Immunization and Vaccine-Preventable Diseases Practice Questions

Q: WHO immunization evaluation coverage survey is normally done in what age group?

12-23 months. ***12-23 months*** - The **WHO immunization coverage survey** focuses on children aged **12-23 months** to ensure that they have completed their primary vaccination series, including doses that are typically given before 12 months of age but are evaluated after that period. - This age group allows for assessment of timely completion of vaccines like **measles (MCV1)** and the third dose of **DTP (DTP3)**, which are crucial indicators of a functioning immunization program. *0-12 months* - This age group is typically undergoing initial vaccinations, but evaluating coverage at this point might miss children who are still completing their scheduled doses. - Surveying this group wouldn't provide a complete picture of children who have received all recommended vaccines by their first birthday. *6-12 months* - Similar to 0-12 months, children in this age range are often in the process of receiving their primary vaccine series (e.g., DTP3 given around 6 months). - A survey at this stage would not fully capture the completion rates of all routine vaccinations due by the first birthday. *9-12 months* - While the first dose of measles vaccine (MCV1) is often given around 9 months, evaluating coverage only within this narrow window might not reflect the overall completion of the full primary immunization schedule. - It would miss children who might receive MCV1 at 12 months or later, and also wouldn't fully assess other vaccines given earlier.

Q: What are the types of HPV vaccines that have been licensed and are available?

Bivalent, Quadrivalent, and Nonavalent. ***Bivalent, Quadrivalent, and Nonavalent*** - Three types of HPV vaccines have been licensed: **bivalent** (2vHPV, Cervarix), **quadrivalent** (4vHPV, Gardasil), and **nonavalent** (9vHPV, Gardasil 9). - The **bivalent vaccine** protects against HPV types 16 and 18 (responsible for ~70% of cervical cancers). - The **quadrivalent vaccine** protects against HPV types 6, 11, 16, and 18 (also covers genital warts). - The **nonavalent vaccine** protects against nine HPV types (6, 11, 16, 18, 31, 33, 45, 52, 58) and is currently the most widely used, offering the broadest protection. *Monovalent* - This term refers to a vaccine targeting only **one specific strain** of a pathogen. - No HPV vaccine has ever been licensed as monovalent, as even the earliest vaccines covered multiple high-risk types. *Trivalent* - This describes a vaccine protecting against **three different strains** of a pathogen. - No **trivalent HPV vaccine** has ever been developed or licensed. *Only Quadrivalent* - While the **quadrivalent vaccine (Gardasil)** was an important advancement, it is not the only type available. - Both **bivalent** and **nonavalent** vaccines are also licensed and available globally.

Q: Vaccines at primary health care centers are stored in:

ILR. ***ILR*** - An **ILR (Ice Lined Refrigerator)** is specifically designed to maintain vaccines within the **recommended temperature range (2°C to 8°C)**, even during power outages. - Its **ice lining** provides a cold reserve, ensuring temperature stability critical for vaccine efficacy, especially in primary health care settings that may have unreliable power supply. *Ultra-low temperature freezer* - **Ultra-low temperature freezers** (e.g., -70°C to -80°C) are used for storing highly sensitive vaccines like some mRNA COVID-19 vaccines, but they are not standard for routine primary health care vaccine storage due to their cost and specialized maintenance requirements. - Storing routine vaccines at such **extreme cold temperatures** can actually damage them or reduce their potency, as many are designed for storage in a refrigerator, not a freezer. *Ice-lined box* - An **ice-lined box** is primarily used for **transporting vaccines** for short periods, such as during outreach sessions or between health facilities. - While it helps maintain temperature, it is a **temporary solution** and not designed for long-term storage at a primary health care center. *None of the options* - This option is incorrect because the **ILR (Ice Lined Refrigerator)** is specifically designed and commonly used for vaccine storage at primary health care levels, making it the most appropriate answer.

Q: In a measles outbreak, measles vaccine can be given to infants at what age range:

6-9 months. ***6-9 months*** - During a **measles outbreak**, infants as young as **6 months** can receive an early dose of the measles vaccine to provide protection. - This early vaccination is crucial in high-risk situations, even though the standard first dose is typically given at **12-15 months** of age. *2-3 months* - Administering the measles vaccine at **2-3 months** is generally avoided because of the presence of persistent **maternal antibodies**. - These antibodies can interfere with the infant's immune response to the vaccine, making it less effective. *3-5 months* - Similar to the 2-3 month range, **maternal antibodies** are still likely present and at sufficiently high levels in infants aged 3-5 months. - This interference reduces the vaccine's efficacy and the likelihood of developing a robust, lasting immune response. *2-7 months* - While this range includes the accepted 6-month age for early vaccination, infants under **6 months** still pose a challenge due to **maternal antibody interference**. - Combining these ages into a single range doesn't differentiate between the reduced efficacy in younger infants versus the permissible early vaccination at 6 months and older during an outbreak.

