Consider the following vaccines :
1. BCG Vaccine
2. Hepatitis B Vaccine
3. Inactivated Polio Vaccine (IPV)
4. Oral Polio Vaccine (OPV) What is the correct order of the above vaccines as per their sensitivity to heat (most sensitive to least sensitive) given in the National Immunization Schedule (NIS) ?
Q342
What is the correct increasing order of minimum age at which the following vaccines are administered to a child, as part of the National Immunization Schedule (NIS) after birth of child ?
1. BCG vaccine
2. Japanese Encephalitis (JE) vaccine
3. Rotavirus vaccine
4. Tetanus and adult diphtheria (Td) vaccine
Select the correct answer using the code given below :
Q343
Which among the following is correct about yellow fever vaccination requirement for international travellers ?
1. Term of validity of the certificate is changed from 10 years to the duration of the life of the vaccinated person.
2. Lifetime validity of the certificate applies automatically to all existing and new certificates.
3. Validity of the certificate begins 4 days after vaccination.
4. In India, booster dose of yellow fever vaccine is required for those whose certificate is prior to the year 2016.
Select the correct answer using the code given below :
Q344
In countries with low levels of measles transmission, what should be the appropriate age for starting immunization with measles-containing vaccine (MCV)?
Q345
As per the Open Vial Policy, partially used multidose vials of which of the following vaccines can be used over more than one immunization session?
1. BCG vaccine
2. DPT vaccine
3. Hepatitis B vaccine
4. Measles vaccine
Select the correct answer using the code given below.
Q346
Which of the following statements regarding the Open Vial Policy, 2015 are correct?
1. It applies only for DPT, TT, Hepatitis B, OPV and Liquid Pentavalent vaccine.
2. Vaccine vials opened in session-site can be used again provided a vaccine vial monitor has not reached the discard point.
3. Open vial should never be submerged in water.
4. Open vials of BCG, Measles and JE should be preserved till the next immunization session.
Q347
As a part of the Universal Immunization Programme in India, the Inactivated Polio Vaccine (IPV) given as fractional IPV by intradermal route is first administered at what age?
Q348
The order of priority of immunization strategy to prevent congenital rubella infection from first to last is :
Q349
In which of the following diseases is post-exposure immunisation prescribed?
Q350
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?
Immunization and Vaccine-Preventable Diseases Indian Medical PG Practice Questions and MCQs
Question 341: Consider the following vaccines :
1. BCG Vaccine
2. Hepatitis B Vaccine
3. Inactivated Polio Vaccine (IPV)
4. Oral Polio Vaccine (OPV) What is the correct order of the above vaccines as per their sensitivity to heat (most sensitive to least sensitive) given in the National Immunization Schedule (NIS) ?
A. 2→1→3→4
B. 2→3→1→4
C. 4→3→2→1 (Correct Answer)
D. 3→1→4→2
Explanation: ***4→3→2→1 (OPV → IPV → Hepatitis B → BCG)***
* **Oral Polio Vaccine (OPV)** is the **most heat-sensitive** vaccine among these options. As a live attenuated viral vaccine, it requires storage at -20°C (freezer storage) and is extremely thermolabile, necessitating the strictest cold chain management with VVM monitoring.
* **Inactivated Polio Vaccine (IPV)** is the second most heat-sensitive vaccine, requiring refrigeration at 2-8°C. While more stable than OPV due to inactivation, it remains highly sensitive to heat exposure and requires careful cold chain maintenance.
* **Hepatitis B Vaccine** has moderate heat sensitivity. As a recombinant subunit vaccine, it requires storage at 2-8°C but is more thermostable than the polio vaccines. It can tolerate brief temperature excursions better than live attenuated vaccines.
* **BCG Vaccine** is the **least heat-sensitive** among these four vaccines, though it still requires proper cold chain management at 2-8°C. While BCG is light-sensitive, it demonstrates relatively better heat stability compared to OPV, IPV, and Hepatitis B vaccines in field conditions per National Immunization Schedule guidelines.
*Incorrect Option 2→1→3→4*
- Incorrectly places Hepatitis B as most sensitive when OPV is actually most thermolabile
*Incorrect Option 2→3→1→4*
- Wrong order placing Hepatitis B first instead of OPV
*Incorrect Option 3→1→4→2*
- Incorrectly suggests IPV is most sensitive and has an inaccurate sequence
Question 342: What is the correct increasing order of minimum age at which the following vaccines are administered to a child, as part of the National Immunization Schedule (NIS) after birth of child ?
