Immunization and Vaccine-Preventable Diseases Practice Questions

Q: What is the schedule of intradermal rabies vaccine?

2-0-2-0-1-1. ***2-0-2-0-1-1*** - This schedule represents the **Thai Red Cross (TRC) regimen** for intradermal rabies vaccination that was standard at the time of this exam (2013). - The numbers indicate the number of vaccine doses administered at different sites: **2 doses on day 0** (bilateral deltoids), **0 doses on day 3**, **2 doses on day 7** (bilateral deltoids), **0 doses on day 14**, **1 dose on day 28**, and **1 dose on day 90**. - This was the **answer expected for NEET 2013** based on the guidelines prevalent at that time. - **Note:** Current WHO guidelines (post-2013) recommend the updated 2-2-2-0-1-1 schedule (4-site ID regimen) which includes doses on days 0, 3, 7, and 28. *2-2-0-1-0-1* - This schedule is **not a recognized** intradermal rabies vaccination protocol. - Does not match any standard WHO-approved regimen for intradermal administration. *2-2-2-0-1-1* - While this may appear incorrect for the 2013 exam context, this schedule actually represents the **current updated Thai Red Cross (4-site ID) regimen** recommended by WHO in recent guidelines. - This regimen provides doses on **days 0, 3, 7, 28, and 90**, which is now the preferred intradermal schedule. - However, for the NEET 2013 exam, the older 2-0-2-0-1-1 schedule was the expected answer. *8-4-4-1-0-1* - This schedule is **not a standard regimen** and involves an impractically high number of doses. - No recognized intradermal rabies protocol uses this many doses on initial days. - Would be **unnecessary and impractical** for effective post-exposure prophylaxis.

Q: Minimum threshold level of herd immunity for Pertussis is?

90%. ***90%*** - Pertussis, due to its **high R-naught (R0)**, requires a very high vaccination coverage to achieve herd immunity. - An estimated 92-94% vaccination coverage is often cited as necessary to prevent outbreaks. *80%* - While 80% might be sufficient for some less contagious diseases, it's **too low a threshold** for a highly transmissible infection like pertussis. - This level would likely still allow for significant localized outbreaks, especially in unvaccinated pockets. *70%* - A 70% threshold is generally considered **insufficient** for controlling the spread of highly contagious respiratory infections. - This level of immunity would mean a higher proportion of susceptible individuals, leading to a greater risk of widespread transmission. *50%* - A 50% herd immunity level is **grossly inadequate** for a disease like pertussis, which is one of the most contagious vaccine-preventable diseases. - This low level of immunity would offer minimal protection against widespread transmission and outbreaks.

Q: To achieve neonatal tetanus elimination, the incidence of neonatal tetanus per 1000 live births should be reduced to less than:

1.0. ***1.0*** - The international target for **neonatal tetanus elimination (NTE)** as defined by WHO/UNICEF is an incidence rate of **less than 1 case per 1,000 live births per year** in every district of a country. - This is the globally recognized threshold for declaring that neonatal tetanus has been eliminated as a public health problem. - Countries achieving this target at the district level are considered to have achieved NTE. *0.1* - While 0.1 per 1,000 live births represents an extremely low incidence, this is not the WHO-defined threshold for **neonatal tetanus elimination**. - The elimination target is less stringent at <1 per 1,000 live births, making disease control achievable while still representing a major public health success. *0.2* - An incidence of 0.2 per 1,000 live births, though very low, is not the internationally recognized threshold for **neonatal tetanus elimination**. - The established WHO/UNICEF target is <1 per 1,000 live births in every district. *0.5* - An incidence of 0.5 per 1,000 live births indicates excellent control of neonatal tetanus but is not the specific cut-off value. - The WHO criterion for elimination is less than 1 case per 1,000 live births per year at the district level.

Q: Vaccines are available against which types of meningococcus?

Type A, B, C, W, and Y. ***Type A, B, C, W, and Y*** - Vaccines are currently available against **all five major meningococcal serogroups**: A, B, C, W-135, and Y. - **Meningococcal conjugate vaccines (MenACWY)** provide protection against serogroups A, C, W-135, and Y, and are widely used globally. - **Meningococcal B vaccines (MenB)** such as Bexsero and Trumenba specifically target serogroup B, which is a leading cause of meningococcal disease in developed countries. - Combined, these vaccines provide comprehensive coverage against the most epidemiologically important meningococcal serogroups worldwide. *Type A* - While vaccines against **meningococcus type A** do exist (as part of conjugate vaccines), this option is incomplete as it excludes the other important serogroups (B, C, W, Y) for which vaccines are also available. *Type B* - **Type B vaccines** are available and important, particularly in developed countries where serogroup B causes significant disease burden. - However, this option alone is insufficient because vaccines also effectively target other serogroups (A, C, W, Y). *Type A, B, and C* - This option is incomplete because it omits **serogroups W and Y**, for which conjugate vaccines (MenACWY) are readily available and widely used. - The question asks which types vaccines are *available* against, not which are most common, making this an incorrect answer.

