Future of Vaccines — MCQs
A girl child has had recurrent yeast and respiratory viral infections since she was 3 months old. Considering studies for her immune status, which of the following vaccines is contraindicated?
The presence of which of the following factors in viruses makes protective vaccines a possibility?
All the following are conjugate vaccines Except
Most common route of administration for inactivated influenza vaccine
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?
All of the following regarding rotavirus vaccine are correct except?
Which of the following statements about measles is incorrect?
6 year old son of pregnant woman is suffering from chicken pox. Which of the following is given to pregnant woman?
A young male came to the hospital with a clean-cut wound without any bleeding. The patient received a full course of tetanus vaccination 10 years ago. What is the best management for this patient?
A patient at 37 weeks' gestation came to the hospital without antenatal check-up and presented with onset of labor. On examination, the mother is Hep B positive. What management should be given to the neonate?
Future of Vaccines Indian Medical PG Practice Questions and MCQs
Question 1: A girl child has had recurrent yeast and respiratory viral infections since she was 3 months old. Considering studies for her immune status, which of the following vaccines is contraindicated?
- A. Killed IPV (Inactivated Poliovirus Vaccine)
- B. DPT (Diphtheria, Pertussis, Tetanus)
- C. TT/Td (Tetanus toxoid)
- D. Measles/MMR (Correct Answer)
- E. Hepatitis B vaccine
Explanation: ***Measles/MMR*** - This patient's history of **recurrent yeast and respiratory viral infections** suggests a potential **immunodeficiency**, which is a contraindication for **live attenuated vaccines** like MMR (Measles, Mumps, Rubella). - Administering live attenuated vaccines to immunocompromised individuals can lead to **uncontrolled replication of the vaccine virus**, causing severe disease. *Killed IPV (Inactivated Poliovirus Vaccine)* - **Inactivated vaccines** do not contain live viruses and are generally safe for immunocompromised individuals. - The patient's underlying immune status does not contraindicate killed vaccines, as there is **no risk of vaccine-induced infection**. *DPT (Diphtheria, Pertussis, Tetanus)* - DPT is a **non-live vaccine** (consisting of toxoids and inactivated bacterial components), making it safe for individuals with immunodeficiency. - These vaccines do not pose a risk of causing the disease in immunocompromised patients, even if their **immune response is suboptimal**. *TT/Td (Tetanus toxoid)* - Tetanus toxoid vaccines are **inactivated vaccines** and are therefore safe for individuals with impaired immune function. - The concern with immunodeficiency is the **ability to mount an effective immune response**, not the safety of the vaccine itself. *Hepatitis B vaccine* - Hepatitis B is a **recombinant inactivated vaccine** that is safe for immunocompromised patients. - While the vaccine may have **reduced immunogenicity** in this population, it is not contraindicated and does not pose a risk of vaccine-induced disease.
Question 2: The presence of which of the following factors in viruses makes protective vaccines a possibility?
- A. Lipids
- B. Protein coat (Correct Answer)
- C. Enzymes
- D. Polysaccharide
Explanation: ***Protein coat*** - The **protein coat** (capsid) of viruses contains **antigenic proteins** that can be recognized by the host immune system. - Vaccines work by exposing the immune system to these viral proteins, stimulating the production of **antibodies** and memory cells for future protection. *Lipids* - While some viruses have a **lipid envelope**, lipids themselves are generally **poor antigens** and do not effectively stimulate a protective immune response on their own. - The immune response against enveloped viruses is primarily directed at the **glycoproteins** embedded within the lipid envelope, not the lipids themselves. *Enzymes* - Viruses contain various enzymes (e.g., reverse transcriptase, RNA polymerase) essential for their replication, but these are typically **intracellular targets**. - **Enzymes** are not usually present on the viral surface in an exposed manner that would consistently trigger a protective antibody response. *Polysaccharide* - **Polysaccharides** are common components of bacterial capsules but are generally **not significant components** of viral structure. - Viruses are primarily composed of nucleic acids and proteins, and the immune response to viruses rarely involves polysaccharides.
Question 3: All the following are conjugate vaccines Except
- A. Neisseria meningitidis
- B. Haemophilus influenzae type b
- C. Hepatitis A (Correct Answer)
- D. Pneumococcal
Explanation: ***Hepatitis A (Correct Answer)*** - The **Hepatitis A vaccine** is a **killed viral vaccine** (inactivated vaccine), meaning it contains whole hepatitis A virus particles that have been inactivated so they cannot replicate or cause disease. - It is **NOT a conjugate vaccine** - inactivated vaccines primarily induce a **humoral immune response** without the need for a carrier protein conjugated to a polysaccharide. - This makes Hepatitis A the exception among the options listed. *Neisseria meningitidis (Incorrect)* - The most common vaccines against *Neisseria meningitidis* are **conjugate vaccines**, where the **polysaccharide capsule** is chemically linked to a protein carrier to enhance immunogenicity in infants and young children. - This conjugation allows for T-cell dependent immunity, leading to better memory responses and protection. *Haemophilus influenzae type b (Incorrect)* - The **Haemophilus influenzae type b (Hib) vaccine** is a **conjugate vaccine**, linking the **polysaccharide capsule** of the bacterium to a carrier protein. - This helps induce a robust T-cell dependent immune response, which is crucial for protecting infants and young children against **invasive Hib disease**. *Pneumococcal (Incorrect)* - **Pneumococcal conjugate vaccines** (PCV13, PCV15, PCV20) link the **polysaccharide capsule** to a protein carrier, enhancing immunogenicity and memory, especially in young children. - While polysaccharide vaccines (PPSV23) also exist, the conjugate forms are the primary vaccines used in routine immunization schedules.
