Global Infectious Disease Control — MCQs
Which of the following vaccines is not included in the Mission Indradhanush program?
Which disease comes under International Surveillance?
Which of the following diseases is not included in the National Vector Borne Disease Control Program?
The best approach to prevent cholera epidemic in a community is:
Which disease was removed from active WHO surveillance requirements following its global eradication?
A child has received full rabies vaccination in December 2023 and now presented with an oozing wound on the great toe and the pet was also vaccinated. Next line of management is
Which method is primarily used to assess HIV prevalence?
Target interventions of National AIDS Control Organisation include all, except?
Which research method is most appropriate for studying the progression of a disease over time?
A patient is brought to the OPD by his wife, complaining about difficulty expressing emotions and lack of participation in daily activities. On examination, resting tremors and rigidity are noted. Given the possible diagnosis, which part of the brain is affected in this patient?
Global Infectious Disease Control Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following vaccines is not included in the Mission Indradhanush program?
- A. Diphtheria
- B. Polio
- C. Tetanus
- D. Typhoid fever vaccine (Correct Answer)
Explanation: ***Typhoid fever vaccine*** - The **typhoid conjugate vaccine (TCV)** was introduced into India's Universal Immunization Programme in a phased manner starting from 2017-2018, but it is **not part of the core Mission Indradhanush vaccines** launched in 2014. - Mission Indradhanush primarily focuses on the original set of vaccines for common, preventable childhood diseases (BCG, DPT, OPV, Hepatitis B, Measles, etc.), and later additions like Rotavirus and PCV. - TCV rollout has been **state-specific and phased**, unlike the universal coverage of core Mission Indradhanush vaccines. *Diphtheria* - The **diphtheria vaccine** is a core component of the Mission Indradhanush program, aiming to protect children against this serious bacterial infection. - It is administered as part of the **DPT (Diphtheria, Pertussis, Tetanus)** or **Pentavalent vaccine** (DPT + Hib + Hepatitis B). *Polio* - The **polio vaccine** is a primary target of Mission Indradhanush, as India has maintained its polio-free status since 2014. - It is given as **OPV (Oral Polio Vaccine)** and/or **IPV (Inactivated Polio Vaccine)** to prevent poliomyelitis. *Tetanus* - The **tetanus vaccine** is included in the Mission Indradhanush program, administered with diphtheria and pertussis as the **DPT vaccine** or as part of the **Pentavalent vaccine**. - It protects against **tetanus**, a severe bacterial infection causing painful muscle spasms and lockjaw.
Question 2: 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 3: Which of the following diseases is not included in the National Vector Borne Disease Control Program?
- A. Tuberculosis (Correct Answer)
- B. Japanese encephalitis
- C. Malaria
- D. Dengue
Explanation: ***Tuberculosis*** - **Tuberculosis** is a bacterial infection primarily affecting the lungs and is not transmitted by a vector. - It is controlled under the **National TB Elimination Programme (NTEP)**, a separate national health program. *Japanese encephalitis* - **Japanese encephalitis** is a viral disease transmitted by mosquitoes, making it a vector-borne disease. - It is one of the diseases specifically targeted by the **National Vector Borne Disease Control Program (NVBDCP)**. *Malaria* - **Malaria** is a parasitic disease transmitted by Anopheles mosquitoes, clearly categorizing it as vector-borne. - It is a primary focus of the **NVBDCP** due to its significant public health impact. *Dengue* - **Dengue** is a viral disease transmitted by Aedes mosquitoes, hence a vector-borne disease. - **Dengue control and prevention** are key objectives of the **NVBDCP**.
Question 4: The best approach to prevent cholera epidemic in a community is:
- A. Health education
- B. Mass chemoprophylaxis with tetracycline
- C. Vaccination of all individuals
- D. Safe water and sanitation (Correct Answer)
Explanation: ***Safe water and sanitation*** - Cholera is primarily transmitted through **fecally contaminated water** and food sources. Ensuring access to **safe drinking water** and proper **sanitation facilities** (e.g., latrines, waste management) is the most effective and sustainable way to break the chain of transmission. - These measures prevent the spread of the *Vibrio cholerae* bacteria in the environment, thereby stopping new infections and preventing large-scale outbreaks. *Health education* - While important for promoting good hygiene practices like handwashing and safe food preparation, **health education alone** is often insufficient to control a widespread cholera epidemic without concomitant improvements in infrastructure. - It may improve individual behaviors but does not address the fundamental environmental contamination that drives large outbreaks. *Mass chemoprophylaxis with tetracycline* - Administering antibiotics like **tetracycline** to entire communities is not a sustainable or practical strategy for epidemic prevention. - It can lead to **antibiotic resistance**, has limited effectiveness in preventing widespread transmission, and carries potential side effects. *Vaccination of all individuals* - **Oral cholera vaccines** are effective and can be used in conjunction with other measures, especially during outbreaks or in high-risk areas. - However, achieving **universal vaccination** quickly enough to prevent an ongoing epidemic can be challenging due to logistical hurdles, cost, and vaccine availability, making it less immediate and comprehensive than addressing water and sanitation.
