Global Health Security — MCQs
Which of the following is NOT a core component of the WHO's global STI control strategy?
HIV sentinel surveillance is used for:
Microorganism used as a weapon in biological terrorism is:
Which disease is most closely associated with intensive international surveillance for global eradication?
Which disease comes under International Surveillance?
Disease not included under International surveillance
Which of the following statements about a primary health centre (PHC) is incorrect?
Which of the following diseases is not covered under the Integrated Disease Surveillance Project (IDSP)?
Targeted critical agents used in a bioterrorist event are except?
Which of the following is not included in the Global Hunger Index?
Global Health Security Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following is NOT a core component of the WHO's global STI control strategy?
- A. Case management
- B. Universal mandatory screening (Correct Answer)
- C. Strategic information systems
- D. Prevention services
Explanation: ***Universal mandatory screening*** - While screening is part of STI control, **universal mandatory screening** for all STIs in the general population is not a core component of the WHO's strategy due to feasibility, cost, and ethical considerations. - The strategy emphasizes **targeted screening** for at-risk populations and opportunistic screening. *Case management* - **Case management**, including accurate diagnosis and effective treatment, is a critical component for managing current infections and preventing further transmission. - This involves syndromic or etiologic approaches to treatment and partner notification. *Strategic information systems* - **Strategic information systems** are essential for monitoring trends, evaluating interventions, and informing policy decisions related to STI control. - This includes surveillance data, program monitoring, and research. *Prevention services* - **Prevention services** are a cornerstone of the WHO's strategy, aiming to reduce the incidence of new infections. - These services encompass health education, condom promotion and distribution, vaccination, and pre-exposure prophylaxis (PrEP).
Question 2: HIV sentinel surveillance is used for:
- A. Detection of high-risk group
- B. Prevalence of HIV infection
- C. Monitoring trends in HIV infection (Correct Answer)
- D. Monitoring disease trends
Explanation: ***Monitoring trends in HIV infection*** - **HIV sentinel surveillance** is specifically designed to track **HIV prevalence trends** over time in selected sentinel populations (ANC attendees, STD clinic attendees, high-risk groups). - The primary objective is to monitor **how HIV infection rates change** over time, helping identify emerging epidemics, evaluate intervention programs, and guide public health policy. - As per **NACO and WHO guidelines**, sentinel surveillance provides repeated cross-sectional prevalence measurements at fixed sites to detect temporal trends in HIV infection. *Monitoring disease trends* - This is **too broad and vague** for the specific purpose of HIV sentinel surveillance. - "Disease trends" could refer to AIDS progression, opportunistic infections, or other disease manifestations, which are **not the focus** of sentinel surveillance. - Sentinel surveillance specifically tracks **infection (seroprevalence)**, not general disease patterns. *Prevalence of HIV infection* - While sentinel surveillance **does measure prevalence**, this is a **method rather than the ultimate purpose**. - Prevalence measurements are taken repeatedly at different time points specifically to **monitor trends**, making this incomplete as the primary objective. *Detection of high-risk group* - Identification of high-risk groups is typically done through **epidemiological studies** and behavioral surveys, not sentinel surveillance. - Sentinel surveillance may **include** high-risk populations as sentinel sites, but its purpose is to monitor trends **within** these groups, not to detect them.