Q: According to the immunization schedule, how many doses of influenza vaccine should children under 9 years of age receiving the vaccine for the first time typically receive?

2 doses at 4 weeks interval. ***2 doses at 4 weeks interval*** - Children **under 9 years of age** receiving the influenza vaccine for the **first time** require **two doses** administered at least **4 weeks (28 days) apart**. - This two-dose priming schedule is essential to ensure adequate immune response and protection against circulating influenza strains. - This recommendation is consistent across **IAP (Indian Academy of Pediatrics)** and **CDC guidelines**. - Children 9 years and older, and younger children who have been previously vaccinated, require only **1 dose annually**. *3 doses at 4 weeks interval* - The standard protocol for influenza vaccination does **not involve three doses**. - A three-dose schedule is typically seen with vaccines like **Hepatitis B**, **DTaP**, or **Hib**, but not for influenza. *2 doses at 4 weeks interval with a booster dose for high-risk children* - While high-risk children (chronic lung disease, heart disease, immunocompromised) are priority groups for influenza vaccination, the schedule remains **two initial doses** for first-time recipients under 9 years. - There is **no additional booster dose** beyond the two-dose series within the same influenza season, even for high-risk children. - Subsequent years require only **1 dose annually**. *None of the options* - This is incorrect as the standard recommendation is clearly established in immunization guidelines. - The **two-dose schedule at 4-week intervals** for first-time recipients under 9 years is well-documented by IAP and international guidelines.

Q: At what age is the BCG vaccination administered in India?

At birth. ***At birth*** - In India, the **BCG vaccine** is routinely administered to infants **at birth** or as early as possible thereafter as per the **Universal Immunization Programme (UIP)**. - This early vaccination aims to provide protection against **severe forms of tuberculosis (TB)**, particularly **tuberculous meningitis** and **disseminated (miliary) TB** in young children. - Early administration is crucial as infants are at highest risk of developing severe TB if exposed. *Incorrect: 1 year* - While other vaccinations might be given at 1 year (such as MMR), the BCG vaccine is specifically recommended at or soon after birth. - Delaying BCG vaccination until 1 year increases the risk of early exposure to TB before immunity can be established, defeating its protective purpose. *Incorrect: 2 years* - The recommended schedule for BCG vaccination in India does not include administration at 2 years of age. - By 2 years, potential exposure to TB may have already occurred, and the vaccine's efficacy in preventing severe forms of the disease would be compromised. *Incorrect: 6 weeks* - At 6 weeks, other vaccines like OPV, DPT, Hepatitis B, Hib, and Rotavirus are administered as part of the UIP schedule. - BCG is specifically given at birth, not at 6 weeks, to provide early protection against severe childhood tuberculosis.

Q: Dukoral is:

Oral cholera vaccine. ***Oral cholera vaccine*** - Dukoral is a **killed oral whole-cell vaccine** against *Vibrio cholerae* O1 and O139, often combined with a recombinant B subunit of cholera toxin. - It provides protection against **cholera**, an acute diarrheal illness caused by bacterial infection of the small intestine. *Oral rotavirus vaccine* - Oral rotavirus vaccines (e.g., Rotarix, RotaTeq) provide protection against **rotavirus**, the most common cause of severe diarrhea in infants and young children. - These vaccines are usually given in multiple doses to infants and are distinct from cholera vaccines. *Oral typhoid vaccine* - An oral typhoid vaccine, such as Ty21a, is used for the prevention of **typhoid fever**, caused by *Salmonella Typhi*. - It is a **live attenuated vaccine** administered in several doses over a week, differing significantly from Dukoral's mechanism and target. *Ready to use therapeutic food* - **Ready-to-use therapeutic food (RUTF)** is a high-energy, micronutrient-rich paste used for the treatment of **severe acute malnutrition (SAM)**, especially in children. - It is a nutritional intervention, not a vaccine, and helps in weight gain and recovery for malnourished individuals.

Q: Antiserum is available for passive immunization against ?

