Vaccination Coverage Assessment — MCQs
Transmission assessment survey (TAS) is done for which of the following purposes?
Which of the following vaccines has the highest coverage among children aged 12-23 months according to NFHS-5 data?
The primary mechanism by which herd immunity protects a population is by:
Which vaccine is contraindicated in a 6-month-old infant whose sibling is on chemotherapy for leukemia?
Which of the following is the true statement regarding measures to prevent typhoid transmission in the community?
Which of the following statements about HPV vaccination is true?
Which statement is TRUE regarding the relationship between HPV vaccination and cervical cancer screening?
All of the following are true about the Herd immunity for infectious diseases except -
For which of the following is PPV-23 most beneficial:
Live vaccines are contraindicated in all except:
Vaccination Coverage Assessment Indian Medical PG Practice Questions and MCQs
Question 1: Transmission assessment survey (TAS) is done for which of the following purposes?
- A. To provide reliable estimates of birth rate, death rate and infant mortality rate
- B. For assessing primary immunization coverage
- C. All of the options
- D. To determine when infections have been reduced below target transmission thresholds (Correct Answer)
Explanation: ***To determine when infections have been reduced below these target thresholds*** - **Transmission assessment surveys (TAS)** are specifically designed to evaluate if the prevalence of a **neglected tropical disease (NTD)**, such as **lymphatic filariasis** or **trachoma**, has fallen below a critical threshold. - This assessment is crucial for determining whether to **stop mass drug administration (MDA)** campaigns and move towards post-MDA surveillance. *To provide reliable estimates of birth rate, death rate and infant mortality rate* - This function is typically associated with **demographic and health surveys (DHS)** or national vital statistics registration systems, not TAS. - These surveys focus on population-level health indicators and cannot determine infectious disease transmission levels. *For assessing primary immunization coverage* - Immunization coverage is assessed through specific **immunization coverage surveys (ICS)** or analysis of routine administrative data. - TAS is designed for infectious disease transmission, not vaccine uptake. *All of the options* - Only the first option accurately describes the specific purpose of a **Transmission Assessment Survey (TAS)**. - The other options relate to different types of public health surveys with distinct objectives.
Question 2: Which of the following vaccines has the highest coverage among children aged 12-23 months according to NFHS-5 data?
- A. BCG vaccine (Correct Answer)
- B. DPT vaccine
- C. Measles vaccine
- D. None of the vaccines
Explanation: ***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%.
Question 3: The primary mechanism by which herd immunity protects a population is by:
- A. Reducing transmission by decreasing susceptible individuals in the population (Correct Answer)
- B. Increases with increased vaccination
- C. Is related to vaccine efficacy
- D. Applies only to infectious diseases
Explanation: ***Reducing transmission by decreasing susceptible individuals in the population*** - **Herd immunity's primary mechanism** is reducing the proportion of susceptible individuals, which decreases the probability of transmission when an infected person encounters others - When a critical threshold of the population is immune (either through vaccination or natural infection), it **breaks the chain of transmission**, making epidemic spread unlikely - This mechanism **indirectly protects unvaccinated individuals** (infants, immunocompromised, vaccine non-responders) by reducing their exposure risk *Increases with increased vaccination* - While increased vaccination coverage **contributes to achieving** herd immunity, this describes a **contributing factor**, not the protective mechanism itself - Vaccination provides individual immunity, which collectively builds toward the herd immunity threshold *Is related to vaccine efficacy* - **Vaccine efficacy** influences the vaccination coverage threshold needed for herd immunity (higher efficacy = lower threshold needed) - This is a **determinant** of herd immunity requirements, not the mechanism by which it protects populations *Applies only to infectious diseases* - This describes the **scope of applicability** of herd immunity, not its mechanism - Herd immunity is specific to communicable diseases because protection depends on preventing **pathogen transmission** between individuals
Question 4: Which vaccine is contraindicated in a 6-month-old infant whose sibling is on chemotherapy for leukemia?