Question 3: Microorganism used as a weapon in biological terrorism is:
- A. Smallpox virus (Correct Answer)
- B. Human norovirus
- C. Rabies virus
- D. Influenza virus
Explanation: ***Smallpox virus*** - The **smallpox virus (Variola major)** is considered the **prime bioterrorism agent** and is classified as a **Category A agent** by the CDC due to its **high infectivity**, **high mortality rate (30%)**, and lack of widespread population immunity since routine vaccination ceased in the 1970s. - It can be easily disseminated through aerosols, causes a severe disfiguring disease with no specific treatment, and would create **widespread panic and public health devastation**. - Smallpox is **eradicated in nature**, so any outbreak would be immediately recognized as intentional, and the virus is now held only in two authorized laboratories, making it a primary bioterrorism concern. *Human norovirus* - While highly contagious and capable of causing widespread outbreaks of **gastroenteritis**, norovirus has a **very low mortality rate** and causes primarily **self-limiting vomiting and diarrhea**. - It typically requires close contact or contaminated food/water for transmission, making **aerosol dissemination less feasible** for a bioweapon. - The disease is generally mild and brief, making it ineffective for causing mass casualties in biological terrorism. *Rabies virus* - Rabies virus is almost uniformly **fatal** once symptoms develop (>99% mortality), but its transmission primarily occurs through the saliva of infected animals via bites, making it **extremely difficult to disseminate on a large scale**. - It has a relatively **long and variable incubation period** (weeks to months) and does not spread directly from person to person, limiting its potential as a rapidly acting or epidemic-causing terrorist agent. - **Post-exposure prophylaxis (PEP)** is highly effective if given promptly, further reducing its utility as a bioweapon. *Influenza virus* - While influenza viruses, particularly **pandemic strains or engineered variants**, can have significant bioterrorism potential (the 1918 Spanish flu killed 50-100 million people), they are considered **less ideal** than smallpox for several reasons. - **Effective countermeasures exist**: vaccines can be developed, antiviral drugs (oseltamivir, zanamivir) are available, and widespread natural immunity to seasonal strains exists in the population. - However, the **mortality rate of seasonal influenza** is much lower than smallpox, and most infections are self-limiting in healthy individuals. - Highly pathogenic strains (e.g., H5N1) are classified as **Category C agents** due to emerging threat potential, but smallpox remains the more feared bioweapon due to complete lack of population immunity and higher case-fatality rate.
Question 4: Which disease is most closely associated with intensive international surveillance for global eradication?
- A. Polio (Correct Answer)
- B. Hepatitis
- C. TB
- D. Leprosy
Explanation: **Polio** - **Polio** has been the focus of an intensive global eradication campaign, requiring robust **international surveillance** to track cases, mutations, and vaccine-derived polioviruses. - The **Global Polio Eradication Initiative (GPEI)**, a major international collaboration, relies heavily on coordinated surveillance efforts to ensure no wild poliovirus remains undetected. *Hepatitis* - While **hepatitis** is a significant global health burden, particularly hepatitis B and C, it is not subject to the same level of internationally coordinated, aggressive surveillance aimed at **global eradication** as polio. - Surveillance for hepatitis often focuses on prevalence, incidence, and risk factors at national and regional levels rather than a centralized, real-time eradication tracking system. *TB* - **Tuberculosis (TB)** is a major global health concern, and there are international efforts for control and elimination, but it is not currently targeted for **global eradication** in the same manner as polio. - Surveillance for TB often involves tracking drug-resistant strains and treatment outcomes, but it doesn't involve the immediate, outbreak-focused international alert system seen with diseases like polio or novel pandemics. *Leprosy* - **Leprosy** is a neglected tropical disease, and while there are international efforts for its control and elimination, primarily led by the WHO, it does not involve the same level of intensive, real-time global surveillance for eradication as **polio**. - Surveillance for leprosy is typically focused on case detection, treatment completion, and identifying areas with high endemicity rather than rapid international notification of individual cases for eradication purposes.
Question 5: Which disease comes under International Surveillance?
- A. Typhoid fever (Correct Answer)
- B. Chikungunya fever
- C. Hepatitis B
- D. Salmonellosis
Explanation: ***Typhoid fever*** - **Typhoid fever** is monitored by the **World Health Organization (WHO)** through global surveillance systems to track incidence, guide vaccination strategies, and implement control measures. - While **not on the mandatory notification list** under the International Health Regulations (IHR) 2005, typhoid is included in **WHO's global disease surveillance** programs due to its significant disease burden in endemic regions. - Among the given options, typhoid fever has the **strongest international surveillance framework** through WHO's Global Foodborne Infections Network and regional surveillance systems. - **Note:** Diseases under **mandatory IHR surveillance** include cholera, plague, yellow fever, smallpox, poliomyelitis, SARS, and novel influenza subtypes. *Chikungunya fever* - Chikungunya is primarily monitored through **national and regional surveillance** systems rather than comprehensive international surveillance frameworks. - WHO tracks outbreaks through epidemic intelligence but it is **not part of mandatory IHR notification**. - Surveillance focuses on **vector control** and outbreak detection at local levels. *Hepatitis B* - **Hepatitis B** surveillance is conducted primarily at **national levels** through prevalence studies, vaccination coverage monitoring, and chronic infection programs. - It is **not under mandatory international surveillance** per IHR, though WHO maintains global estimates and monitoring frameworks. - Focus is on **prevention through vaccination** and treatment of chronic infections. *Salmonellosis* - Non-typhoidal **salmonellosis** is monitored mainly through **national food safety** and public health surveillance systems. - **Not designated for mandatory international surveillance** under IHR 2005. - International coordination occurs through networks like WHO's Global Foodborne Infections Network for outbreak investigation.
