Immunization and Vaccine-Preventable Diseases Practice Questions

Q: Sentinel centre for vaccine-preventable diseases does not provide information on

incidence rates. ***Incidence rates*** - Sentinel surveillance centers typically focus on **monitoring trends** and **spatial distribution** of vaccine-preventable diseases, as well as immunization coverage. - They generally **do not provide population-wide incidence rates**, as this requires comprehensive, population-level data collection which is beyond their scope. *time trend* - Sentinel centers are crucial for tracking the **time trend** of vaccine-preventable diseases, allowing public health officials to observe patterns and changes over periods. - This information helps in understanding disease seasonality, effectiveness of vaccination campaigns, and early detection of **outbreaks**. *place distribution* - These centers provide valuable insights into the **geographical or spatial distribution** of vaccine-preventable diseases. - This helps in identifying **hotspots** or regions with higher disease activity, guiding targeted interventions. *immunization* - Sentinel surveillance also monitors aspects of **immunization coverage** and the effectiveness of vaccination programs. - Data from these centers can indicate gaps in vaccination and the impact of immunization strategies on disease burden.

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: The appropriate treatment for the baby of a woman who is HBsAg positive but HBeAg negative is

Both active and passive immunisation soon after birth. **Both active and passive immunisation soon after birth** - **Active immunization** (Hepatitis B vaccine) provides long-term immunity by stimulating the infant's immune system to produce antibodies. - **Passive immunization** (Hepatitis B immune globulin, HBIG) provides immediate, short-term protection through pre-formed antibodies, crucial for preventing infection in the critical perinatal period. *Passive immunisation soon after birth but active immunisation after one year of age* - Delaying active immunization until after one year of age would leave a significant window during which the infant is vulnerable to **Hepatitis B infection** from the mother, as passive immunity is only temporary. - The combination of immediate active and passive immunisation is far more effective at preventing **perinatal transmission**. *Only active immunisation soon after birth* - Active immunization alone may not provide immediate enough protection through antibody development, leaving the infant susceptible to **Hepatitis B infection** during their first few weeks of life when exposure risk is highest. - The onset of protective immunity from the vaccine can take several weeks, which is insufficient for immediate protection against perinatal exposure. *Only passive immunisation soon after birth* - While passive immunisation provides immediate protection, it is only temporary and does not confer long-term immunity against **Hepatitis B**. - Without active immunisation, the infant would eventually lose the passively acquired antibodies and remain vulnerable to future **Hepatitis B exposures**.

Q: A 2 year old child has presented for vaccination, who has never been vaccinated earlier. As per the Universal Immunization Program, which vaccines will be administered to the child on the first visit?

BCG, DPT-I and Measles vaccine. ***BCG, DPT-I and Measles vaccine*** - As per the **Universal Immunization Program (UIP)** for a previously unvaccinated child, **all age-appropriate vaccines** should be administered on the first visit. - At 2 years of age, the child is eligible for **BCG**, the first dose of **DPT (DPT-I)**, and **Measles vaccine** (if no prior measles vaccination, which is the case here). *BCG and Hepatitis B vaccine* - While **BCG** is appropriate, **Hepatitis B vaccine** is typically given at birth and then subsequent doses at 6, 10, and 14 weeks as part of the primary series. A 2-year-old would likely need further doses of DPT and Measles. - This option misses other crucial age-appropriate vaccines like **DPT-I** and the **Measles vaccine** for a 2-year-old child. *DPT-I vaccine only* - Administering only **DPT-I** would result in missed opportunities for protection against **tuberculosis (BCG)** and **measles**, both of which are critical for a 2-year-old. - This approach does not follow the principle of providing **all age-appropriate vaccines** on the first contact with an unvaccinated child. *DPT-I and Hepatitis B vaccine* - This option correctly includes **DPT-I** but misses the essential **BCG** and **Measles vaccine** for a 2-year-old, which are crucial for this age group. - While Hepatitis B is important, the primary series would have been missed, and focusing solely on DPT-I and Hepatitis B for a 2-year-old is an incomplete vaccination schedule.

Q: Which of the following are correct in respect of Diphtheria? 1. The incubation period is 14 to 28 days 2. Diphtheria antitoxin is used in treatment of cases 3. It is one of the diseases protected from, by the Pentavalent vaccine given in National Program

2 and 3 only. **Correct Answer: Option B (2 and 3 only)** **Analysis of Statements:** **Statement 1: INCORRECT** - The incubation period for diphtheria is **2 to 5 days** (range: 1-10 days), NOT 14 to 28 days - The stated period of 14-28 days is inaccurate **Statement 2: CORRECT** - **Diphtheria antitoxin (DAT)** is the mainstay of treatment - It neutralizes the exotoxin produced by *Corynebacterium diphtheriae* - Must be given early to prevent irreversible toxin-mediated tissue damage **Statement 3: CORRECT** - **Pentavalent vaccine** (DPT-HepB-Hib) is given under India's Universal Immunization Programme - Protects against 5 diseases: Diphtheria, Pertussis, Tetanus, Hepatitis B, and *Haemophilus influenzae* type b - Contains diphtheria toxoid for active immunization **Why Other Options are Incorrect:** *Option A (1, 2 and 3)* - Incorrect because Statement 1 has wrong incubation period *Option C (1 and 3 only)* - Incorrect because Statement 1 has wrong incubation period - Also omits the important fact about antitoxin treatment *Option D (1 and 2 only)* - Incorrect because Statement 1 has wrong incubation period - Also omits the important fact about Pentavalent vaccine protection

Question 1

Sentinel centre for vaccine-preventable diseases does not provide information on

Accepted Answer

incidence rates

Answer

time trend

Answer

place distribution

Answer

immunization

Question 2

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 3

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 4

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 5

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 6

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 7

The appropriate treatment for the baby of a woman who is HBsAg positive but HBeAg negative is

Accepted Answer

Both active and passive immunisation soon after birth

Answer

Passive immunisation soon after birth but active immunisation after one year of age

Answer

Only active immunisation soon after birth

Answer

Only passive immunisation soon after birth

Question 8

Consider the following statements :

Statement-1 : In the National Immunization Program, BCG vaccine is given only on the left upper arm

Statement-2 : This is done to maintain uniformity and for helping surveyors in verifying receipt of the vaccine

Which one of the following is correct in respect of the above Statements ?

Accepted Answer

Both Statement-1 and Statement-2 are correct and Statement-2 is the correct explanation for Statement-1

Answer

Statement-1 is true but Statement-2 is false

Answer

Both Statement-1 and Statement-2 are correct and Statement-2 is not the correct explanation for Statement-1

Answer

Statement-2 is true but Statement-1 is false

Question 9

A 2 year old child has presented for vaccination, who has never been vaccinated earlier. As per the Universal Immunization Program, which vaccines will be administered to the child on the first visit?

Accepted Answer

BCG, DPT-I and Measles vaccine

Answer

BCG and Hepatitis B vaccine

Answer

DPT-I vaccine only

Answer

DPT-I and Hepatitis B vaccine

Question 10

Which of the following are correct in respect of Diphtheria?

1. The incubation period is 14 to 28 days
2. Diphtheria antitoxin is used in treatment of cases
3. It is one of the diseases protected from, by the Pentavalent vaccine given in National Program

Accepted Answer

2 and 3 only

Answer

1, 2 and 3

Answer

1 and 3 only

Answer

1 and 2 only

Immunization and Vaccine-Preventable Diseases — MCQs

Immunization and Vaccine-Preventable Diseases — MCQs

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