Question 4: Most common route of administration for inactivated influenza vaccine
- A. Intranasal
- B. Subcutaneous
- C. Oral
- D. Intramuscular (Correct Answer)
Explanation: ***Intramuscular*** - Most **inactivated influenza vaccines (IIV)** are administered via the **intramuscular route**. - This route ensures effective delivery of the vaccine antigens to muscle tissue, where a strong **systemic immune response** can be generated. - The **deltoid muscle** is the preferred site for adults and older children. *Intranasal* - The **live attenuated influenza vaccine (LAIV)**, not the inactivated vaccine, is administered intranasally. - This route is used for LAIV to mimic natural infection and induce both systemic and **mucosal immunity**. - Intranasal route is **not used** for inactivated influenza vaccines. *Subcutaneous* - The **subcutaneous route** is not the standard route for inactivated influenza vaccines. - While it can be used in certain circumstances (e.g., patients with bleeding disorders), **intramuscular injection** is the preferred and most common route. *Oral* - **Oral administration** is not used for influenza vaccines. - This route is typically reserved for vaccines that need to elicit a strong **mucosal immune response** in the gut (e.g., oral polio vaccine, rotavirus vaccine).
Question 5: 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 6: All of the following regarding rotavirus vaccine are correct except?
- A. Oral vaccine
- B. Cannot be given after 6 months of age (Correct Answer)
- C. Available as monovalent and pentavalent
- D. Live vaccine
Explanation: ***Cannot be given after 6 months of age*** - This statement is **INCORRECT**, making it the correct answer for this "EXCEPT" question. - The rotavirus vaccine CAN be given after 6 months of age when completing the vaccination series. - **Rotarix (RV1)**: First dose at 6-14 weeks, second dose by **8 months of age** - **RotaTeq (RV5)**: First dose at 6-14 weeks, complete 3-dose series by **8 months of age** - The key restriction is that the **first dose must be given between 6 to 14 weeks 6 days** (not after 15 weeks due to increased intussusception risk), but subsequent doses can be given after 6 months to complete the series. *Oral vaccine* - **CORRECT statement**: The rotavirus vaccine is an **oral vaccine**, administered as drops into the infant's mouth. - This route avoids injections and improves compliance in pediatric immunization. *Available as monovalent and pentavalent* - **CORRECT statement**: Two types are available: - **Rotarix (RV1)**: Monovalent vaccine targeting G1P[8] strain - **RotaTeq (RV5)**: Pentavalent vaccine targeting G1, G2, G3, G4, and P[8] strains - Both are highly effective in preventing severe rotavirus gastroenteritis. *Live vaccine* - **CORRECT statement**: Both rotavirus vaccines contain **live, attenuated viruses**. - This stimulates robust mucosal and systemic immunity against rotavirus infection. - Contraindicated in severe combined immunodeficiency (SCID) and after intussusception.
Question 7: Which of the following statements about measles is incorrect?
- A. Secondary attack rate is 90%
- B. Maximum incidence in 6 months to 3 years age group
- C. Best age for immunization is 9-12 months
- D. Secondary attack rate is 30% (Correct Answer)
Explanation: ***Secondary attack rate is 30%*** - Measles is highly contagious, and its **secondary attack rate** is much higher than 30%, often reaching **90% or more** among susceptible household contacts. - A 30% secondary attack rate would be exceptionally low for a disease with measles's known **high transmissibility**. *Maximum incidence in 6 months to 3 years age group* - This statement is correct as **maternal antibodies wane** around 6 months, making infants susceptible, and young children in this age range are often actively exposed in community settings. - Peak incidence occurs in this age group, particularly in **unvaccinated or under-vaccinated populations**. *Best age for immunization is 9-12 months* - This is the **recommended age** for measles vaccination under India's **Universal Immunization Programme (UIP)**. - Immunizing at this age ensures that waning maternal antibodies do not interfere with vaccine efficacy while providing timely protection during the high-risk period. *Secondary attack rate is 90%* - This statement is correct. Measles is one of the **most contagious infectious diseases**, with a secondary attack rate among susceptible household contacts often **exceeding 90%**. - Its high transmissibility is due to its **airborne spread** and long communicable period.
