Anti-vaccination Movement and Hesitancy — MCQs

10 questions

What are the possible mild reactions after receiving the influenza vaccine?

Which of the following regarding the vaccine vial monitor (VVM) is true? 1. It is used for monitoring heat exposure of the vaccine by healthcare workers in primary healthcare. 2. It shows cumulative exposure of the vaccine to the heat. 3. It can be used to assess the potential efficacy of the vaccine 4. Calculation of the expiry date can be done using VVM. 5. The expiry date of the vaccine can be relaxed if VVM is an acceptable range. 6. If the square and the circle are the same in color, then the vaccine can be safely used.

Which of the following is true about the Sabin vaccine for polio?

Which immunization is typically given at 6 months of age?

Mission Indradhanush is for:

All of the following are true about the Herd immunity for infectious diseases except -

An 18-year-old girl is brought to the emergency department because of a 1-day history of severe headache with photophobia and diffuse myalgias. She is a college student and lives in a dormitory in a large urban area. She has not traveled recently. On arrival, she is lethargic. Her temperature is 39.3°C (102.7°F), pulse is 120/min, and blood pressure is 88/58 mm Hg. Examination shows scattered petechiae and ecchymoses on the trunk and lower extremities. There is decreased range of motion of the neck. Cerebrospinal fluid analysis shows a cell count of 1,600/μL (80% neutrophils) and a lactate concentration of 5.1 mmol/L. Which of the following is most likely to have prevented this patient's condition?

In a case of meningitis, Neisseria meningitides was grown in culture after 48 hours. Which measure is to be taken immediately ?

Which statement is true regarding the influenza vaccine?

Q10

Match the following scientists with their discoveries. 1. Walter Reed a. Prevention of scurvy by citrus fruits 2. Edward Jenner b. Yellow fever 3. James Lind c. Smallpox vaccination

Anti-vaccination Movement and Hesitancy Indian Medical PG Practice Questions and MCQs

Question 1: What are the possible mild reactions after receiving the influenza vaccine?

A. Itching
B. Local swelling
C. Fever
D. All of the options (Correct Answer)

Explanation: ***All of the options*** - All three reactions listed (local swelling, fever, and itching) are recognized **mild side effects** of the influenza vaccine. - **Local reactions** such as swelling, soreness, redness, and itching at the injection site are common and typically resolve within 1-2 days. - **Systemic reactions** like low-grade fever, headache, malaise, and muscle aches can occur as the immune system responds to the vaccine, usually lasting 1-2 days. - Since all the individual options represent possible mild reactions, the correct answer encompasses all of them. *Why individual options alone are incomplete* - Selecting only "Local swelling," "Fever," or "Itching" would be medically accurate but incomplete, as the question asks for "possible mild reactions" (plural). - Each individual option represents only one type of mild reaction, while multiple types can occur. - The most comprehensive and correct answer includes all possible mild reactions listed.

Question 2: Which of the following regarding the vaccine vial monitor (VVM) is true? 1. It is used for monitoring heat exposure of the vaccine by healthcare workers in primary healthcare. 2. It shows cumulative exposure of the vaccine to the heat. 3. It can be used to assess the potential efficacy of the vaccine 4. Calculation of the expiry date can be done using VVM. 5. The expiry date of the vaccine can be relaxed if VVM is an acceptable range. 6. If the square and the circle are the same in color, then the vaccine can be safely used.

A. 1,2,3,4,5
B. 3,4
C. 1,2 (Correct Answer)
D. 5,6

Explanation: ***Correct: Statements 1, 2*** **Statement 1 - TRUE**: The VVM is primarily designed for **healthcare workers** to monitor vaccine heat exposure at all levels, including primary healthcare settings. This is a key WHO tool for cold chain monitoring. **Statement 2 - TRUE**: VVMs provide a **cumulative record** of time and temperature exposure, reflecting the total heat stress a vaccine has experienced throughout its journey from manufacturer to administration. *Statement 3 - FALSE* - While VVMs assess heat exposure that affects vaccine stability, they do **not directly measure vaccine efficacy** or provide quantitative measures of immune response potential. - Heat damage indicated by VVM indirectly suggests reduced potency, but the VVM itself cannot assess efficacy. *Statement 4 - FALSE* - VVMs are **not used to calculate expiry dates**. Manufacturing expiry dates are determined through stability studies under controlled conditions by the manufacturer. *Statement 5 - FALSE* - The **expiry date cannot be relaxed or extended** based on VVM status. The manufacturer's stated expiry date must always be respected regardless of how favorable the VVM reading is. *Statement 6 - FALSE* - This is the **opposite** of how VVM works. If the **inner square is the same color or darker than the outer circle**, the vaccine has been exposed to excessive heat and **should NOT be used**. - The vaccine is safe when the inner square is lighter than the outer circle.