Question 6: Disease not included under International surveillance
- A. Common cold
- B. Tension headache (Correct Answer)
- C. Rabies
- D. Malaria
- E. Yellow fever
Explanation: ***Tension headache*** - **Tension headaches** are a common, benign, and typically self-limiting condition that does not pose a public health threat requiring international attention. - They are **not communicable** and do not have the potential for widespread international spread. - This is a **non-infectious neurological symptom** with no epidemic potential. *Common cold* - While the **common cold** is highly contagious and caused by various respiratory viruses, it is **not under formal international surveillance**. - It is generally a mild, self-limiting illness that does not meet the criteria for International Health Regulations (IHR) reporting. - However, severe acute respiratory syndromes (like SARS or COVID-19) are under international surveillance due to their pandemic potential. *Rabies* - **Rabies** is a fatal zoonotic disease included under **WHO International Health Regulations (IHR)** surveillance. - It requires international monitoring due to high case-fatality rate (nearly 100%) and potential for cross-border transmission through animal movement. - WHO coordinates global surveillance to track animal reservoirs, implement vaccination programs, and prevent human deaths. *Malaria* - **Malaria** is a major disease under **WHO Global Malaria Programme** surveillance with mandatory reporting requirements. - International surveillance tracks disease burden, drug resistance patterns, vector control effectiveness, and progress toward elimination goals. - It causes significant morbidity and mortality, particularly in tropical and subtropical regions. *Yellow fever* - **Yellow fever** is a mosquito-borne viral hemorrhagic disease explicitly listed under **WHO International Health Regulations (IHR)**. - Countries must report outbreaks and maintain vaccination requirements for international travel from endemic areas. - International surveillance prevents epidemic spread and guides vaccination campaigns.
Question 7: Which of the following statements about a primary health centre (PHC) is incorrect?
- A. Tertiary care surgical procedures (Correct Answer)
- B. Caters about 20,000- 30,000 people
- C. Provide water and sanitation and basic health requirements
- D. There is one medical officer and one staff nurse
Explanation: ***Tertiary care surgical procedures*** - Primary Health Centres (PHCs) are designed to provide **basic and essential healthcare services** at the community level, not advanced surgical interventions. - **Tertiary care procedures**, which involve complex surgeries or specialized treatments, are typically performed at **district hospitals** or super-specialty hospitals. - PHCs focus on **primary healthcare** including outpatient care, basic laboratory services, immunization, maternal and child health services, and health education. *Caters about 20,000-30,000 people* - This statement is **correct** regarding the population coverage of a PHC in rural areas. - According to IPHS norms, a PHC serves **20,000-30,000 population** in plain areas and **30,000 population** in hilly/tribal/difficult areas. - The PHC acts as the **first point of contact** for individuals seeking health services in a defined geographical area. *Provide water and sanitation and basic health requirements* - This is a **correct** statement, as PHCs are responsible for promoting health and preventing disease through community-level interventions. - They ensure access to **safe water, sanitation, and essential primary healthcare**. - PHCs focus on improving **public health determinants** alongside providing clinical services through health education and environmental health activities. *There is one medical officer and one staff nurse* - This statement is **correct** and describes the **minimum staffing pattern** at PHCs according to Indian Public Health Standards (IPHS). - A standard PHC has at least **1 Medical Officer, 1 Staff Nurse, and support staff** including ANMs (Auxiliary Nurse Midwives) who work at sub-centers. - Additional staff may be present depending on whether it's a 4-bedded or 6-bedded PHC.
Question 8: Which of the following diseases is not covered under the Integrated Disease Surveillance Project (IDSP)?
