Immunization Schedule — MCQs
In a 10-year-old school child under the school health program, which vaccine should be administered?
The efficiency of cold chain system for oral polio vaccine as monitored by Vaccine Vial Monitor (VVM) depends on:
Which of the following vaccines is not part of the National Immunization Programme?
All of the following statements about MMR vaccine are true EXCEPT:
What is the recommended storage temperature for vaccines?
Which vaccination schedule is correct for PCV (Pneumococcal Conjugate Vaccine)?
Most common cause of post-measles death?
Hepatitis B vaccine administered at birth is
A woman delivers a healthy baby with weight 2.2 kg at the time of birth. What measures are to be taken? 1. The baby should be exclusively breast fed for first six months 2. The vaccination with OPV and BCG should be delayed till the baby is 2.5 kg of weight 3. Baby should be kept with mother and kangaroo care to be given Select the correct answer using the code given below:
Best method to diagnose HIV in an infant?
Immunization Schedule Indian Medical PG Practice Questions and MCQs
Question 1: In a 10-year-old school child under the school health program, which vaccine should be administered?
- A. DPT
- B. BCG
- C. Td (Correct Answer)
- D. MMR
Explanation: ***Td (Tetanus-Diphtheria)*** - For a 10-year-old child under the school health program in India, the recommended vaccination is a booster dose of **Td (tetanus-diphtheria)**. - This ensures continued **protection against tetanus and diphtheria**, as immunity from the primary series may wane over time. - **Td is preferred over TT** (tetanus toxoid alone) as it provides protection against both tetanus and diphtheria. - This is administered at **10 years and 16 years** as per the Indian Academy of Pediatrics immunization schedule. *DPT* - **DPT (diphtheria, pertussis, tetanus)** is administered in infancy and early childhood (at 6, 10, and 14 weeks, with boosters at 16-24 months and 4-6 years). - The **pertussis component is not given** in later childhood or adolescence due to increased reactogenicity in older children. *BCG* - **BCG (Bacille Calmette-Guérin)** vaccine protects against tuberculosis and is given **at birth** in endemic areas like India. - It is **not routinely administered** to a 10-year-old unless there are specific risk factors or documented non-vaccination status. *MMR* - **MMR (measles, mumps, rubella)** vaccine is given as **two doses**: first at 9-12 months and second at 16-24 months (or 4-6 years). - A 10-year-old child would have **already completed** their MMR vaccination schedule.
Question 2: The efficiency of cold chain system for oral polio vaccine as monitored by Vaccine Vial Monitor (VVM) depends on:
- A. Viral potency test
- B. Temperature indicator of the system
- C. Change in the colour of vaccine
- D. Change in colour of monitor (Correct Answer)
Explanation: ***Change in colour of monitor*** - The Vaccine Vial Monitor (VVM) is a label on vaccine vials that changes color progressively when exposed to heat, indicating cumulative heat exposure. - A change in the **VVM's color** signifies that the vaccine may have been exposed to temperatures that could reduce its potency and determines its usability. *Viral potency test* - A **viral potency test** directly measures the amount of live virus in a vaccine sample, which is a laboratory-based assessment and not a real-time field indicator of cold chain efficiency. - While it assesses the vaccine's actual effectiveness, it is not what the VVM monitors in the field for cold chain breaks. *Temperature indicator of the system* - A **temperature indicator** on the cold chain system itself monitors the temperature of the storage unit, not the cumulative heat exposure of individual vaccine vials. - While important for overall cold chain management, it doesn't directly indicate the heat exposure specific to a vaccine vial like a VVM does. *Change in the colour of vaccine* - A change in the **color of the vaccine** itself could indicate contamination or degradation due to various factors, not exclusively due to inadequate cold chain management as monitored by VVM. - The VVM is a separate label designed specifically to monitor heat exposure effects on the vaccine.
Question 3: Which of the following vaccines is not part of the National Immunization Programme?
