Immunization and Vaccine-Preventable Diseases Practice Questions

Q: Open vial policy applies to which one of the following vaccines?

Hep B. ***Hepatitis B*** - The **Hepatitis B vaccine** is a **liquid multi-dose vial vaccine** that follows the **Open Vial Policy (OVP)**. - Under OVP, once opened, **Hep B can be used for up to 28 days** if: the vaccine vial monitor (VVM) has not reached the discard point, the expiry date has not passed, vaccines are stored under appropriate cold chain conditions (2-8°C), and the vial has not been contaminated or submerged in water. - **OVP applies specifically to liquid vaccines in multi-dose vials**, helping to reduce vaccine wastage in immunization programs. *BCG* - **BCG is a freeze-dried vaccine** that requires reconstitution before use. - Once reconstituted, BCG must be **discarded after 6 hours or at the end of the immunization session**, whichever is earlier. - This is **NOT classified under OVP** but follows the **reconstituted vaccine policy**. OVP specifically refers to liquid vaccines that can be kept for longer periods (up to 28 days). *Measles* - **Measles vaccine** is also a **freeze-dried vaccine** requiring reconstitution. - Like BCG, once reconstituted it must be **discarded within 6 hours or at the end of the session**. - Does **NOT fall under OVP** as it is not a liquid vaccine. *JE* - **Japanese Encephalitis (JE) vaccine** is a **freeze-dried vaccine** requiring reconstitution. - Must be **discarded within 6 hours** of reconstitution or at the end of the session. - Does **NOT follow OVP** as it requires reconstitution before use. **Key Point:** Open Vial Policy applies only to **liquid multi-dose vial vaccines** (DPT, TT, Hepatitis B, IPV, liquid Pentavalent), NOT to reconstituted vaccines (BCG, Measles, JE) which have a 6-hour discard rule.

Q: Which of the following is a contraindication for BCG vaccination in a newborn?

HIV infection-symptomatic. ***HIV infection-symptomatic*** - **Symptomatic HIV infection** in a newborn is a contraindication for BCG vaccination due to the risk of disseminated BCG disease in immunocompromised individuals. - Live attenuated vaccines like BCG can cause severe, life-threatening infections in individuals with compromised cellular immunity. *Prematurity* - **Prematurity** is generally not an absolute contraindication for BCG vaccination, although vaccination may be deferred until the infant is stable or reaches a certain weight. - The decision to vaccinate a premature infant often depends on the local epidemiology of tuberculosis and the infant's overall health status. *History of Tuberculosis in mother* - A maternal history of tuberculosis is **not a contraindication** for BCG vaccination in a newborn, especially if the newborn has been evaluated and is not actively infected. - Vaccinating infants in contact with TB cases can be an important part of preventing active disease. *Low birth weight* - **Low birth weight** is generally not an absolute contraindication for BCG vaccination, although it might lead to a delayed vaccination schedule. - The vaccine can be safely administered to healthy low birth weight infants, with careful consideration of their overall health.

Q: As per WHO recommendations which one of the following mumps vaccine strains should NOT be used in National Immunization Programme?

Rubini. ***Rubini*** - The **Rubini strain** of mumps vaccine is not recommended by the WHO for national immunization programs due to its **low immunogenicity** and **reduced efficacy**. - Studies have shown that the antibody response and protection offered by the Rubini strain are inferior compared to other widely used mumps vaccine strains. *Jeryl Lynn* - The **Jeryl Lynn strain** is a widely used and well-established mumps vaccine strain, with a good track record of efficacy and safety. - It is one of the strains commonly found in combined measles, mumps, and rubella **(MMR) vaccines** and is recommended by the WHO. *RIT 4385* - **RIT 4385** is another name for the **Jeryl Lynn strain** of mumps vaccine, referring to a specific manufacturing process or original isolate. - As such, it is a recommended and effective strain for national immunization programs. *L-Zagreb* - The **L-Zagreb strain** is a mumps vaccine strain that is also recommended by the WHO for inclusion in national immunization programs due to its demonstrated efficacy and safety profile. - It is used in various parts of the world as a component of MMR vaccines.

Q: Vaccine-associated Paralytic Poliomyelitis (VAPP) is mostly observed due to which of the following vaccine strain serotype?