- A. Tuberculosis
- B. Cholera
- C. Herpes zoster (Correct Answer)
- D. Meningococcal disease
Explanation: ***Herpes zoster*** - **Herpes zoster** (shingles) is not included in the Integrated Disease Surveillance Project (IDSP) as it is neither an epidemic-prone disease nor a notifiable disease under the program. - IDSP focuses on diseases with significant public health impact, epidemic potential, or those requiring immediate public health response. - While herpes zoster can cause morbidity in immunocompromised individuals, it does not pose a widespread public health threat requiring national surveillance. *Tuberculosis* - **Tuberculosis (TB)** is explicitly covered under IDSP as a major notifiable disease due to its high burden in India and significant public health importance. - TB surveillance under IDSP helps monitor disease trends, detect outbreaks, and evaluate the effectiveness of the National Tuberculosis Elimination Programme. - Regular reporting and surveillance are essential for achieving TB elimination goals. *Cholera* - **Cholera** is a priority disease under IDSP as an epidemic-prone disease with potential for rapid outbreaks and high mortality if untreated. - It is part of the core surveillance list due to its ability to cause severe dehydration and waterborne epidemics. - Early detection through IDSP enables timely implementation of control measures including safe water supply and oral rehydration therapy. *Meningococcal disease* - **Meningococcal disease** (acute bacterial meningitis) is covered under IDSP due to its high case fatality rate, epidemic potential, and need for urgent public health response. - Surveillance is critical for early outbreak detection and implementation of preventive measures such as mass vaccination and chemoprophylaxis. - Close monitoring helps identify circulating serotypes and guide vaccination strategies.
Question 9: Targeted critical agents used in a bioterrorist event are except?
- A. Ricinus communis
- B. Small pox
- C. Coxiella burnetii (Correct Answer)
- D. Viral hemorrhagic fevers -Junin virus
Explanation: ***Coxiella burnetii*** - This is the **correct answer** as it is classified as a **Category B biological agent**, not a Category A critical agent. - While *C. burnetii* causes **Q fever** and has high infectivity with potential for widespread illness, it typically has **lower mortality rates** compared to Category A agents. - Category B agents are second-priority because they are moderately easy to disseminate but cause lower mortality than Category A agents. *Ricinus communis* - This refers to **ricin toxin** derived from castor beans, classified as a **Category B agent**. - However, ricin is considered more dangerous than Q fever due to its potent toxicity and lack of antidote. - Can cause severe multi-organ damage upon inhalation or ingestion, though less lethal than Category A agents. *Smallpox* - Caused by **variola virus**, classified as a **Category A critical agent**. - High infectivity, severe illness, high mortality rate, and lack of natural immunity in most populations. - Historical use as a bioweapon and potential for rapid global spread make it a top-tier threat. *Viral hemorrhagic fevers - Junin virus* - **Category A critical agent** due to high infectivity, severe disease presentation, and high mortality rates. - Includes agents like Ebola, Marburg, Lassa, and Junin viruses that cause severe multi-system disease. - Person-to-person transmission potential and lack of effective treatments make these priority threats.
Question 10: Which of the following is not included in the Global Hunger Index?
- A. Undernourishment
- B. Under 5 mortality rate
- C. Child undernutrition
- D. Infant Mortality Rate (IMR) (Correct Answer)
Explanation: ***Infant Mortality Rate (IMR)*** - The **Infant Mortality Rate (IMR)** measures deaths of infants under one year of age and is an indicator of overall community health and access to medical care, but it is **not directly included** in the GHI calculation. - While related to health and well-being, the GHI focuses on direct measures of **food insecurity** and its immediate consequences on children. *Undernourishment* - **Undernourishment**, defined as the proportion of the population that is consuming insufficient caloric energy, is a **direct component** of the GHI. - It reflects the overall **food supply** and access at the population level. *Under 5 mortality rate* - The **Under-5 Mortality Rate** (child mortality) is a key indicator in the GHI, reflecting the fatal consequences of a combination of **inadequate nutrition** and unhealthy environments. - It captures deaths of children before their fifth birthday, which can be heavily influenced by **nutritional status**. *Child undernutrition* - **Child undernutrition** is represented in the GHI by two indicators: **child stunting** (low height for age) and **child wasting** (low weight for height). - These are crucial measures reflecting **chronic** and **acute undernutrition** in children, respectively.
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