- A. TT
- B. OPV
- C. Measles
- D. Hepatitis A (Correct Answer)
Explanation: ***Hepatitis A*** - The **Hepatitis A vaccine** is **not included** in India's routine **Universal Immunization Programme (UIP)**. - While it protects against **hepatitis A infection**, it is only used in India for outbreak control in specific high-risk situations, not as a universal routine vaccine. - The UIP prioritizes vaccines for diseases with higher public health burden and those targeted for elimination/eradication. *TT (Tetanus Toxoid)* - **Tetanus Toxoid (TT)** is a crucial component of India's **Universal Immunization Programme**. - It is administered to pregnant women (to prevent neonatal tetanus) and as part of childhood immunization (DPT/Pentavalent vaccine). - Protects against **tetanus**, a potentially fatal bacterial infection. *OPV (Oral Polio Vaccine)* - **Oral Polio Vaccine (OPV)** has been a cornerstone of India's **Universal Immunization Programme** under the Pulse Polio Programme. - Administered to infants and children to provide protection against **poliomyelitis**. - India has been polio-free since 2014, with OPV being gradually replaced by IPV (Inactivated Polio Vaccine). *Measles* - The **Measles vaccine** (given as MR - Measles-Rubella vaccine) is a vital part of India's **Universal Immunization Programme**. - Administered at 9-12 months and 16-24 months of age. - Helps control **measles**, a highly contagious viral disease that can cause serious complications and death in children.
Question 4: All of the following statements about MMR vaccine are true EXCEPT:
- A. All live vaccines without exception are contraindicated in pregnant women (Correct Answer)
- B. MMR is a live vaccine
- C. Adverse events from MMR vaccine include fever (usually 6-12 days following vaccination), rash in 5% of vaccinated persons, arthralgia, aseptic meningitis, lymphadenopathy
- D. Evidence shows that aseptic meningitis is associated with all mumps vaccine strains except the Jeryl Lynn strain
Explanation: ***Correct Answer: All live vaccines without exception are contraindicated in pregnant women*** - This statement is **FALSE**, making it the correct answer to this EXCEPT question - While **most live vaccines are contraindicated in pregnancy** (including MMR), the word **"without exception"** makes this statement incorrect - **Exceptions exist**: Yellow fever vaccine may be administered during pregnancy if travel to endemic areas is unavoidable and the risk of disease outweighs the theoretical vaccine risk - The absolute nature of this statement contradicts clinical guidelines that recognize situational exceptions *True Statement - MMR is a live vaccine* - **MMR vaccine** contains **live-attenuated viruses** of measles, mumps, and rubella - This live-attenuated nature produces robust, long-lasting immunity - Being a live vaccine necessitates contraindications in immunocompromised patients and pregnant women *True Statement - Adverse events from MMR vaccine* - **Fever** typically occurs **6-12 days post-vaccination** (not immediately), reflecting viral replication - **Rash** occurs in approximately **5% of vaccinees** - Other documented adverse events include **arthralgia** (especially in adult women), **aseptic meningitis** (rare), and **lymphadenopathy** - These adverse events are far less severe than complications from natural measles, mumps, or rubella infection *True Statement - Aseptic meningitis and vaccine strains* - **Urabe** and **Leningrad-Zagreb** mumps vaccine strains have been associated with higher rates of vaccine-associated **aseptic meningitis** (approximately 1 in 100,000 to 1 in 1 million doses) - The **Jeryl Lynn strain** (used in the United States and many other countries) has **negligible or no association** with aseptic meningitis - This safety profile makes the Jeryl Lynn strain the preferred mumps component in MMR vaccines
Question 5: What is the recommended storage temperature for vaccines?
