Immunization and Vaccine-Preventable Diseases Practice Questions

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.

Q: In an outbreak of encephalitis in a community, according to the Universal Immunization Schedule, what is the route of administration for the vaccine likely used for the infection?

Live & intramuscular. ***Live & intramuscular*** - The most common cause of encephalitis in outbreaks included in the Universal Immunization Schedule is **Japanese Encephalitis (JE)**, for which the **live attenuated SA 14-14-2 vaccine** is administered **intramuscularly**. - As per the **National Immunization Schedule of India (current UIP)**, JE vaccine is given via **IM route** at 9-12 months of age. - **Live attenuated vaccines** stimulate a strong, long-lasting immune response, often with a single dose. *Incorrect: Live & subcutaneous* - While the older **inactivated JE vaccine** (used before 2013) was given subcutaneously, the **current live attenuated SA 14-14-2 vaccine** used in India's UIP is administered **intramuscularly**. - Subcutaneous route was appropriate for the older killed vaccine formulation but not for the current live vaccine. *Incorrect: Killed & intramuscular* - The current JE vaccine in India's UIP is **live attenuated, not killed**. - While killed vaccines are often given intramuscularly (e.g., inactivated polio), the primary vaccine for encephalitis outbreaks is the **live SA 14-14-2 vaccine**. - Killed vaccines typically require **multiple doses** and boosters to achieve adequate immunity. *Incorrect: Killed & subcutaneous* - Although the **older inactivated (killed) JE vaccine** was given subcutaneously before 2013, this has been replaced in the UIP. - The **current standard** is the live attenuated vaccine given intramuscularly, which provides better immunogenicity and requires fewer doses.

Q: In a 10-year-old school child under the school health program, which vaccine should be administered?

Td. ***Td (Tetanus-Diphtheria)*** - For a 10-year-old child under the school health program in India, the recommended vaccination is a booster dose of **Td (tetanus-diphtheria)**. - This ensures continued **protection against tetanus and diphtheria**, as immunity from the primary series may wane over time. - **Td is preferred over TT** (tetanus toxoid alone) as it provides protection against both tetanus and diphtheria. - This is administered at **10 years and 16 years** as per the Indian Academy of Pediatrics immunization schedule. *DPT* - **DPT (diphtheria, pertussis, tetanus)** is administered in infancy and early childhood (at 6, 10, and 14 weeks, with boosters at 16-24 months and 4-6 years). - The **pertussis component is not given** in later childhood or adolescence due to increased reactogenicity in older children. *BCG* - **BCG (Bacille Calmette-Guérin)** vaccine protects against tuberculosis and is given **at birth** in endemic areas like India. - It is **not routinely administered** to a 10-year-old unless there are specific risk factors or documented non-vaccination status. *MMR* - **MMR (measles, mumps, rubella)** vaccine is given as **two doses**: first at 9-12 months and second at 16-24 months (or 4-6 years). - A 10-year-old child would have **already completed** their MMR vaccination schedule.

Q: Which of the following regarding the vaccine vial monitor (VVM) is true? 1. It is used for monitoring heat exposure of the vaccine by healthcare workers in primary healthcare. 2. It shows cumulative exposure of the vaccine to the heat. 3. It can be used to assess the potential efficacy of the vaccine 4. Calculation of the expiry date can be done using VVM. 5. The expiry date of the vaccine can be relaxed if VVM is an acceptable range. 6. If the square and the circle are the same in color, then the vaccine can be safely used.

1,2. ***Correct: Statements 1, 2*** **Statement 1 - TRUE**: The VVM is primarily designed for **healthcare workers** to monitor vaccine heat exposure at all levels, including primary healthcare settings. This is a key WHO tool for cold chain monitoring. **Statement 2 - TRUE**: VVMs provide a **cumulative record** of time and temperature exposure, reflecting the total heat stress a vaccine has experienced throughout its journey from manufacturer to administration. *Statement 3 - FALSE* - While VVMs assess heat exposure that affects vaccine stability, they do **not directly measure vaccine efficacy** or provide quantitative measures of immune response potential. - Heat damage indicated by VVM indirectly suggests reduced potency, but the VVM itself cannot assess efficacy. *Statement 4 - FALSE* - VVMs are **not used to calculate expiry dates**. Manufacturing expiry dates are determined through stability studies under controlled conditions by the manufacturer. *Statement 5 - FALSE* - The **expiry date cannot be relaxed or extended** based on VVM status. The manufacturer's stated expiry date must always be respected regardless of how favorable the VVM reading is. *Statement 6 - FALSE* - This is the **opposite** of how VVM works. If the **inner square is the same color or darker than the outer circle**, the vaccine has been exposed to excessive heat and **should NOT be used**. - The vaccine is safe when the inner square is lighter than the outer circle.