Type–2 only. ***Type–2 only*** - Vaccine-associated paralytic poliomyelitis (VAPP) is primarily linked to the **Sabin type 2 oral poliovirus vaccine (OPV)** strain. - This is because the type 2 strain in OPV is inherently more neurovirulent and genetically unstable compared to the other serotypes, making it more prone to reverting to a **paralytogenic form**. *Type–1 only* - While type 1 poliovirus can cause wild poliomyelitis and has been part of OPV, it is **less commonly associated with VAPP** compared to type 2. - The type 1 component of OPV is generally more genetically stable and less likely to revert to a neurovirulent form in vaccinated individuals. *Type–3* - Similar to type 1, the type 3 poliovirus strain in OPV is also **less frequently implicated in VAPP** than type 2. - Type 3 poliovirus has been eradicated globally in both its wild and vaccine-derived forms due to successful vaccination campaigns. *Both Type-1 and 2* - Although VAPP can theoretically occur with vaccine strains of both type 1 and type 2, the **overwhelming majority of cases are caused by the type 2 strain**. - The risk of VAPP from type 1 is significantly lower, making "type 2 only" the most accurate answer for the highest incidence.

Q: Hold over time of cold chain equipment depends on all of the following factors EXCEPT:

Types of vaccines kept. ***Types of vaccines kept*** - The **type of vaccine** stored does not directly influence how long the cold chain equipment can maintain its temperature. - The physical parameters of the equipment and its contents, not the biological nature of the vaccines, determine the hold-over time. *Condition of icepack lining* - The **integrity and condition of icepack lining** are crucial as damaged linings can lead to faster melting of ice, reducing the hold-over time. - A good lining ensures optimal insulation and prolonged effectiveness of the icepacks in maintaining cold temperatures. *Ambient temperature* - **Higher ambient temperatures** will naturally cause the cold chain equipment to warm up more quickly, thus reducing its hold-over time. - Conversely, lower ambient temperatures will extend the period for which the equipment can maintain the required temperature range. *Quantity of vaccines kept* - An **increased quantity of vaccines (or other contents)** within the cold chain equipment can influence the hold-over time, particularly if they are not pre-cooled. - The thermal mass of the contents can either help maintain temperature if pre-cooled or absorb cold if warmer, affecting the equilibrium and duration of optimal temperature.

Q: Pentavalent vaccine provides protection against which of the following diseases?

Diphtheria, Pertussis, Tetanus, Hepatitis B and Hib. ***Diphtheria, Pertussis, Tetanus, Hepatitis B and Hib*** - The **Pentavalent vaccine** is a combination vaccine that provides protection against five common childhood diseases. - These five diseases are **Diphtheria**, **Pertussis** (whooping cough), **Tetanus**, **Hepatitis B**, and infections caused by **Haemophilus influenzae type b (Hib)**. *Diphtheria, Pertussis, Tuberculosis, Measles and Hepatitis B* - While it includes **Diphtheria**, **Pertussis**, and **Hepatitis B**, this option incorrectly lists **Tuberculosis** and **Measles** as components. - The vaccine for Tuberculosis is **BCG**, and Measles is part of the MMR vaccine, not the pentavalent vaccine. *Diphtheria, Pertussis, Tetanus, Hepatitis B and Rubella* - This option correctly identifies **Diphtheria**, **Pertussis**, **Tetanus**, and **Hepatitis B** but incorrectly includes **Rubella**. - **Rubella** is typically part of the **MMR vaccine**, not the pentavalent vaccine. *Diphtheria, Pertussis, Measles, Hepatitis B and Hib* - This option correctly includes **Diphtheria**, **Pertussis**, **Hepatitis B**, and **Hib**, but incorrectly lists **Measles**. - **Measles** is administered as part of the **MMR vaccine**, not as a component of the pentavalent vaccine.

Q: Which of the following vaccines should be stored at the lowest level in an Ice-Lined Refrigerator (ILR)?