Rabies. ***Rabies*** - **Antiserum** (or rabies immune globulin, RIG) provides immediate **passive immunity** against rabies, neutralizing the virus before the body can mount an active immune response. - It is administered in conjunction with the **rabies vaccine** for post-exposure prophylaxis, especially in severe exposures. *Typhoid* - **Typhoid fever** is primarily prevented through vaccination (active immunization) and improved sanitation. - There is no routinely available antiserum for **passive immunization** against *Salmonella typhi* infection. *Measles* - **Measles** is prevented through active immunization with the MMR (measles, mumps, rubella) vaccine. - While immune globulin can be used for passive protection in exposed, immunocompromised individuals, it's not commonly referred to as "antiserum" in the same context as rabies. *Mumps* - **Mumps** is prevented by active immunization with the MMR vaccine. - Similar to measles, there is no commonly used specific antiserum for **passive immunity** against mumps in the clinical setting.

Q: Which day is not included in the pre-exposure prophylaxis dose schedule for the rabies vaccine?

Day 3. ***Day 3*** - The standard pre-exposure prophylaxis (PrEP) schedule for rabies vaccine typically involves three doses given on **Day 0, Day 7, and Day 21 or 28**. - A dose on Day 3 is **not part of the standard recommended PrEP schedule**. *Day 0* - This is the **initial dose** in the pre-exposure prophylaxis series for rabies. - It marks the beginning of the vaccination schedule to build immunity. *Day 7* - This is the **second dose** in the pre-exposure prophylaxis series for rabies. - It follows the initial dose and is crucial for developing a robust immune response. *Day 28* - This dose, along with Day 21, can be the **final dose** in the pre-exposure prophylaxis series for rabies, depending on the specific regimen used. - It completes the primary vaccination course to ensure long-lasting protection.

Q: India started 2-dose vaccination strategy for measles, in -

2010. ***2010*** - India implemented the **two-dose measles vaccination strategy** as part of its Universal Immunization Program starting in **2010**. - This decision was based on recommendations to improve immunity and reduce measles incidence, moving from a single-dose to a more effective **two-dose schedule**. *2008* - While important immunization initiatives were ongoing, the specific policy of a **two-dose measles vaccination strategy** had not yet been introduced in India during 2008. - At this time, the focus was primarily on ensuring high coverage of the **first dose** of measles vaccine. *2009* - The year 2009 saw continued efforts to strengthen the Universal Immunization Program, but the official launch of the **two-dose measles vaccination strategy** in India occurred later. - Discussions and planning for the transition were likely underway, but implementation began in the subsequent year. *2011* - By 2011, the **two-dose measles vaccination strategy** was already being implemented across India, having been introduced in 2010. - This year marked a period of expanding coverage and consolidation of the new 2-dose schedule rather than its initial introduction.

Question 1

What is the schedule of intradermal rabies vaccine?

Accepted Answer

2-0-2-0-1-1

Answer

2-2-0-1-0-1

Answer

8-4-4-1-0-1

Answer

2-2-2-0-1-1

Question 2

Minimum threshold level of herd immunity for Pertussis is?

Accepted Answer

90%

Answer

80%

Answer

70%

Answer

50%

Question 3

To achieve neonatal tetanus elimination, the incidence of neonatal tetanus per 1000 live births should be reduced to less than:

Accepted Answer

1.0

Answer

0.1

Answer

0.5

Answer

0.2

Question 4

Vaccines are available against which types of meningococcus?

Accepted Answer

Type A, B, C, W, and Y

Answer

Type A

Answer

Type B

Answer

Type A, B, and C

Question 5

According to the immunization schedule, how many doses of influenza vaccine should children under 9 years of age receiving the vaccine for the first time typically receive?

Accepted Answer

2 doses at 4 weeks interval

Answer

2 doses at 4 weeks interval with a booster dose for high-risk children

Answer

3 doses at 4 weeks interval

Answer

None of the options

Question 6

At what age is the BCG vaccination administered in India?

Accepted Answer

At birth

Answer

1 year

Answer

2 years

Answer

6 weeks

Question 7

Dukoral is:

Accepted Answer

Oral cholera vaccine

Answer

Oral rotavirus vaccine

Answer

Oral typhoid vaccine

Answer

Ready to use therapeutic food

Question 8

Antiserum is available for passive immunization against ?

Accepted Answer

Rabies

Answer

Typhoid

Answer

Mumps

Answer

Measles

Question 9

Which day is not included in the pre-exposure prophylaxis dose schedule for the rabies vaccine?

Accepted Answer

Day 3

Answer

Day 0

Answer

Day 7

Answer

Day 28

Question 10

India started 2-dose vaccination strategy for measles, in -

Accepted Answer

2010

Answer

2008

Answer

2009

Answer

2011

Immunization and Vaccine-Preventable Diseases — MCQs

Immunization and Vaccine-Preventable Diseases — MCQs

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