Immunization and Vaccine-Preventable Diseases — MCQs

Consider the following statements with regard to Ice-Lined Refrigerator (ILR) employed for storing vaccines at the sub-district level : I. These types of refrigerators are top-opening. II. Based on the temperature zone, the inside of ILRs can be divided into 3 parts. III. The upper part of ILR is cooler compared to the lower part. IV. Vaccines should never be kept directly on the floor of the ILR as they can get damaged. Which of the statements given above are correct?

Q339

In a child who has not received any dose of DPT and OPV immunization, up to what age can these vaccines be given under the Universal Immunization Programme?

Q340

Which among the following vaccines best represent interventions that focus on cancer prevention too ? 1. Hepatitis A vaccine 2. Hepatitis B vaccine 3. Hemophilus influenzae B vaccine 4. Human papilloma virus vaccine Select the correct answer using the code given below :

Immunization and Vaccine-Preventable Diseases Indian Medical PG Practice Questions and MCQs

Question 331: A pregnant woman with a 2-year-old child gives a history of completing required antenatal vaccinations during her previous pregnancy. Which of the following would you recommend for her current pregnancy?

A. Give a booster dose of Td
B. Give 2 doses of TT
C. Give a booster dose of TT (Correct Answer)
D. Give 2 doses of Td

Explanation: ***Give a booster dose of TT*** - The woman completed her required antenatal vaccination (TT2 or more) **2 years ago** during her previous pregnancy - Since the interval is **less than 3 years**, she only requires **one booster dose of TT** to maintain protective immunity against tetanus - According to **Indian National Immunization Program** guidelines, **Tetanus Toxoid (TT)** remains the standard vaccine for antenatal immunization in India - If the last dose was given <3 years ago: **1 booster dose**; if 3-5 years: **1 dose**; if 5-10 years: **1 dose**; if >10 years: **2 doses** *Give a booster dose of Td* - While **Td (Tetanus-Diphtheria)** or Tdap is recommended in some international guidelines (WHO, US CDC) to provide dual protection against tetanus and diphtheria, it is **not the standard practice in India's national immunization program** - For **FMGE and Indian Medical PG exams**, the focus is on **TT as per Indian protocols**, not Td/Tdap *Give 2 doses of TT* - Giving **two doses** is unnecessary because she completed her vaccination series just 2 years ago, and her baseline immunity is adequate - Two doses during pregnancy are indicated only for women with **unknown or incomplete immunization status** or when >10 years have elapsed since the last dose - As per Indian guidelines, she requires only **one booster dose**, not a full series *Give 2 doses of Td* - This is incorrect because she doesn't require a **primary series** - she only needs a single booster - Additionally, **Td is not the standard antenatal vaccine in India's national program**; TT is used - Two doses of Td would be considered only if the woman had no prior tetanus immunization history

Question 332: Which of the following vials, as shown in the image, can be used for administering vaccines?

A. Only 1
B. 1,2,3,4
C. 2,4
D. 1,2 (Correct Answer)

Explanation: ***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.

Question 333: Identify person shown in the image below:

A. Louis Pasteur
B. Edward Jenner (Correct Answer)
C. James Lind
D. William Harvey

Explanation: ***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.

Question 334: All are correct regarding the following route of vaccine administration except:

A. Induces both systemic and mucosal immunity
B. Higher antigenic dose (Correct Answer)
C. Immunity induced at Waldeyer ring
D. Higher compliance

Explanation: ***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.

Question 335: All are correct about the vaccine shown except:

A. Bivalent
B. Recombinant vaccine
C. Recommended in all women in age group 25-45 years (Correct Answer)
D. 3 dosages

Explanation: ***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.

Question 336: Which is correct about the Vaccine Vial monitor shown in the image? (Recent NEET Pattern 2016-17)

A. Vaccine can be used, if expiry date not passed
B. Vaccine can be used, after expiry date
C. Vaccine cannot be used, irrespective of expiry date (Correct Answer)
D. Vaccine is at discard point, consult supervisor

Explanation: ***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 337: All are correct about Mission Indradhanush (the launched programme) except:

A. Launched in 2014
B. Covers 5 vaccine preventable diseases (Correct Answer)
C. Target year 2020
D. Covers all unvaccinated and partially vaccinated children

Explanation: ***Correct: Covers 5 vaccine preventable diseases*** - **Mission Indradhanush** initially covered **seven vaccine-preventable diseases** (not 5). - The seven diseases were: Diphtheria, Whooping Cough, Tetanus, Polio, Tuberculosis, Measles, and Hepatitis B. - This statement is incorrect, making it the correct answer to this "except" question. *Incorrect: Launched in 2014* - Mission Indradhanush was launched in **December 2014** by the Ministry of Health and Family Welfare, Government of India. - The program's primary objective was to rapidly increase full immunization coverage in the country. *Incorrect: Target year 2020* - The initial goal of Mission Indradhanush was to achieve **90% full immunization coverage by 2020**. - This target was later brought forward to 2018 with the launch of **Intensified Mission Indradhanush (IMI)**. *Incorrect: Covers all unvaccinated and partially vaccinated children* - Mission Indradhanush focuses on accelerating full immunization coverage for **unvaccinated and partially vaccinated children** up to two years of age. - It also includes pregnant women who missed out on routine immunization.