- A. -4°C to 0°C
- B. 0°C to 4°C
- C. +2°C to 8°C (Correct Answer)
- D. +4°C to 12°C
Explanation: ***+2°C to +8°C*** - This temperature range, often referred to as the **"cold chain,"** is crucial for maintaining the **potency and efficacy** of most vaccines. - Temperatures outside this range can lead to **vaccine degradation**, rendering them ineffective. *-4°C to 0°C* - Temperatures in this range are too cold and could lead to **freezing of vaccines**, especially those with aluminum adjuvants, causing **irreversible damage** to their structure and efficacy. - Frozen vaccines should typically be **discarded** as their potency cannot be guaranteed. *0°C to 4°C* - While close to the recommended range, the lower end of this range **risks freezing**, particularly a concern during temperature fluctuations or with improper refrigeration. - It does not provide the optimal and safe upper buffer for vaccine stability compared to the +2°C to +8°C range. *+4°C to 12°C* - The upper end of this range (above +8°C) is **too warm** and can significantly accelerate the **degradation of heat-sensitive vaccines**, reducing their effectiveness. - Prolonged exposure to temperatures even within the lower part of this range (e.g., constantly at +4°C) might still be suboptimal for long-term storage of some very sensitive vaccines.
Question 6: Which vaccination schedule is correct for PCV (Pneumococcal Conjugate Vaccine)?
- A. 6, 10, 14 weeks, booster at 12 months (Correct Answer)
- B. 2, 4, 6 months
- C. 6, 10, 14 weeks
- D. 2, 4, 6 months, booster at 15 months
Explanation: ***6, 10, 14 weeks, booster at 12 months*** - This is the **standard recommended schedule** for PCV (3+1 schedule) as per **IAP (Indian Academy of Pediatrics) guidelines**. - The initial three doses at 6, 10, and 14 weeks provide **primary immunity**, while the booster at 12 months significantly **enhances and extends protection** against invasive pneumococcal disease. - This schedule is included in the **Universal Immunization Programme (UIP)** in India. *2, 4, 6 months* - This schedule follows the **US CDC** pattern primarily used for DTaP, Hib, and PCV in the United States. - It **lacks the critical booster dose** at 12 months as per Indian guidelines and uses months instead of weeks for the primary series. - Not the standard schedule tested in **Indian Medical PG exams**. *6, 10, 14 weeks* - This provides the **primary series** but omits the crucial **booster dose** typically given at 12 months. - Without the booster, **long-term protection against pneumococcal disease** may be insufficient, leading to waning immunity. - An incomplete vaccination schedule. *2, 4, 6 months, booster at 15 months* - This follows the **US CDC schedule** with a delayed booster. - Indian guidelines recommend the primary series at **6, 10, 14 weeks** (not months) with booster at **12 months** (not 15 months). - Not aligned with **IAP/NTAGI recommendations** for India.
Question 7: Most common cause of post-measles death?
- A. SSPE
- B. Pneumonia (Correct Answer)
- C. Myocarditis
- D. Diarrhea
Explanation: ***Pneumonia*** - **Pneumonia**, particularly secondary bacterial pneumonia, is the **most common cause of death** in children following a measles infection. - Measles causes **immune suppression** and damage to the respiratory epithelium, making individuals vulnerable to severe respiratory infections. *SSPE* - **Subacute sclerosing panencephalitis (SSPE)** is a rare, fatal, late complication of measles, occurring years after the initial infection. - While always fatal, its rarity means it is not the most common cause of overall measles-related mortality. *Myocarditis* - **Myocarditis**, inflammation of the heart muscle, can be a rare complication of measles, but it is not the leading cause of death. - Cardiac complications are less frequently observed as the primary cause of death compared to respiratory infections. *Diarrhea* - **Diarrhea** is a common complication of measles, especially in malnourished children, and can contribute to mortality due to **dehydration** and electrolyte imbalances. - However, severe respiratory complications like pneumonia are still responsible for a higher proportion of measles-related deaths.