1. BCG vaccine
2. Japanese Encephalitis (JE) vaccine
3. Rotavirus vaccine
4. Tetanus and adult diphtheria (Td) vaccine
Select the correct answer using the code given below :
A. 1→2→3→4
B. 1→3→2→4 (Correct Answer)
C. 2→3→1→4
D. 3→1→4→2
Explanation: **1→3→2→4**
- This order reflects the standard schedule of vaccine administration in the **National Immunization Schedule (NIS)**, starting with vaccines given at birth or shortly after, followed by those administered in late infancy and early childhood, and finally those for adolescents.
- The correct sequence is: **BCG at birth**, **Rotavirus at 6 weeks**, **Japanese Encephalitis at 9 months**, and **Td at 10 and 16 years**.
*1→2→3→4*
- This option incorrectly places the **Japanese Encephalitis (JE) vaccine** before the **Rotavirus vaccine**. The Rotavirus vaccine is typically given at 6 weeks, while JE is given later at 9 months.
- The sequence of **JE** and **Rotavirus** is inverted compared to the NIS guidelines.
*2→3→1→4*
- This order is incorrect because it places the **BCG vaccine** after both the **Japanese Encephalitis (JE) vaccine** and the **Rotavirus vaccine**, even though BCG is administered at birth.
- The early administration of **BCG** at birth is a fundamental aspect of the immunization schedule, making this sequence incorrect.
*3→1→4→2*
- This option incorrectly places the **Rotavirus vaccine** as the earliest, ahead of the **BCG vaccine**, which is given at birth or very soon after.
- It also incorrectly places the **Td vaccine** before the **Japanese Encephalitis (JE) vaccine**, as JE is given at 9 months and Td later, in adolescence.
Question 343: Which among the following is correct about yellow fever vaccination requirement for international travellers ?
1. Term of validity of the certificate is changed from 10 years to the duration of the life of the vaccinated person.
2. Lifetime validity of the certificate applies automatically to all existing and new certificates.
3. Validity of the certificate begins 4 days after vaccination.
4. In India, booster dose of yellow fever vaccine is required for those whose certificate is prior to the year 2016.
Select the correct answer using the code given below :
A. 2 and 4
B. 2 and 3
C. 1 and 2 (Correct Answer)
D. 1 and 3
Explanation: ***1 and 2***
- The **term of validity** of the International Certificate of Vaccination or Prophylaxis (ICVP) for yellow fever changed from 10 years to **lifetime duration** on **July 11, 2016** (WHO IHR amendment).
- This **lifetime validity** applies automatically to all existing and new ICVPs, regardless of when they were issued.
- Both statements accurately reflect current WHO International Health Regulations.
*2 and 4*
- While statement 2 is correct, statement 4 is incorrect; **India does not require a booster dose** for yellow fever even if the certificate is prior to 2016.
- The lifetime validity supersedes all previous recommendations, and India follows WHO guidelines.
*2 and 3*
- While statement 2 is correct, statement 3 is incorrect; the **validity of the certificate begins 10 days after vaccination**, not 4 days.
- This 10-day period allows for the development of adequate immune response to the yellow fever vaccine.
*1 and 3*
- While statement 1 is correct regarding the change to lifetime validity, statement 3 is incorrect; the **certificate's validity begins 10 days after vaccination**, not 4 days.
- The 10-day waiting period is a standard requirement under WHO IHR.
Question 344: In countries with low levels of measles transmission, what should be the appropriate age for starting immunization with measles-containing vaccine (MCV)?
A. 9 months
B. 12 months (Correct Answer)
C. 15-18 months
D. 6 months
Explanation: ***12 months***
- In countries with **low measles transmission**, the recommended age for the first dose of **Measles-Containing Vaccine (MCV)** is **12 months** (or 12-15 months).
- In low-transmission settings, **maternal antibodies persist longer** due to reduced natural boosting from circulating virus, so vaccination can be safely delayed to 12 months for optimal immune response.
- This timing ensures maternal antibodies have waned sufficiently while avoiding interference with vaccine effectiveness.
*9 months*
- The 9-month schedule is recommended for countries with **high measles transmission** where the risk of early infection is greater.
- In low-transmission settings, vaccinating at 9 months would mean giving the vaccine when maternal antibodies may still interfere with seroconversion.
- WHO recommends 9 months only in high-burden countries or outbreak situations.
*15-18 months*
- This age range is typically reserved for the **second dose** of the measles vaccine (MCV2) to ensure long-term immunity and catch up children who didn't respond to the first dose.
- Starting immunization at this age would leave a significant period of vulnerability to measles infection.