Question 8: 6 year old son of pregnant woman is suffering from chicken pox. Which of the following is given to pregnant woman?
- A. Acyclovir + immunoglobulin
- B. Only immunoglobulin (Correct Answer)
- C. Vaccination
- D. Acyclovir
Explanation: ***Only immunoglobulin*** - Giving **immunoglobulin** to a pregnant woman exposed to **chickenpox** provides immediate passive immunity, which is crucial as she is at risk of infection from her child. - This is particularly important because chickenpox during pregnancy can lead to severe maternal disease and congenital varicella syndrome in the fetus. *Acyclovir + immunoglobulin* - **Acyclovir** is an antiviral that treats active varicella infection but is not typically given prophylactically in combination with immunoglobulin for exposure unless the woman is already immunocompromised or develops symptoms. - The primary goal for exposed pregnant women is preventing infection through passive immunity, not immediately treating a potential infection. *Vaccination* - **Varicella vaccine** is a live attenuated vaccine and is **contraindicated** during pregnancy due to the theoretical risk of fetal infection. - It is used for pre-conception immunity or post-exposure prophylaxis in non-pregnant individuals if given within a short window, but not for pregnant women. *Acyclovir* - **Acyclovir** is an antiviral medicine used to treat active chickenpox infections, not to prevent infection immediately after exposure. - It would be considered if the pregnant woman develops symptoms of chickenpox, but not as a primary prophylactic measure in this scenario.
Question 9: A young male came to the hospital with a clean-cut wound without any bleeding. The patient received a full course of tetanus vaccination 10 years ago. What is the best management for this patient?
- A. Single-dose tetanus toxoid (Correct Answer)
- B. Human tetanus immunoglobulin only
- C. Human tetanus immunoglobulin and a full course of vaccine
- D. No treatment required
Explanation: ***Single-dose tetanus toxoid*** - For a **clean-cut wound** in a patient who completed a **primary tetanus vaccination series** and received their last dose more than 5 years ago but less than 10 years ago, a **single booster dose** of tetanus toxoid is recommended. [1] - A booster ensures continued protection, as vaccine-induced immunity wanes over time, but the prior full course provides a robust anamnestic response with a single dose. *Human tetanus immunoglobulin and a full course of vaccine* - This regimen (tetanus immunoglobulin + vaccine) is typically reserved for patients with **unvaccinated status**, an **unknown vaccination history**, or a **severely contaminated wound** (e.g., rusty nail, soil contamination) who have not been fully vaccinated. - The patient had a **clean-cut wound** and completed a full course of vaccination 10 years ago, making immunoglobulin unnecessary and a full course of vaccine excessive. *Human tetanus immunoglobulin only* - Administering **tetanus immunoglobulin alone** is appropriate for immediate, passive immunity in situations where a patient is unvaccinated or has an unknown vaccination status and has a significant risk of tetanus from a contaminated wound. [2] - This patient has a clean wound and a history of full vaccination, so a booster is sufficient to stimulate active immunity. *No treatment required* - While the patient was fully vaccinated 10 years ago, the protection from tetanus vaccination can **wane over time**, especially after 5-10 years. - A **booster dose** is crucial to maintain adequate protection against tetanus, even for a clean wound, given the 10-year interval since the last dose.
Question 10: A patient at 37 weeks' gestation came to the hospital without antenatal check-up and presented with onset of labor. On examination, the mother is Hep B positive. What management should be given to the neonate?
- A. Hep B vaccine+ IG (Correct Answer)
- B. Hep B vaccine only
- C. Only IG
- D. First IG then Hep B vaccine after 1 month
Explanation: ***Hep B vaccine + IG*** - Neonates born to mothers with **positive hepatitis B surface antigen (HBsAg)** should receive both the **hepatitis B vaccine** and **hepatitis B immune globulin (HBIG)** within **12 hours of birth**. - This combination provides both **passive immunity** (from HBIG) and **active immunity** (from the vaccine) to rapidly protect the newborn from perinatal hepatitis B transmission. *Hep B vaccine only* - Administering only the **hepatitis B vaccine** would provide active immunity, but the **onset of protection is slower**, leaving the neonate vulnerable during the immediate high-risk period of exposure. - While essential for long-term protection, the vaccine alone is **insufficient for immediate post-exposure prophylaxis** in a high-risk scenario. *Only IG* - Administering only **HBIG** provides immediate passive immunity, offering short-term protection, but it **does not confer long-lasting immunity**. - Without the vaccine, the infant would remain susceptible to future HBV infection once the passive antibodies wane, which typically occurs within a few months. *First IG then Hep B vaccine after 1 month* - Delaying the **hepatitis B vaccine** by a month would leave the neonate inadequately protected against subsequent exposure or potential continued viral replication after the HBIG's passive immunity declines. - The goal in this high-risk situation is to initiate **both passive and active immunity as quickly as possible** to maximize protection against perinatal transmission.
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free