- A. Oral polio vaccine (Correct Answer)
- B. Hepatitis B
- C. Rotavirus vaccine
- D. DPT
Explanation: ***Oral polio vaccine*** - The **oral polio vaccine (OPV)** is a live attenuated vaccine containing weakened but live viruses. - It is **absolutely contraindicated** in individuals with immunocompromised household contacts (like a sibling on **chemotherapy**) due to the risk of **vaccine-associated paralytic poliomyelitis (VAPP)** from shedding of the live vaccine virus. - The shed virus can be transmitted to and cause disease in immunocompromised contacts. - This is the primary reason most countries have switched to **inactivated polio vaccine (IPV)**. *Hepatitis B* - The **Hepatitis B vaccine** is an inactivated (non-live) recombinant vaccine. - It poses no risk of transmitting live virus to an immunocompromised individual. - It is safe to administer to an infant with an immunocompromised household contact. *Rotavirus vaccine* - The **Rotavirus vaccine** is also a live attenuated vaccine, and there is a **relative contraindication** when household contacts are severely immunocompromised. - The vaccine virus can be shed in stool for several days after vaccination. - However, compared to OPV, the risk of serious disease transmission is considered much lower, and some guidelines allow its use with precautions (strict hand hygiene, avoiding diaper changes by immunocompromised contacts). - In the context of this question, **OPV has a stronger absolute contraindication** than rotavirus vaccine. *DPT* - The **DPT vaccine** (Diphtheria, Pertussis, Tetanus) is an **inactivated vaccine** containing toxoids and killed bacterial components. - It is safe to administer to an infant with an immunocompromised household contact as there is no risk of shedding live pathogens.
Question 5: Which of the following is the true statement regarding measures to prevent typhoid transmission in the community?
- A. Typhoid vaccine administration is the best method of preventing transmission.
- B. Person-to-person transmission is the primary mode of spread.
- C. Drug resistance in typhoid is not as big a problem as in TB.
- D. Hygiene practice and clean sanitation control are more important than the typhoid vaccine. (Correct Answer)
Explanation: ***Hygiene practice and clean sanitation control is more important than the typhoid vaccine.*** - **Improved sanitation**, safe water supplies, and adequate hygiene practices are fundamental in controlling the spread of **typhoid fever**, as the disease is primarily transmitted through the **oral-fecal route**. - While vaccines are an important tool, they offer only partial protection and must be combined with **robust public health infrastructure** and **sanitation measures** for effective prevention. *Typhoid vaccine administration is the best method of preventing transmission.* - Typhoid vaccines offer protection, but their effectiveness is not 100%, and they typically require **booster doses** - **Vaccination campaigns** are most effective when implemented alongside improvements in **water and sanitation infrastructure**, as vaccines alone cannot fully prevent transmission in areas with poor hygiene. *Person-to-person transmission is the primary mode of spread.* - While person-to-person transmission can occur, especially in settings with poor hygiene, the primary mode of spread for typhoid is through the **ingestion of food or water contaminated** with the feces of an infected person or carrier. - This emphasizes the crucial role of **water and food safety** rather than just focusing on direct person-to-person contact. *Drug resistance in typhoid is not as big a problem as in TB.* - **Antimicrobial resistance (AMR)** in typhoid fever, particularly to fluoroquinolones and extended-spectrum beta-lactamase (ESBL) producing strains, is a **significant and growing global health concern**, complicating treatment. - While TB also faces serious drug resistance issues, the escalating problem of **extensively drug-resistant (XDR)** and **multi-drug resistant (MDR)** typhoid strains makes it a substantial threat, impacting treatment options and increasing morbidity and mortality.
Question 6: Which of the following statements about HPV vaccination is true?
- A. It is given to women aged 20-40 years.
- B. The primary dose consists of 2 doses.
- C. It has an efficacy greater than 70% for cervical cancer. (Correct Answer)
- D. There are two types available in the market.