Q: Which of the following vaccines has the highest coverage among children aged 12-23 months according to NFHS-5 data?

BCG vaccine. ***BCG vaccine (Correct Answer)*** - According to **NFHS-5 (2019-21)**, BCG vaccine has the **highest coverage at 93.3%** among children aged 12-23 months in India. - BCG is administered **at birth or as soon as possible thereafter**, making it the first vaccine in the immunization schedule. - Its high coverage is attributed to **institutional deliveries** and administration at birth in healthcare facilities. - BCG serves as a **key indicator** of access to immunization services. *Measles/MR vaccine* - NFHS-5 data shows **measles/MR first dose coverage at 88.7%**, which is lower than BCG. - Despite being part of routine immunization, measles coverage is **second highest** among commonly tracked vaccines. - Coverage gaps exist due to **dropout rates** and challenges in reaching children at 9-12 months of age. *DPT vaccine* - **DPT3 (third dose) coverage is 76.4%** according to NFHS-5, showing significant dropout from the first dose. - The **multi-dose requirement** (at 6, 10, and 14 weeks) leads to progressive decline in coverage. - DPT3 completion is used as an indicator of **immunization program performance** and demonstrates dropout challenges. *None of the vaccines* - This is incorrect as **all three vaccines have substantial coverage** in India's Universal Immunization Programme. - NFHS-5 data clearly documents **high coverage rates** for these essential childhood vaccines, with BCG leading at over 93%.

Q: Which of the following vaccines is not part of the National Immunization Programme?

Hepatitis A. ***Hepatitis A*** - The **Hepatitis A vaccine** is **not included** in India's routine **Universal Immunization Programme (UIP)**. - While it protects against **hepatitis A infection**, it is only used in India for outbreak control in specific high-risk situations, not as a universal routine vaccine. - The UIP prioritizes vaccines for diseases with higher public health burden and those targeted for elimination/eradication. *TT (Tetanus Toxoid)* - **Tetanus Toxoid (TT)** is a crucial component of India's **Universal Immunization Programme**. - It is administered to pregnant women (to prevent neonatal tetanus) and as part of childhood immunization (DPT/Pentavalent vaccine). - Protects against **tetanus**, a potentially fatal bacterial infection. *OPV (Oral Polio Vaccine)* - **Oral Polio Vaccine (OPV)** has been a cornerstone of India's **Universal Immunization Programme** under the Pulse Polio Programme. - Administered to infants and children to provide protection against **poliomyelitis**. - India has been polio-free since 2014, with OPV being gradually replaced by IPV (Inactivated Polio Vaccine). *Measles* - The **Measles vaccine** (given as MR - Measles-Rubella vaccine) is a vital part of India's **Universal Immunization Programme**. - Administered at 9-12 months and 16-24 months of age. - Helps control **measles**, a highly contagious viral disease that can cause serious complications and death in children.

Q: Which vaccine is associated with complications such as osteomyelitis?

BCG vaccine. ***BCG vaccine*** - The BCG vaccine, particularly when given to immunocompromised individuals or sometimes due to improper administration, can lead to disseminated infection, including **BCG osteitis** or **osteomyelitis**. - This complication, though rare, involves the infection of **bone tissue** by the attenuated *Mycobacterium bovis* strain used in the vaccine. *Hepatitis B vaccine* - The Hepatitis B vaccine is generally safe, with common side effects limited to **local reactions** at the injection site. - It is not associated with an increased risk of developing **osteomyelitis**. *Measles vaccine* - The measles vaccine (MMR) is a live attenuated vaccine, and side effects usually include **fever** or a mild rash. - There is no established link between the measles vaccine and the development of **osteomyelitis**. *IPV* - Inactivated Poliovirus Vaccine (IPV) is a safe vaccine, and its serious complications are exceedingly rare, primarily involving **severe allergic reactions**. - It does not contain live virus and is not known to cause **osteomyelitis**.

Q: Which of the following statements about measles is incorrect?

Secondary attack rate is 30%. ***Secondary attack rate is 30%*** - Measles is highly contagious, and its **secondary attack rate** is much higher than 30%, often reaching **90% or more** among susceptible household contacts. - A 30% secondary attack rate would be exceptionally low for a disease with measles's known **high transmissibility**. *Maximum incidence in 6 months to 3 years age group* - This statement is correct as **maternal antibodies wane** around 6 months, making infants susceptible, and young children in this age range are often actively exposed in community settings. - Peak incidence occurs in this age group, particularly in **unvaccinated or under-vaccinated populations**. *Best age for immunization is 9-12 months* - This is the **recommended age** for measles vaccination under India's **Universal Immunization Programme (UIP)**. - Immunizing at this age ensures that waning maternal antibodies do not interfere with vaccine efficacy while providing timely protection during the high-risk period. *Secondary attack rate is 90%* - This statement is correct. Measles is one of the **most contagious infectious diseases**, with a secondary attack rate among susceptible household contacts often **exceeding 90%**. - Its high transmissibility is due to its **airborne spread** and long communicable period.