- The two-dose schedule provides approximately 97% protection when completed.
*6 months*
- Administering MCV at 6 months is generally not recommended as maternal **antibodies** are still high and can significantly interfere with the vaccine's effectiveness, leading to poor immune response.
- Vaccination at this age might be considered only in very high-risk situations like **outbreaks**, during international travel to endemic areas, or in emergency humanitarian settings.
- When given at 6 months, it is not counted as part of the routine schedule, and the child still needs doses at 9 and 15 months.
Question 345: As per the Open Vial Policy, partially used multidose vials of which of the following vaccines can be used over more than one immunization session?
1. BCG vaccine
2. DPT vaccine
3. Hepatitis B vaccine
4. Measles vaccine
Select the correct answer using the code given below.
A. 1, 2 and 4
B. 2 and 3 only (Correct Answer)
C. 1, 3 and 4
D. 1 and 2 only
Explanation: **2 and 3 only**
- The **Open Vial Policy (OVP)** allows for the continued use of partially used **DPT (Diphtheria, Pertussis, Tetanus)** and **Hepatitis B vaccines** in multidose vials over multiple immunization sessions.
- This policy is based on the vaccine's stability, **preservative content**, and the low risk of contamination when handled correctly.
*1, 2 and 4*
- This option incorrectly includes the **BCG vaccine** and **Measles vaccine**.
- **BCG** and **Measles vaccines** are **live attenuated vaccines** that come in single-dose vials or require specific handling for same-day use once reconstituted, and are **not covered by the OVP** for use over multiple sessions.
*1, 3 and 4*
- This option incorrectly includes the **BCG vaccine** and **Measles vaccine** which are **not eligible** for extended use under the OVP.
- Both BCG and Measles vaccines are **sensitive to heat and light** and easily contaminated once reconstituted.
*1 and 2 only*
- This option incorrectly includes the **BCG vaccine** and excludes the **Hepatitis B vaccine**.
- As previously stated, **BCG vaccine is excluded** from the OVP, while **Hepatitis B vaccine** is explicitly included due to its inactivated nature and preservative content.
Question 346: Which of the following statements regarding the Open Vial Policy, 2015 are correct?
1. It applies only for DPT, TT, Hepatitis B, OPV and Liquid Pentavalent vaccine.
2. Vaccine vials opened in session-site can be used again provided a vaccine vial monitor has not reached the discard point.
3. Open vial should never be submerged in water.
4. Open vials of BCG, Measles and JE should be preserved till the next immunization session.
A. 4. Open vials of BCG, Measles and JE should be preserved till the next immunization session.
B. 3. Open vial should never be submerged in water.
C. 1. It applies only for DPT, TT, Hepatitis B, OPV and Liquid Pentavalent vaccine.
D. 2. Vaccine vials opened in session-site can be used again provided a vaccine vial monitor has not reached the discard point. (Correct Answer)
Explanation: ***2. Vaccine vials opened in session-site can be used again provided a vaccine vial monitor has not reached the discard point.***
- The **Open Vial Policy, 2015**, permits the reuse of opened vials for specific vaccines if certain conditions are met, including the **Vaccine Vial Monitor (VVM)** indicating the vaccine is still potent.
- This policy aims to reduce vaccine wastage while ensuring vaccine safety and efficacy.
- This is the **core principle** of the Open Vial Policy and represents the primary objective of the policy.
*3. Open vial should never be submerged in water.*
- This statement is **CORRECT** according to the Open Vial Policy guidelines.
- Vaccine vials should **never be submerged in water** as this can damage labels, obscure information, and increase the risk of contamination.
- However, in the context of this question asking for the statement that best represents the Open Vial Policy, **Statement 2 is the better answer** as it directly addresses the core reuse principle.
*4. Open vials of BCG, Measles and JE should be preserved till the next immunization session.*
- **INCORRECT**: BCG, Measles, and JE vaccines are **reconstituted vaccines** that are sensitive to light and heat.
- They must be **discarded within 4-6 hours** after reconstitution and **cannot be preserved** until the next immunization session due to rapid loss of potency and increased risk of contamination.
- These vaccines are **explicitly excluded** from the Open Vial Policy.
*1. It applies only for DPT, TT, Hepatitis B, OPV and Liquid Pentavalent vaccine.*
- **INCORRECT**: The Open Vial Policy, 2015, specifically applies to **DPT, TT, Hepatitis B, OPV, liquid Pentavalent, Td, and Fractional IPV (fIPV) vaccines**.
- This statement is incorrect because it uses the word "only" and **omits Td and fIPV** from the list of applicable vaccines.