Explanation: ***It has an efficacy greater than 70% for cervical cancer.*** - HPV vaccines are highly effective in preventing **HPV infections**, which are the primary cause of cervical cancer. Studies show they have an efficacy of **over 70%** (and often much higher for certain strains) in preventing cervical precancers and cancers. - The vaccine works by inducing an immune response to the **HPV L1 capsid protein**, which prevents the virus from infecting cells. *It is given to women aged 20-40 years.* - The primary target group for HPV vaccination is **adolescents**, typically aged 9-14 years, before potential exposure to the virus. - While catch-up vaccination may be recommended for young adults up to age 26, routine vaccination in women aged 20-40 years is **less common and less effective** due to likely prior exposure. *The primary dose consists of 2 doses.* - For individuals initiating vaccination before their 15th birthday, the primary dose schedule consists of **2 doses**. - For individuals 15 years and older, a **3-dose schedule** is typically recommended. *There are two types available in the market.* - Currently, there are **three types** of HPV vaccines available globally: bivalent (targeting HPV 16, 18), quadrivalent (targeting HPV 6, 11, 16, 18), and **nonavalent (targeting HPV 6, 11, 16, 18, 31, 33, 45, 52, 58)**. - The specific types available in a particular market may vary, but globally, there are more than two.
Question 7: Which statement is TRUE regarding the relationship between HPV vaccination and cervical cancer screening?
- A. Vaccinated women require less frequent screening than unvaccinated women
- B. Screening recommendations are currently the same regardless of vaccination status (Correct Answer)
- C. HPV vaccination eliminates the need for cervical cancer screening
- D. Screening should begin at a younger age in vaccinated women
Explanation: ***Screening recommendations are currently the same regardless of vaccination status*** * Current guidelines recommend the same cervical cancer screening schedule for all eligible individuals, **regardless of their HPV vaccination status**. * This is because the HPV vaccine does not protect against all oncogenic HPV types, and individuals may have been exposed to HPV prior to vaccination. *Vaccinated women require less frequent screening than unvaccinated women* * This statement is incorrect because there is **no evidence to support less frequent screening** for vaccinated women. * The persistence of **high-risk HPV types not covered by the vaccine** and the possibility of prior exposure necessitate consistent screening. *HPV vaccination eliminates the need for cervical cancer screening* * This is incorrect; HPV vaccination significantly reduces the risk of cervical cancer but **does not eliminate it completely**. * Vaccines protect against the most common high-risk HPV types but **not all of them**, making continued screening essential. *Screening should begin at a younger age in vaccinated women* * This is incorrect; current guidelines recommend the **same starting age for cervical cancer screening** (typically 21 or 25, depending on the guideline) for both vaccinated and unvaccinated women. * There is **no clinical rationale to initiate screening earlier** in vaccinated individuals.
Question 8: All of the following are true about the Herd immunity for infectious diseases except -
- A. It is more easily achieved for infections that do not have a sub-clinical phase (Correct Answer)
- B. In the case of tetanus it does not protect the individual
- C. It is affected by the presence and distribution of alternative animal hosts
- D. It refers to group protection beyond what is afforded by the protection of immunized individuals
Explanation: ***It is more easily achieved for infections that do not have a sub-clinical phase*** - This statement is incorrect because infections with a **sub-clinical phase** (asymptomatic carriers) can still contribute to transmission, making herd immunity harder to achieve. - The presence of asymptomatic but infectious individuals means that a higher percentage of the population needs to be immune to protect the unimmunized. *In the case of tetanus it does not protect the individual* - **Tetanus** is caused by a toxin produced by *Clostridium tetani*, which is ubiquitous in the environment and does not spread person-to-person. - Therefore, **herd immunity** (protection from indirect transmission) is irrelevant for tetanus; individual vaccination is the only way to prevent the disease. *It is affected by the presence and distribution of alternative animal hosts* - For **zoonotic diseases**, such as rabies or influenza, the presence of **animal reservoirs** can make achieving herd immunity in the human population more challenging. - These animal hosts can maintain the pathogen's circulation, allowing for reintroduction into the human population. *It refers to group protection beyond what is afforded by the protection of immunized individuals* - **Herd immunity** occurs when a sufficiently high proportion of the population is immune to an infectious disease, indirectly protecting non-immune individuals. - This collective immunity reduces the likelihood of an outbreak and limits disease transmission within the population.