Q: Mission Indradhanush was started in

Dec-14. ***Dec-14*** - Mission Indradhanush, a flagship immunization program in India, was launched on **December 25, 2014**. - Its primary aim was to **immunize all children and pregnant women** against preventable diseases. *Jan-05* - This date does not correspond to the launch of Mission Indradhanush. Other health initiatives or policies may have been introduced around this time. - The focus on a comprehensive, nationwide immunization drive as seen in Mission Indradhanush came later. *Jul-10* - This date is incorrect for the inception of Mission Indradhanush. There were various health programs ongoing in India during 2010. - No major national immunization campaign of the scale of Mission Indradhanush began in July 2010. *Mar-16* - While significant developments and phases of Mission Indradhanush occurred after its launch, March 2016 was not the initiation date. - This period might have seen the implementation of subsequent phases or intensified efforts of the mission.

Q: What is the recommended regimen for human diploid cell vaccine for pre-exposure rabies vaccination?

0, 7, 28 then booster dose 1 year. ***0, 7, 28 then booster dose 1 year*** - The recommended schedule for **pre-exposure prophylaxis** with human diploid cell vaccine (HDCV) in India is three doses on days **0, 7, and 28**. - A **booster dose at 1 year** is recommended for individuals with **continuous risk of exposure** (e.g., veterinarians, laboratory workers, animal handlers). - This schedule provides adequate antibody titers and long-term protection. Further boosters may be given every 3-5 years based on antibody titers or risk assessment. *0, 7, 21 then booster dose 12 months* - While the 0, 7, 21 (or 21-28) day schedule is used in some international protocols (WHO/CDC), the **standard schedule in India is 0, 7, 28 days**. - The booster timing at 12 months is appropriate, but the primary series schedule is not the preferred Indian guideline. *0, 7, 28 then booster dose 2 years* - The primary series schedule of 0, 7, 28 days is correct. - However, the **booster interval of 2 years is too long** for the first booster dose in pre-exposure prophylaxis. The first booster is recommended at **1 year**, with subsequent boosters at longer intervals (3-5 years) based on risk. *0, 14, 28 then booster dose 90 days* - A **day 14 dose is not part of the standard schedule** for pre-exposure rabies vaccination. - A **booster at 90 days is incorrect** – this is far too soon and not part of established pre-exposure prophylaxis guidelines. The first booster should be at 1 year, not 3 months.

Question 1

WHO immunization evaluation coverage survey is normally done in what age group?

Accepted Answer

12-23 months

Answer

0-12 months

Answer

6-12 months

Answer

9-12 months

Question 2

What are the types of HPV vaccines that have been licensed and are available?

Accepted Answer

Bivalent, Quadrivalent, and Nonavalent

Answer

Monovalent

Answer

Trivalent

Answer

Only Quadrivalent

Question 3

Vaccines at primary health care centers are stored in:

Accepted Answer

ILR

Answer

Ultra-low temperature freezer

Answer

Ice-lined box

Answer

None of the options

Question 4

In a measles outbreak, measles vaccine can be given to infants at what age range:

Accepted Answer

6-9 months

Answer

2-3 months

Answer

3-5 months

Answer

2-7 months

Question 5

Which of the following vaccines has the highest coverage among children aged 12-23 months according to NFHS-5 data?

Accepted Answer

BCG vaccine

Answer

DPT vaccine

Answer

Measles vaccine

Answer

None of the vaccines

Question 6

Which of the following vaccines is not part of the National Immunization Programme?

Accepted Answer

Hepatitis A

Answer

TT

Answer

OPV

Answer

Measles

Question 7

Which vaccine is associated with complications such as osteomyelitis?

Accepted Answer

BCG vaccine

Answer

Hepatitis B vaccine

Answer

Measles vaccine

Answer

IPV

Question 8

Which of the following statements about measles is incorrect?

Accepted Answer

Secondary attack rate is 30%

Answer

Secondary attack rate is 90%

Answer

Maximum incidence in 6 months to 3 years age group

Answer

Best age for immunization is 9-12 months

Question 9

Mission Indradhanush was started in

Accepted Answer

Dec-14

Answer

Jan-05

Answer

Jul-10

Answer

Mar-16

Question 10

What is the recommended regimen for human diploid cell vaccine for pre-exposure rabies vaccination?

Accepted Answer

0, 7, 28 then booster dose 1 year

Answer

0, 14, 28 then booster dose 90 days

Answer

0, 7, 28 then booster dose 2 years

Answer

0, 7, 21 then booster dose 12 months

Immunization and Vaccine-Preventable Diseases — MCQs

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