Question 5: Which disease was removed from active WHO surveillance requirements following its global eradication?
- A. Guinea worm
- B. Typhoid
- C. HIV/AIDS
- D. Smallpox (Correct Answer)
Explanation: ***Smallpox*** - Smallpox was **globally eradicated** in 1980 through a concerted vaccination effort, making it the first human disease eradicated. - Due to its eradication, it has been **removed from active WHO surveillance requirements** as it no longer poses a threat to public health. *Guinea worm* - While significant progress has been made in Guinea worm eradication, it has **not yet been fully eradicated**, with a few endemic areas remaining. - It is currently still subject to **active surveillance efforts** by the WHO to monitor progress towards elimination. *Typhoid* - Typhoid is caused by *Salmonella Typhi* and remains a significant public health issue, especially in areas with poor sanitation. - It is a **notifiable disease** and continuously monitored by the WHO and national health agencies, especially with concerns about **antimicrobial resistance**. *HIV/AIDS* - HIV/AIDS is a **global pandemic** with ongoing high prevalence and incidence rates worldwide, particularly in certain regions. - It is under **intensive surveillance and control programs** by the WHO, given its significant global health burden and lack of a definitive cure or vaccine for complete eradication.
Question 6: A child has received full rabies vaccination in December 2023 and now presented with an oozing wound on the great toe and the pet was also vaccinated. Next line of management is
- A. RIG + 5 doses of vaccine
- B. 5 doses of vaccines only
- C. No vaccine required
- D. 2 doses of Rabies vaccine (Correct Answer)
Explanation: ***2 doses of Rabies vaccine*** - For individuals who have received **previous full rabies vaccination** (either pre-exposure or post-exposure prophylaxis), a subsequent exposure requires only **two booster doses of vaccine on days 0 and 3**, regardless of wound category. - Even though this is a **Category III exposure** (oozing wound with break in skin), **no RIG is required** for previously immunized individuals as per WHO and APCRI guidelines. - The pre-existing immunity from the prior vaccination provides a **rapid anamnestic (memory) response**, eliminating the need for passive immunization or a full primary series. *RIG + 5 doses of vaccine* - This regimen is for individuals with **no prior vaccination history** and represents the full post-exposure prophylaxis for Category III exposures (transdermal bites, oozing wounds). - The child has been previously vaccinated, rendering this extensive protocol unnecessary and potentially harmful due to **immune complex formation** if RIG is given to an immune individual. *5 doses of vaccines only* - This approach is suitable for **previously unvaccinated individuals** with Category II exposure (nibbling, minor scratches without bleeding) where RIG may not be available. - However, in a previously vaccinated individual, the full 5-dose series is **excessive and not indicated** as immunity is already established. *No vaccine required* - Even with a previously vaccinated child and a vaccinated pet, there is still a **potential risk of exposure** to rabies, especially with a Category III wound (oozing wound). - Omitting vaccination entirely would be **negligent** and violates standard guidelines, as vaccine efficacy is not 100% and animal vaccination status can be uncertain or lapsed.
Question 7: Which method is primarily used to assess HIV prevalence?
- A. Sentinel surveillance in high-risk populations (Correct Answer)
- B. Passive surveillance through reporting systems
- C. Disease registries for HIV patients
- D. Active case finding through outreach programs
Explanation: ***Sentinel surveillance in high-risk populations*** - **Sentinel surveillance** focuses on specific, well-defined groups, such as pregnant women or individuals attending STD clinics, to get a representative estimate of **HIV prevalence** in the broader community. - This method is particularly effective for diseases that are difficult to track through general population surveys due to stigma or low overall prevalence. *Passive surveillance through reporting systems* - **Passive surveillance** relies on healthcare providers voluntarily reporting cases, which often leads to **underreporting** and an incomplete picture of an epidemic's true scope. - It primarily captures known cases rather than estimating the overall **prevalence** within a population. *Disease registries for HIV patients* - **Disease registries** are valuable for tracking the natural history, treatment outcomes, and long-term trends among *diagnosed* individuals, but they do not capture undiagnosed cases, thus not accurately representing **prevalence**. - They provide data on incidence (new cases) and patient management but are less suited for estimating the total number of people living with the disease at a given time. *Active case finding through outreach programs* - **Active case finding** aims to identify new cases within specific communities, usually in response to an outbreak or in populations with known high risk. - While it identifies undiagnosed individuals, its primary goal is case identification and linkage to care, rather than providing a **statistically representative prevalence** estimate for an entire population.
