliver antigens directly into muscle tissue, promoting effective antigen-presenting cell uptake. *1, 2 and 3* - This option incorrectly includes the **BCG vaccine**, which is administered intradermally, not intramuscularly. - The **BCG vaccine** creates a localized immune response in the skin, which is crucial for its protective mechanism against tuberculosis. *1, 3 and 4* - This combination is incorrect because it includes the **BCG vaccine**, which is given intradermally. - Administering **BCG intramuscularly** could lead to adverse reactions and reduce vaccine efficacy. *1, 2 and 4* - This option is incorrect as it again includes the **BCG vaccine**, which is administered **intradermally**. - Proper route of administration is critical for vaccine safety and effectiveness, and only **Hepatitis B, Pentavalent, and IPV** are given intramuscularly among the listed choices.

Question 1

Consider the following statements regarding Vaccine Vial Monitor (VVM) on the vial of oral polio vaccine :
The vaccine is not potent and should be discarded

1. if the colour of the small square within the circle is lighter in colour than that of the circle

2. if the small square within the circle is of the same colour as the circle

3. if the small square within the circle is darker in colour than the colour of the circle
Which of the statements given above is/are correct?

Accepted Answer

2 and 3

Answer

1 only

Answer

1 and 2

Answer

2 only

Question 2

Which one of the following is an absolute contraindication for administration of killed vaccine?

Accepted Answer

Severe reaction to a previous dose

Answer

Hodgkin's disease

Answer

Pregnancy

Answer

Immunodeficiency

Question 3

Match List-I with List-II and select the correct answer using the code given below the Lists:

Accepted Answer

A→4  B→3  C→1  D→2

Answer

A→3  B→4  C→1  D→2

Answer

A→2  B→1  C→4  D→3

Answer

A→1  B→2  C→3  D→4

Question 4

Which of the following vaccines has NOT been introduced in the Universal Immunization Programme in India?

Accepted Answer

Cervical cancer vaccine

Answer

Injectable polio vaccine

Answer

MMR vaccine

Answer

Pentavalent vaccine

Question 5

With reference to Vaccine Vial Monitors (VVM) being used on vaccine vials, which of the following statements is/are correct?

1. It gives information about heat exposure over a period of time
2. It directly indicates vaccine potency

Select the correct answer using the code given below:

Accepted Answer

1 only

Answer

2 only

Answer

Neither 1 nor 2

Answer

Both 1 and 2

Question 6

At the end of an immunization session, you found that a reconstituted BCG vaccine vial has around two doses left in it. What should be done in such a situation?

Accepted Answer

Discard the vial in a red coloured bin

Answer

Discard the vial in a black coloured bin

Answer

Take decision depending upon the Vaccine Vial Monitor (VVM) status

Answer

Can reuse the remaining two doses during the next immunization session

Question 7

Which is the first step in carrying out an Adverse Event Following Immunization (AEFI)?

Accepted Answer

Confirm information in report

Answer

Collect data about the suspected vaccine

Answer

Observe the immunization service in action

Answer

Formulate a working hypothesis

Question 8

A pregnant woman visits a medical officer for an antenatal check up. The woman mentions that she had received two doses of Tetanus Toxoid vaccine four years ago. Which of the following steps should the medical officer take with regard to administration of Tetanus Toxoid vaccine as per the Government of India recommended schedule?

Accepted Answer

Two doses of Tetanus Toxoid vaccine should be administered with an interval of four weeks between the two doses

Answer

No Tetanus Toxoid vaccine is required

Answer

Only one dose of Tetanus Toxoid vaccine is required

Answer

Tetanus Immunoglobulin should be administered in the third trimester of pregnancy

Question 9

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?

Accepted Answer

When the child completes nine months of age

Answer

Not required

Answer

When the child completes fifteen months of age

Answer

After four weeks

Question 10

Which of the following vaccines are given through the intramuscular route?

1. BCG vaccine
2. Hepatitis B vaccine
3. Pentavalent vaccine
4. Inactivated Polio vaccine

Accepted Answer

2, 3 and 4

Answer

1, 2 and 3

Answer

1, 3 and 4

Answer

1, 2 and 4

Immunization and Vaccine-Preventable Diseases — MCQs

Immunization and Vaccine-Preventable Diseases — MCQs

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