Q: Recommended HPV vaccination schedule for 9 to 14-year-olds according to WHO SAGE guidelines is:

1 or 2 doses. ***1 or 2 doses*** - The **WHO Strategic Advisory Group of Experts (SAGE)** on Immunization recommends a simplified **one- or two-dose schedule** for girls and boys aged 9–14 years. - This recommendation, updated in April 2022, is based on evidence demonstrating comparable efficacy of **single-dose HPV vaccination** to multi-dose regimens in this age group, while improving accessibility and uptake. - **Key advantage**: Reduced doses improve vaccination completion rates and reduce programmatic costs without compromising protection. *3 doses* - A **three-dose schedule** (0, 1-2, 6 months) was the original recommendation but is **no longer recommended** for the 9–14 age group. - Three doses are now reserved for **immunocompromised individuals** or those starting vaccination at older ages in some guidelines. - Maintaining a three-dose schedule would increase costs and reduce completion rates unnecessarily. *3 or 4 doses* - **Four doses** have never been part of any WHO HPV vaccination recommendation. - This option represents an excessive and unsupported schedule that would create unnecessary barriers to vaccination coverage. *4 doses* - **Four doses** are not recommended by WHO SAGE for any age group or clinical scenario. - This would represent over-vaccination without evidence of additional benefit and would significantly impair program implementation.

Q: Which is not a contraindication for OPV?

Diarrhoea. ***Diarrhoea*** - **Diarrhoea** is not considered a contraindication for OPV; while it may reduce vaccine efficacy, the vaccine should still be administered. - Minor illnesses, including mild **gastrointestinal upset**, are not reasons to defer vaccination. *Leukemia* - **Leukemia** is a **malignancy** of the blood cells, leading to an **immunocompromised state**. - Live vaccines like OPV are generally **contraindicated** in individuals with leukemia due to the risk of vaccine-associated paralytic poliomyelitis (VAPP). *Malignancy* - Children with **malignancies**, especially those undergoing treatment like **chemotherapy** or **radiation**, are often **immunocompromised**. - Live oral vaccines are typically **contraindicated** in these patients to prevent serious infections from the live attenuated virus. *Immunocompromised* - Being **immunocompromised**, whether due to disease (e.g., HIV, primary immunodeficiency) or medication (e.g., high-dose corticosteroids), is a **contraindication** for live attenuated vaccines like OPV. - The weakened immune system cannot effectively clear the vaccine virus, leading to a higher risk of **serious infection** or **vaccine-associated paralysis**.

Q: Yellow fever vaccine is valid for?

Lifelong. ***Life long*** - As per the **International Health Regulations (IHR) 2005**, a single dose of yellow fever vaccine provides **lifelong protection**, eliminating the need for booster doses. - This change in policy reflects robust evidence demonstrating sustained immunity beyond 10 years, making previous 10-year validity periods obsolete. *20 years* - While reflecting a prolonged period of protection, **20 years** is not the officially recognized validity period. - The latest WHO recommendations state **lifelong validity**, superseding previous duration estimates. *5 years* - A 5-year validity period was used historically but is now outdated. - **Evidence has shown long-term immunity**, supporting a much longer, effectively lifelong, protection. *10 years* - The **10-year validity** was the standard for many years, necessitating booster doses for travelers. - This has been updated to **lifelong validity** based on conclusive data proving persistent protective immunity.

Question 1

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 2

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 3

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 4

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

Question 5

In an outbreak of encephalitis in a community, according to the Universal Immunization Schedule, what is the route of administration for the vaccine likely used for the infection?

Accepted Answer

Live & intramuscular

Answer

Live & subcutaneous

Answer

Killed & intramuscular

Answer

Killed & subcutaneous

Question 6

In a 10-year-old school child under the school health program, which vaccine should be administered?

Accepted Answer

Td

Answer

DPT

Answer

BCG

Answer

MMR

Question 7

Which of the following regarding the vaccine vial monitor (VVM) is true?

1. It is used for monitoring heat exposure of the vaccine by healthcare workers in primary healthcare.
2. It shows cumulative exposure of the vaccine to the heat.
3. It can be used to assess the potential efficacy of the vaccine
4. Calculation of the expiry date can be done using VVM.
5. The expiry date of the vaccine can be relaxed if VVM is an acceptable range.
6. If the square and the circle are the same in color, then the vaccine can be safely used.

Accepted Answer

1,2

Answer

1,2,3,4,5

Answer

3,4

Answer

5,6

Question 8

Recommended HPV vaccination schedule for 9 to 14-year-olds according to WHO SAGE guidelines is:

Accepted Answer

1 or 2 doses

Answer

3 doses

Answer

3 or 4 doses

Answer

4 doses

Question 9

Which is not a contraindication for OPV?

Accepted Answer

Diarrhoea

Answer

Leukemia

Answer

Malignancy

Answer

Immunocompromised

Question 10

Yellow fever vaccine is valid for?

Accepted Answer

Lifelong

Answer

20 years

Answer

5 years

Answer

10 years

Immunization and Vaccine-Preventable Diseases — MCQs

Immunization and Vaccine-Preventable Diseases — MCQs

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