OPV. ***OPV (Oral Polio Vaccine)*** - **OPV** is a **heat-sensitive** vaccine that requires storage at the **coldest temperature** to maintain its potency. - In the traditional ILR storage protocol, OPV is stored at the **lowest level** (bottom shelf) where the temperature is coldest (0-2°C). - This positioning helps prevent heat degradation of the live attenuated virus. - **Note:** OPV has been largely replaced by IPV in India's routine immunization, but this remains a standard exam concept. *DPT (Diphtheria, Pertussis, Tetanus)* - DPT is a **freeze-sensitive vaccine** that should NOT be stored at the coldest parts of the refrigerator. - Freezing can cause **flocculation** and loss of potency, particularly affecting the pertussis component. - Stored in the **middle shelves** to avoid both freezing and excessive heat. *Hepatitis B* - Hepatitis B vaccine is **highly freeze-sensitive** and can lose efficacy permanently if frozen. - The aluminum adjuvant aggregates when frozen, reducing immunogenicity. - Stored in the **middle or upper shelves**, away from the coldest zone. *Rotavirus Vaccine* - Rotavirus vaccine is **freeze-sensitive** and must be protected from sub-zero temperatures. - Freezing can damage the viral particles and reduce vaccine effectiveness. - Stored in the **middle or upper shelves** of the ILR. **Key Principle:** In ILR storage, heat-sensitive vaccines (OPV, measles) go at the bottom (coldest), while freeze-sensitive vaccines (DPT, Hep B, IPV, Rota) go in the middle/upper shelves to prevent freezing damage.

Question 1

Open vial policy applies to which one of the following vaccines?

Accepted Answer

Hep B

Answer

JE

Answer

BCG

Answer

Measles

Question 2

Which of the following is a contraindication for BCG vaccination in a newborn?

Accepted Answer

HIV infection-symptomatic

Answer

Prematurity

Answer

History of Tuberculosis in mother

Answer

Low birth weight

Question 3

As per WHO recommendations which one of the following mumps vaccine strains should NOT be used in National Immunization Programme?

Accepted Answer

Rubini

Answer

Jeryl Lynn

Answer

RIT 4385

Answer

L-Zagreb

Question 4

Vaccine-associated Paralytic Poliomyelitis (VAPP) is mostly observed due to which of the following vaccine strain serotype?

Accepted Answer

Type–2 only

Answer

Type–1 only

Answer

Type–3

Answer

Both Type-1 and 2

Question 5

Hold over time of cold chain equipment depends on all of the following factors EXCEPT:

Accepted Answer

Types of vaccines kept

Answer

Condition of icepack lining

Answer

Ambient temperature

Answer

Quantity of vaccines kept

Question 6

Which one of the following statements regarding sequential administration of Inactivated Polio Vaccine (IPV) and Oral Polio Vaccine (OPV) is NOT correct?

Accepted Answer

Intestinal mucosal immunity is lost due to IPV administration

Answer

The combined schedules of IPV and OPV appear to reduce or prevent Vaccine Associated Paralytic Polio (VAPP)

Answer

It will be cost effective in developing countries for Polio prevention

Answer

IPV and OPV together may optimize both the humoral and mucosal immunogenicity of Polio vaccine

Question 7

Which one of the following statements regarding Rabies Immunoglobulin is NOT true?

Accepted Answer

It can be administered till 15 days after the first dose of anti-rabies vaccine

Answer

It should be administered primarily into or around the wound sites

Answer

There is no scientific ground for performing a skin test prior to administering equine immunoglobulin

Answer

It should be administered only once as soon as possible after the initiation of post exposure prophylaxis

Question 8

Pentavalent vaccine provides protection against which of the following diseases?

Accepted Answer

Diphtheria, Pertussis, Tetanus, Hepatitis B and Hib

Answer

Diphtheria, Pertussis, Tuberculosis, Measles and Hepatitis B

Answer

Diphtheria, Pertussis, Tetanus, Hepatitis B and Rubella

Answer

Diphtheria, Pertussis, Measles, Hepatitis B and Hib

Question 9

Which statement is TRUE regarding the relationship between HPV vaccination and cervical cancer screening?

Accepted Answer

Screening recommendations are currently the same regardless of vaccination status

Answer

Vaccinated women require less frequent screening than unvaccinated women

Answer

HPV vaccination eliminates the need for cervical cancer screening

Answer

Screening should begin at a younger age in vaccinated women

Question 10

Which of the following vaccines should be stored at the lowest level in an Ice-Lined Refrigerator (ILR)?

Accepted Answer

OPV

Answer

DPT

Answer

Hep B

Answer

Rota

Immunization and Vaccine-Preventable Diseases — MCQs

Immunization and Vaccine-Preventable Diseases — MCQs

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