Question 347: As a part of the Universal Immunization Programme in India, the Inactivated Polio Vaccine (IPV) given as fractional IPV by intradermal route is first administered at what age?
A. 14 weeks
B. 9 months
C. 6 weeks (Correct Answer)
D. Birth
Explanation: ***6 weeks***
- In the Universal Immunization Programme (UIP) in India, the first dose of **fractional Inactivated Polio Vaccine (fIPV)** is administered to infants at **6 weeks of age** via the **intradermal route**.
- This timing coordinates with other routine vaccinations given at 6 weeks, such as the first dose of the **pentavalent vaccine** (diphtheria, pertussis, tetanus, Hepatitis B, and Hib).
*14 weeks*
- The second dose of **fIPV** is typically administered at **14 weeks of age** within the UIP schedule.
- This dose also aligns with other scheduled vaccinations at 14 weeks, reinforcing immunity against polio.
*9 months*
- At **9 months of age**, infants receive the first dose of **measles and rubella (MR) vaccine** and **Vitamin A supplementation** under the UIP.
- No polio vaccine doses are scheduled at 9 months.
*Birth*
- At birth, infants are given the **oral polio vaccine (OPV0)**, **Hepatitis B birth dose**, and **Bacille Calmette-Guérin (BCG) vaccine**.
- While initial polio immunization begins at birth, the **IPV is not administered at this stage**.
Question 348: The order of priority of immunization strategy to prevent congenital rubella infection from first to last is :
A. Women of reproductive age group → children 1-14 years → Infants
B. Infants → women of reproductive age group → children 1-14 years
C. Women of reproductive age group → Infants → children 1-14 years
D. Infants → children 1-14 years → women of reproductive age group (Correct Answer)
Explanation: ***Infants → children 1-14 years → women of reproductive age group***
- **Infants first**: Establishing **routine infant immunization** (MR/MMR vaccine) is the cornerstone of sustainable rubella control and prevention of congenital rubella syndrome (CRS).
- **Children 1-14 years**: Conducting **catch-up campaigns** in this age group rapidly builds **herd immunity** and interrupts rubella virus circulation in the community.
- **Women of reproductive age**: Supplementary vaccination of susceptible women provides additional protection but should only be implemented **after** establishing routine infant immunization to avoid the **"honeymoon period" paradox**.
- This sequence follows **WHO-recommended rubella immunization strategy** for achieving CRS elimination while maintaining long-term sustainability.
*Women of reproductive age group → children 1-14 years → Infants*
- Prioritizing women first without establishing routine infant immunization is **not sustainable** and can paradoxically increase CRS risk in the long term.
- This approach fails to interrupt viral transmission and leaves future generations vulnerable once selective vaccination campaigns end.
*Infants → women of reproductive age group → children 1-14 years*
- While starting with infants is correct, vaccinating women before the 1-14 year age group is **less efficient** for rapidly building herd immunity.
- Children aged 1-14 years are the **primary drivers of rubella transmission** in communities and should be prioritized for catch-up campaigns.
*Women of reproductive age group → Infants → children 1-14 years*
- This sequence incorrectly places women first and delays vaccination of the 1-14 year age group, who are **critical for establishing herd immunity**.
- Without addressing the major reservoir of infection (older children), pregnant women remain at risk from community transmission.
Question 349: In which of the following diseases is post-exposure immunisation prescribed?
A. Poliomyelitis
B. Yellow fever
C. Rabies (Correct Answer)
D. Cholera
Explanation: ***Rabies***
- **Rabies post-exposure prophylaxis (PEP)** is critical with documented or suspected exposure, given its near 100% fatality rate once symptoms appear.
- PEP consists of both **rabies vaccine** and **rabies immunoglobulin** administered as soon as possible after exposure.
*Poliomyelitis*
- Poliovirus vaccination is a **pre-exposure intervention** aimed at preventing infection in the first place through herd immunity.
- There is no specific post-exposure immunization strategy for polio once exposure has occurred.
*Yellow fever*
- The yellow fever vaccine is a highly effective **pre-exposure preventive measure** for individuals traveling to or living in endemic areas.
- While it provides long-lasting immunity, it is not used as a post-exposure treatment.
*Cholera*
- Cholera vaccines are primarily used for **pre-exposure prevention**, especially for travelers or populations in endemic areas.
- Post-exposure management of cholera focuses on **rehydration therapy** and antibiotics, not immunization.
Question 350: 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?
A. 1 only
B. 2 and 3 (Correct Answer)
C. 1 and 2
D. 2 only
Explanation: ***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.