Question 338: Consider the following statements with regard to Ice-Lined Refrigerator (ILR) employed for storing vaccines at the sub-district level : I. These types of refrigerators are top-opening. II. Based on the temperature zone, the inside of ILRs can be divided into 3 parts. III. The upper part of ILR is cooler compared to the lower part. IV. Vaccines should never be kept directly on the floor of the ILR as they can get damaged. Which of the statements given above are correct?

A. I and IV
B. II and III (Correct Answer)
C. III and IV
D. I and II

Explanation: ***II and IV*** - **Statement II is correct**: ILRs can be divided into **3 temperature zones** based on cold air distribution: - **Upper zone** (near door): Warmest area - **Middle zone**: Optimal temperature (2-8°C) for vaccine storage - **Lower zone/floor**: Coldest area with risk of freezing - **Statement IV is correct**: Vaccines should **never be placed directly on the floor** of the ILR as this is the coldest zone where temperatures can drop below 0°C, causing **freeze damage** to vaccines like DPT, Hepatitis B, and TT which are freeze-sensitive. *I and III* - **Statement I is incorrect**: ILRs used at sub-district level in India's Universal Immunization Programme are **front-opening** (not top-opening) refrigerators. Top-opening freezers may be used for ice-pack preparation, but vaccine storage ILRs are front-opening. - **Statement III is incorrect**: The **lower part is cooler** than the upper part, not the opposite. Cold air sinks, making the floor area the coldest zone (prone to freezing), while the upper area near the door is relatively warmer.

Question 339: In a child who has not received any dose of DPT and OPV immunization, up to what age can these vaccines be given under the Universal Immunization Programme?

A. DPT up to 7 years of age and OPV up to 5 years of age (Correct Answer)
B. DPT up to 10 years of age and OPV up to 7 years of age
C. DPT up to 12 years of age and OPV up to 10 years of age
D. DPT up to 8 years of age and OPV up to 6 years of age

Explanation: ***DPT up to 7 years of age and OPV up to 5 years of age*** - Under the **Universal Immunization Programme (UIP)**, this represents the accepted upper age limit for catch-up vaccination in children who have not received any previous doses - **DPT vaccine** (Diphtheria, Pertussis, Tetanus) can be given up to **7 years of age** for primary immunization series - **OPV (Oral Polio Vaccine)** can be administered up to **5 years of age** for catch-up immunization - Beyond these ages, alternative formulations are typically used (Td vaccine for older children instead of DPT) *DPT up to 10 years of age and OPV up to 7 years of age* - These age limits **exceed the standard UIP guidelines** for catch-up vaccination - Not the recommended upper age limits for primary immunization series - Would be beyond the typical age range for initiating these vaccines in unimmunized children *DPT up to 12 years of age and OPV up to 10 years of age* - These age cut-offs are **significantly higher than UIP recommendations** - For children beyond standard ages, **Td (Tetanus-diphtheria)** vaccine is preferred over DPT - These limits do not align with catch-up vaccination protocols under UIP *DPT up to 8 years of age and OPV up to 6 years of age* - While closer to the correct limits, these ages still **exceed the standard recommendations** - The accepted upper limits are **7 years for DPT** and **5 years for OPV** under UIP guidelines - Not the officially recognized age cut-offs for catch-up immunization

Question 340: Which among the following vaccines best represent interventions that focus on cancer prevention too ? 1. Hepatitis A vaccine 2. Hepatitis B vaccine 3. Hemophilus influenzae B vaccine 4. Human papilloma virus vaccine Select the correct answer using the code given below :

A. 1 and 4
B. 2 and 3
C. 2 and 4 (Correct Answer)
D. 1 and 2

Explanation: ***2 and 4*** - The **Hepatitis B vaccine** prevents **Hepatitis B virus (HBV)** infection, which is a major risk factor for developing **hepatocellular carcinoma (HCC)**, a type of liver cancer. Vaccination significantly reduces the incidence of HBV-related liver cancer. - The **Human Papillomavirus (HPV) vaccine** protects against high-risk HPV types, which are responsible for almost all cases of **cervical cancer**, as well as many cases of anal, oropharyngeal, vaginal, and penile cancers. - Both vaccines directly prevent cancer by preventing the viral infections that cause these malignancies. *1 and 4* - The **Hepatitis A vaccine** prevents **Hepatitis A virus (HAV)** infection, which causes acute liver inflammation but is **not associated with chronic liver disease or liver cancer**. - While the **HPV vaccine** indeed prevents cancer, the inclusion of Hepatitis A vaccine makes this option incorrect for cancer prevention. *2 and 3* - The **Hepatitis B vaccine** effectively prevents liver cancer by preventing HBV infection. - The **Hemophilus influenzae B (Hib) vaccine** prevents serious infections caused by *Haemophilus influenzae* type b, such as meningitis and epiglottitis, but it has **no direct role in cancer prevention**. *1 and 2* - The **Hepatitis A vaccine** prevents HAV infection but **does not prevent cancer**. - While the **Hepatitis B vaccine** effectively prevents liver cancer, the inclusion of Hepatitis A vaccine makes this option incomplete for the best representation of cancer prevention interventions.

Practice by Chapter

Principles of Immunization

Practice Questions

Types of Vaccines

Practice Questions

Universal Immunization Program

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Cold Chain System

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Vaccine Storage and Handling

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Adverse Events Following Immunization

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National Immunization Schedule

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Polio Eradication

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Measles Elimination

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Tetanus Control

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New and Underutilized Vaccines

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Vaccination Coverage Assessment

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