Question 8: Hepatitis B vaccine administered at birth is
- A. A pentavalent vaccine
- B. A fixed combination vaccine of Hepatitis B and Hib
- C. A monovalent vaccine of Hepatitis B (Correct Answer)
- D. A combined vaccine of inactivated Polio and Hepatitis B
Explanation: ***A monovalent vaccine of Hepatitis B*** - The **initial dose** of the Hepatitis B vaccine given at birth is a **single-antigen (monovalent)** preparation. It is given as a **standalone vaccine** to ensure prompt protection against Hepatitis B virus. - This early administration is critical for preventing **perinatal transmission** of Hepatitis B from an infected mother to her newborn, and establishing immunity as soon as possible. *A pentavalent vaccine* - **Pentavalent vaccines** typically protect against five different diseases: **Diphtheria, Tetanus, Pertussis (DTP), *Haemophilus influenzae* type b (Hib), and Hepatitis B**. - While Hepatitis B is one component, the vaccine administered at birth is usually monovalent, and the pentavalent vaccine is given later in the infant's immunization schedule. *A fixed combination vaccine of Hepatitis B and Hib* - A fixed combination vaccine of Hepatitis B and **Hib (Haemophilus influenzae type b)** is available and used in some immunization schedules. - However, the **first dose** given at birth is specifically a monovalent Hepatitis B vaccine, not a combined Hib vaccine, to target immediate Hepatitis B protection. *A combined vaccine of inactivated Polio and Hepatitis B* - Combined vaccines that include **inactivated Polio vaccine (IPV)** and **Hepatitis B** do exist but are generally administered later, at 6 weeks and subsequent doses. - The **birth dose** of Hepatitis B vaccine is exclusively for Hepatitis B protection and does not typically include polio antigen.
Question 9: A woman delivers a healthy baby with weight 2.2 kg at the time of birth. What measures are to be taken? 1. The baby should be exclusively breast fed for first six months 2. The vaccination with OPV and BCG should be delayed till the baby is 2.5 kg of weight 3. Baby should be kept with mother and kangaroo care to be given Select the correct answer using the code given below:
- A. 2 and 3 only
- B. 1 and 2 only
- C. 1, 2 and 3
- D. 1 and 3 only (Correct Answer)
Explanation: ***1 and 3 only*** - **Exclusive breastfeeding** for the first six months is crucial for **nutrition** and **immunity**, especially for low birth weight babies. - **Kangaroo Mother Care (KMC)**, involving skin-to-skin contact, helps regulate the baby's temperature, promotes bonding, and supports weight gain in LBW infants. *2 and 3 only* - While **Kangaroo Mother Care (KMC)** is appropriate for this baby, the recommendation to delay vaccination is incorrect. - **BCG vaccination** should be given at birth to babies weighing **≥2 kg** as per IAP guidelines, so a 2.2 kg baby qualifies for immediate vaccination. *1 and 2 only* - **Exclusive breastfeeding** is appropriate, but delaying vaccinations is not indicated for a baby weighing 2.2 kg. - **BCG** is given at birth for babies ≥2 kg, and routine immunization schedule should be followed without delay based on birth weight alone. *1, 2 and 3* - While statements 1 and 3 correctly identify beneficial practices (exclusive breastfeeding and kangaroo care), statement 2 is incorrect. - **Vaccination guidelines** (IAP/UIP) recommend administering **BCG at birth** for babies ≥2 kg, and routine immunizations as per schedule without weight-based delays for a 2.2 kg baby.
Question 10: Best method to diagnose HIV in an infant?
- A. ELISA
- B. PCR (Correct Answer)
- C. Western blot
- D. All of the options
Explanation: ***PCR*** - **Polymerase Chain Reaction (PCR)** detects **HIV nucleic acids** (DNA or RNA) directly, which is crucial for infants because maternal antibodies can persist for up to 18 months, interfering with antibody-based tests. - PCR allows for early diagnosis, often within the first few weeks or months of life, facilitating timely intervention. *ELISA* - **Enzyme-linked immunosorbent assay (ELISA)** detects HIV antibodies. - In infants, ELISA can be misleading due to the presence of **maternal HIV antibodies** transferred across the placenta, making it unreliable for diagnosing active infection. *Western blot* - **Western blot** is used to confirm positive ELISA results in adults by detecting specific HIV proteins. - Like ELISA, it relies on the detection of **antibodies** and is therefore not reliable in infants due to maternally transmitted antibodies. *All of the options* - This option is incorrect because **ELISA** and **Western blot** are antibody-based tests that are unreliable in infants due to the presence of **maternal antibodies**. - Only **PCR** directly detects the virus itself, making it the preferred diagnostic method in this age group.
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