Question 8: Target interventions of National AIDS Control Organisation include all, except?
- A. Detection & treatment for sexually transmitted infections
- B. Abscess prevention & management in injecting drug users
- C. Condom promotion & distribution
- D. Provision of lubricants to Injecting drug users (Correct Answer)
Explanation: ***Provision of lubricants to Injecting drug users*** - The provision of lubricants is primarily relevant for **safe sexual practices** to prevent friction and condom breakage, not directly for injecting drug users to mitigate injection-related risks. - While **harm reduction** is a key focus, this specific intervention does not align with the direct prevention of HIV transmission routes typically targeted for injecting drug users, such as shared needles or inadequate sterile practices. *Detection & treatment for sexually transmitted infections* - **STIs** increase the risk of HIV transmission by causing genital lesions and inflammation, thus their detection and treatment are crucial for HIV prevention. - This intervention is a cornerstone of National AIDS Control Organisation (NACO) programs to reduce HIV vulnerability in high-risk populations. *Abscess prevention & management in injecting drug users* - **Abscesses** are common complications of injecting drug use, often resulting from unsterile practices or shared needles, which are also routes for HIV transmission. - Addressing these complications is part of a broader **harm reduction strategy** aimed at minimizing health risks among injecting drug users, including HIV. *Condom promotion & distribution* - **Condom promotion and distribution** is a fundamental intervention for preventing sexual transmission of HIV by providing a physical barrier. - This is a central component of NACO's strategy to promote safer sexual practices among the general population and high-risk groups.
Question 9: Which research method is most appropriate for studying the progression of a disease over time?
- A. Cohort Study (Correct Answer)
- B. Cross sectional study
- C. Randomized Control Trials
- D. Interventional Studies
Explanation: ***Cohort Study*** - A **cohort study** observes a group of individuals over a period of time, allowing researchers to track the **natural progression of a disease** from exposure through onset and various stages. - This design is ideal for investigating the **incidence** of disease and identifying risk factors over time. *Cross sectional study* - A **cross-sectional study** assesses exposure and outcome at a **single point in time**, providing a snapshot. - It cannot establish temporality or observe disease progression, as it does not follow individuals over time. *Randomized Control Trials* - **Randomized controlled trials (RCTs)** are primarily designed to evaluate the **effectiveness of interventions** or treatments by comparing outcomes between an experimental group and a control group. - While they follow participants over time, their main goal is not to study the natural progression of an untreated disease. *Interventional Studies* - **Interventional studies** involve manipulating an exposure or treatment to observe its effect, often to test a hypothesis about a causal relationship. - While they track outcomes over time, their focus is on the impact of the intervention rather than the natural history or progression of a disease without intervention.
Question 10: A patient is brought to the OPD by his wife, complaining about difficulty expressing emotions and lack of participation in daily activities. On examination, resting tremors and rigidity are noted. Given the possible diagnosis, which part of the brain is affected in this patient?
- A. Basal ganglia (Correct Answer)
- B. Hippocampus
- C. Cerebellum
- D. Premotor cortex
Explanation: **Basal ganglia (Correct)** - The symptoms described—**resting tremors**, **rigidity**, difficulty expressing emotions, and lack of participation—are classic features of **Parkinson's disease**, which is characterized by the degeneration of dopaminergic neurons in the **substantia nigra**, a component of the basal ganglia [1]. - The basal ganglia play a crucial role in motor control, learning, and emotion, and their dysfunction leads to the characteristic motor and non-motor symptoms observed [2]. *Hippocampus (Incorrect)* - The hippocampus is primarily involved in **memory formation** and spatial navigation. - Damage to the hippocampus typically results in **amnesia** or difficulties with new learning, not motor symptoms like tremors or rigidity [3]. *Cerebellum (Incorrect)* - The cerebellum is responsible for **coordination**, balance, and fine motor control [2]. - **Cerebellar dysfunction** typically manifests as **ataxia**, dysmetria, and intention tremors, which differ from the resting tremors and rigidity seen in this patient. *Premotor cortex (Incorrect)* - The premotor cortex is involved in the planning and preparation of movements, as well as the control of trunk and proximal limb muscles. - While it contributes to motor control, its primary dysfunction does not typically cause the combination of **resting tremors** and **rigidity** characteristic of Parkinson's disease.
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