Question 9: For which of the following is PPV-23 most beneficial:
- A. Child less than 2 years
- B. Sickle cell anemia patient (Correct Answer)
- C. Cystic fibrosis patient
- D. Patient with recurrent rhinitis and sinusitis
Explanation: ***Sickle cell anemia patient*** - Individuals with **sickle cell anemia** are at a **high risk of invasive pneumococcal disease** due to functional asplenia, making PPV-23 highly beneficial for them. - The **PPV-23 vaccine** targets 23 serotypes of *Streptococcus pneumoniae* and is recommended for those aged 2 years and older with certain chronic medical conditions, including sickle cell disease. - This is one of the **strongest indications** for PPV-23 due to the severe immunocompromise from splenic dysfunction. *Child less than 2 years* - The **polysaccharide vaccines** like PPV-23 are generally **not effective in children younger than 2 years** as their immature immune system does not respond well to polysaccharide antigens. - For children in this age group, the **pneumococcal conjugate vaccine (PCV13)**, which elicits a T-cell-dependent immune response, is recommended. *Cystic fibrosis patient* - While patients with **cystic fibrosis** are at increased risk for respiratory infections, the primary pathogens are typically *Pseudomonas aeruginosa* and *Staphylococcus aureus*, not *Streptococcus pneumoniae*. - Although pneumococcal vaccination (including PPV-23) is generally recommended for individuals with chronic lung disease, it is **not as specifically indicated or beneficial as for sickle cell patients** who demonstrate profoundly impaired splenic function. *Patient with recurrent rhinitis and sinusitis* - **Recurrent rhinitis and sinusitis** are commonly caused by **viral infections**, allergies, or anatomical abnormalities, not typically by serious invasive pneumococcal disease against which PPV-23 offers protection. - While some episodes might involve *Streptococcus pneumoniae*, this condition does not place a patient in the same **high-risk category for severe, invasive pneumococcal infections** that would mandate PPV-23 vaccination as a primary intervention.
Question 10: Live vaccines are contraindicated in all except:
- A. Breastfeeding mothers (Correct Answer)
- B. Pregnant women
- C. Immunocompromised patients
- D. Patients on high-dose immunosuppressants
Explanation: ***Breastfeeding mothers*** - Live vaccines are generally **safe for breastfeeding mothers** and their infants, as the vaccine viruses are not typically excreted in breast milk in levels that can infect the infant. - The benefits of vaccinating the mother outweigh any theoretical risks, and it can provide **passive immunity** to the infant through antibodies in breast milk. *Pregnant women* - Live vaccines are **contraindicated during pregnancy** due to the theoretical risk of transmitting the attenuated virus to the fetus and causing congenital infection. - Examples include **MMR** and **varicella vaccines**, which should be administered before or after pregnancy. *Immunocompromised patients* - Live vaccines are **contraindicated** in individuals with compromised immune systems due to the risk of the attenuated vaccine virus causing **disseminated infection** or severe disease. - This includes patients with **HIV/AIDS** (with low CD4 counts), congenital immunodeficiencies, and those undergoing active cancer treatment. *Patients on high-dose immunosuppressants* - These patients are considered **immunocompromised**, and live vaccines are **contraindicated** because their suppressed immune system may not be able to effectively control the attenuated vaccine virus, leading to severe infection. - Examples of such medications include high-dose corticosteroids, chemotherapy agents, and biologics that target immune cells.
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