Question 3: Which of the following is true about the Sabin vaccine for polio?

A. Given intramuscularly.
B. Contains only 1 strain of the virus.
C. The doses are given at 1-week intervals.
D. Four doses are given in primary immunization. (Correct Answer)

Explanation: ***Four doses are given in primary immunization.*** - The **Sabin vaccine** (oral polio vaccine, OPV) is administered in **four doses** during primary immunization in India: at birth, 6 weeks, 10 weeks, and 14 weeks. - This schedule ensures robust and lasting immunity by stimulating both mucosal and systemic immune responses. - The birth dose provides early protection, while subsequent doses at 4-week intervals allow for optimal immune response development. *The doses are given at 1-week intervals.* - The standard immunization schedule for OPV does not involve 1-week intervals; doses are spaced **4 weeks apart** (at 6, 10, and 14 weeks after the birth dose). - Administering doses too closely may not allow for optimal **immune response development** and may not provide sufficient protection. *Given intramuscularly.* - The Sabin vaccine is an **oral vaccine**, administered as drops into the mouth. - Its oral route allows it to induce both humoral and **mucosal immunity** in the gut, which is crucial for preventing intestinal replication of the poliovirus. - The **inactivated polio vaccine (IPV/Salk vaccine)** is the one given intramuscularly. *Contains only 1 strain of the virus.* - The Sabin vaccine used in India is **bivalent OPV (bOPV)**, containing live-attenuated strains of poliovirus **types 1 and 3**. - India switched from trivalent OPV (tOPV - types 1, 2, 3) to bivalent OPV in 2016 following the global withdrawal of type 2-containing vaccines after eradication of wild poliovirus type 2. - Monovalent vaccines (mOPV) may be used for outbreak responses in specific situations.

Question 4: Which immunization is typically given at 6 months of age?

A. Measles vaccine
B. DPT vaccine (Correct Answer)
C. BCG vaccine
D. None of the options

Explanation: **DPT vaccine** - The DPT (diphtheria, pertussis, and tetanus) vaccine is administered in multiple doses during infancy as part of the primary immunization series. - At **6 months of age**, the **third dose of DPT** is typically given (following doses at 6 weeks, 10 weeks, and 14 weeks according to the Indian immunization schedule). - Among the options provided, DPT is the only vaccine routinely administered at 6 months of age. - This vaccine protects against three serious bacterial infections: **diphtheria**, which can cause breathing problems; **pertussis (whooping cough)**, a severe respiratory illness; and **tetanus**, which causes painful muscle spasms. *Measles vaccine* - The measles vaccine (given as part of the **MMR vaccine** or as MR vaccine in India) is typically administered at **9 to 12 months of age** for the first dose, and a second dose between 15-18 months or 4-6 years. - It is not routinely given at 6 months, as maternal antibodies can interfere with its effectiveness at this younger age. *BCG vaccine* - The BCG (Bacillus Calmette-Guérin) vaccine protects against **tuberculosis** and is given at **birth** or in early infancy as a single dose. - It is not administered at 6 months of age. *None of the options* - This option is incorrect because the **DPT vaccine** (third dose) is a standard immunization given at 6 months of age according to the Indian immunization schedule. - Multiple vaccines are actually given at 6 months (including OPV, Hepatitis B, Hib, PCV), but among the listed options, only DPT is correct.

Question 5: Mission Indradhanush is for:

A. Non-communicable diseases
B. Universal immunization (Correct Answer)
C. Family planning
D. Safe water and sanitation

Explanation: ***Universal immunization*** - **Mission Indradhanush** is a flagship program launched by the Government of India in 2014 to achieve **full immunization coverage** for children and pregnant women. - The mission aims to immunize children against 12 vaccine-preventable diseases, including diphtheria, whooping cough, tetanus, polio, tuberculosis, measles, hepatitis B, and meningitis/pneumonia caused by Haemophilus influenzae type b. *Non-communicable diseases* - Programs for **non-communicable diseases** typically focus on screening, early detection, and management of conditions like diabetes, hypertension, and cancer. - While important for public health, this is not the primary focus of Mission Indradhanush, which targets infectious diseases. *Family planning* - **Family planning programs** aim to provide information and access to contraception and reproductive health services to individuals and couples. - This is a distinct public health initiative separate from the immunization efforts of Mission Indradhanush. *Safe water and sanitation* - Initiatives for **safe water and sanitation** focus on improving access to clean drinking water and proper waste disposal systems to prevent waterborne and sanitation-related diseases. - While crucial for preventing many infections, this is not within the scope of Mission Indradhanush's primary objective of increasing vaccine coverage.

Question 6: 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 7: An 18-year-old girl is brought to the emergency department because of a 1-day history of severe headache with photophobia and diffuse myalgias. She is a college student and lives in a dormitory in a large urban area. She has not traveled recently. On arrival, she is lethargic. Her temperature is 39.3°C (102.7°F), pulse is 120/min, and blood pressure is 88/58 mm Hg. Examination shows scattered petechiae and ecchymoses on the trunk and lower extremities. There is decreased range of motion of the neck. Cerebrospinal fluid analysis shows a cell count of 1,600/μL (80% neutrophils) and a lactate concentration of 5.1 mmol/L. Which of the following is most likely to have prevented this patient's condition?

A. Intravenous vancomycin
B. Polysaccharide conjugate vaccine (Correct Answer)
C. Erythromycin therapy
D. Doxycycline therapy
E. Toxoid vaccine

Explanation: ***Polysaccharide conjugate vaccine*** - This patient presents with symptoms highly suggestive of **bacterial meningitis** and **septic shock**, likely caused by *Neisseria meningitidis*, given the petechiae, ecchymoses, and rapid deterioration. - A **meningococcal conjugate vaccine** would have provided protection against most common serogroups of *N. meningitidis* (A, C, W-135, Y) and is strongly recommended for college students living in dormitories due to increased risk of transmission. *Intravenous vancomycin* - This is an **acute treatment** for bacterial meningitis, specifically active against *Streptococcus pneumoniae* and some resistant strains. - It would not have **prevented** the condition; preventative measures are typically vaccines or prophylactic antibiotics. *Erythromycin therapy* - Erythromycin is an antibiotic used for various bacterial infections, including atypical pneumonia and some skin infections. - It is **not the primary prophylactic agent** for meningococcal disease and would not have prevented this specific condition. *Doxycycline therapy* - Doxycycline is a broad-spectrum antibiotic used for a range of infections, including tick-borne diseases and certain respiratory infections. - It is **not indicated for the prevention** of meningococcal meningitis. *Toxoid vaccine* - **Toxoid vaccines** protect against diseases caused by bacterial toxins, such as tetanus and diphtheria. - *Neisseria meningitidis* causes disease primarily through direct invasion and immune response to its capsular polysaccharides, not primarily exotoxins, so a toxoid vaccine would not be effective here.

Question 8: In a case of meningitis, Neisseria meningitides was grown in culture after 48 hours. Which measure is to be taken immediately ?

A. Antibiotic treatment of contacts (Correct Answer)
B. All of the options
C. Isolation of contacts
D. Vaccination of contacts

Explanation: ***Correct: Antibiotic treatment of contacts*** - **Chemoprophylaxis is the immediate priority** for close contacts of confirmed *Neisseria meningitidis* cases - Should be administered **within 24 hours** of case identification to prevent secondary cases - **Recommended antibiotics**: Rifampicin (2 days), Ciprofloxacin (single dose), or Ceftriaxone (single dose) - **Close contacts include**: household members, daycare contacts, anyone directly exposed to patient's oral secretions, healthcare workers exposed to respiratory secretions - This is the **most effective immediate measure** to prevent transmission as meningococcal disease has a 2-10 day incubation period *Incorrect: Isolation of contacts* - **Contacts do NOT require isolation** according to WHO and CDC guidelines - Only the **index patient** requires droplet precautions for 24 hours after starting appropriate antibiotics - Contacts can continue normal activities while on chemoprophylaxis and should monitor for symptoms - Isolating healthy contacts is not evidence-based and creates unnecessary social disruption *Incorrect: Vaccination of contacts* - Meningococcal vaccination is important for **long-term prevention** but not immediate post-exposure prophylaxis - Vaccines take **7-14 days** to develop protective immunity, too slow for immediate protection - Recommended in **outbreak settings** or for high-risk groups as an adjunct to chemoprophylaxis - Does not replace the need for immediate antibiotic prophylaxis *Incorrect: All of the options* - **Only antibiotic chemoprophylaxis** is the immediate measure required - Isolation of contacts is not standard practice for meningococcal disease - Vaccination is a secondary/long-term measure, not immediate - The question asks for the **immediate** measure, which is unequivocally chemoprophylaxis

Question 9: Which statement is true regarding the influenza vaccine?

A. The live attenuated vaccine is given by nasal spray.
B. All statements are correct. (Correct Answer)
C. The inactivated vaccine is used most commonly.
D. The inactivated vaccine is given intramuscularly in the deltoid.

Explanation: ***All statements are correct.*** - Each of the preceding statements is factually accurate regarding influenza vaccines. - The **inactivated vaccine** is widely used, the **live attenuated vaccine** is administered via nasal spray, and the **inactivated vaccine** is given intramuscularly [1]. *The inactivated vaccine is used most commonly.* - The **inactivated influenza vaccine (IIV)**, given by injection, is the most frequently administered type of influenza vaccine. - It is recommended for most age groups and is safe for individuals with chronic medical conditions, pregnant women, and the elderly. *The live attenuated vaccine is given by nasal spray.* - The **live attenuated influenza vaccine (LAIV)**, also known as FluMist, is administered as a **nasal spray** [1]. - This vaccine is suitable for healthy individuals aged 2-49 years and is not recommended for pregnant women or individuals with certain immune compromising conditions. *The inactivated vaccine is given intramuscularly in the deltoid.* - The standard route of administration for the **inactivated influenza vaccine (IIV)** is via **intramuscular injection**, most commonly into the **deltoid muscle** in adults and older children [1]. - This method ensures proper absorption and an effective immune response, a common practice for many vaccines.

Question 10: Match the following scientists with their discoveries. 1. Walter Reed a. Prevention of scurvy by citrus fruits 2. Edward Jenner b. Yellow fever 3. James Lind c. Smallpox vaccination

A. 1-b, 2-a, 3-c
B. 1-c, 2-b, 3-a
C. 1-b, 2-c, 3-a (Correct Answer)
D. 1-a, 2-c, 3-b

Explanation: ***1-b, 2-c, 3-a*** - **Walter Reed** is renowned for his work on **yellow fever**, confirming that mosquitoes transmit the disease. - **Edward Jenner** is famous for developing the **smallpox vaccine**, a pivotal moment in immunology. - **James Lind** conducted experiments demonstrating that **citrus fruits prevent scurvy**, a groundbreaking discovery in nutritional science. *1-b, 2-a, 3-c* - This option incorrectly attributes **smallpox vaccination** to James Lind instead of Edward Jenner. - It also incorrectly links **scurvy prevention** to Edward Jenner, rather than James Lind. *1-c, 2-b, 3-a* - This option incorrectly states that **Walter Reed** discovered the **smallpox vaccination** instead of yellow fever transmission. - It also wrongly attributes **yellow fever** to **Edward Jenner**, though it correctly attributes scurvy prevention to James Lind. *1-a, 2-c, 3-b* - This option incorrectly attributes **scurvy prevention** to **Walter Reed** instead of James Lind. - It also incorrectly links **yellow fever** to **James Lind** instead of Walter Reed, though it correctly matches Edward Jenner with smallpox vaccination.

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