UPSC-CMS 2017 Practice Questions

Q: Which is the first step in carrying out an Adverse Event Following Immunization (AEFI)?

Confirm information in report. ***Confirm information in report*** - The initial and crucial step is to **verify the accuracy and completeness of the reported information** to ensure reliable data for further investigation. - This involves checking details such as the **patient's demographics, vaccine administered, date of vaccination, and the reported adverse event** itself. *Collect data about the suspected vaccine* - While essential for an AEFI investigation, **collecting specific vaccine data comes after confirming the initial report**, as you first need a verified event to investigate. - This step focuses on the **vaccine's batch number, expiry date, and manufacturer**, which are vital for causality assessment but not the very first action. *Observe the immunization service in action* - **Observing the immunization service** is a step that might be taken later in an investigation if a program error or procedural issue is suspected, not the immediate first step for an individual AEFI. - This helps identify **potential programmatic errors** in vaccine administration or storage, which is a downstream investigative measure. *Formulate a working hypothesis* - **Formulating a working hypothesis** is part of the analytical phase of an AEFI investigation, which occurs after initial data collection and confirmation, not as the very first step. - A hypothesis guides further investigation into potential causes but requires **initial confirmed data** to be meaningful.

Q: At the end of an immunization session, you found that a reconstituted BCG vaccine vial has around two doses left in it. What should be done in such a situation?

Discard the vial in a red coloured bin. ***Discard the vial in a red coloured bin*** - **Reconstituted BCG vaccine must be discarded at the end of the immunization session** or after **4 hours of reconstitution**, whichever comes first, as per WHO and India's Universal Immunization Programme (UIP) guidelines - This is because reconstituted BCG is **highly susceptible to bacterial contamination** and loses potency over time - **Red coloured bin** is used for **contaminated waste** including discarded vaccine vials in the biomedical waste management system (though yellow bins are sometimes used for pharmaceutical waste) - The multi-dose vial policy based on VVM status applies to **unopened/non-reconstituted vaccines**, not to already reconstituted vaccines *Take decision depending upon the Vaccine Vial Monitor (VVM) status* - VVM status is checked **before opening or reconstituting** the vaccine vial, not after reconstitution - For **reconstituted vaccines** like BCG, the time limit (4 hours or end of session) takes precedence over VVM considerations - VVM-based multi-dose vial policy does not apply to already reconstituted vaccines *Can reuse the remaining two doses during the next immunization session* - This is **completely incorrect** and dangerous - Reconstituted BCG must be discarded after **4 hours** or at the **end of the session**, whichever is earlier - Reusing reconstituted BCG poses serious risks of **bacterial contamination** and **loss of vaccine potency** *Discard the vial in a black coloured bin* - Black bins are used for **general non-hazardous waste**, not for biomedical waste - Vaccine vials must be disposed of as **biomedical waste** in red or yellow bins, not black bins

Q: With reference to Vaccine Vial Monitors (VVM) being used on vaccine vials, which of the following statements is/are correct? 1. It gives information about heat exposure over a period of time 2. It directly indicates vaccine potency Select the correct answer using the code given below:

1 only. ***1 only*** - **Vaccine Vial Monitors (VVMs)** are designed to show **cumulative heat exposure** over time, indicating whether a vaccine has been stored within an acceptable temperature range throughout its shelf life. - The color change of the VVM helps healthcare workers determine if a vaccine has been exposed to excessive heat, which can compromise its quality. - VVMs are time-temperature indicators that change color progressively based on both duration and degree of heat exposure. *2 only* - VVMs do **not directly measure vaccine potency**. While excessive heat exposure indicated by a VVM can *imply* reduced potency, the VVM itself does not provide a quantitative measure of a vaccine's effectiveness. - Vaccine potency can only be accurately assessed through specific laboratory tests, not by a visual indicator on the vial. - The VVM is an **indirect indicator** of potential potency loss through monitoring storage conditions. *Neither 1 nor 2* - This is incorrect because statement 1 is accurate - VVMs do provide information about cumulative heat exposure over time. - VVMs are crucial tools in cold chain management for monitoring vaccine storage conditions. *Both 1 and 2* - This is incorrect because while VVMs do indicate heat exposure (statement 1 is correct), they do **not directly** indicate vaccine potency (statement 2 is incorrect). - It's important to differentiate between an indicator of proper storage conditions and a direct measure of efficacy.

Q: Why is matching done in a case-control study?

To remove the effect of known confounders. ***To remove the effect of known confounders*** - **Matching** in a case-control study helps to control for the influence of specific variables (known confounders) that might otherwise distort the observed association between the exposure and outcome. - By matching cases and controls on characteristics like age, sex, or socioeconomic status, researchers ensure that these factors are similarly distributed in both groups, isolating the effect of the primary exposure. *To remove the effect of unknown confounders* - Matching is effective for **known confounders** that are identified and controlled during study design. - It does not address the impact of **unknown** or unmeasured confounding variables, which can still influence the study's results. *To eliminate selection bias* - **Selection bias** occurs when participants are not representative of the target population; matching primarily addresses confounding, not the initial selection process. - While careful selection is crucial to minimize selection bias, matching itself is more related to controlling for nuisance variables *after* selection. *To eliminate interviewer’s bias* - **Interviewer bias** (or observer bias) arises when the interviewer's expectations or knowledge influence data collection or interpretation. - This type of bias is typically addressed through blinding (e.g., blinded interviewers, participants, or outcome assessors), not through matching study participants.

Q: Which of the following vaccines has NOT been introduced in the Universal Immunization Programme in India?

Cervical cancer vaccine. ***Cervical cancer vaccine (HPV vaccine)*** ✓ **Correct Answer (as of 2017)** - At the time of this examination (UPSC-CMS 2017), the **HPV vaccine** had NOT been introduced into the Universal Immunization Programme (UIP) in India. - While pilot studies were conducted, nationwide rollout had not occurred. - **Update**: India officially introduced HPV vaccination in the UIP in 2024 for girls aged 9-14 years, but this question reflects the 2017 status. *Injectable polio vaccine (IPV)* - The **Injectable Polio Vaccine (IPV)** was introduced into the UIP in **2015** in a phased manner. - IPV was added alongside the oral polio vaccine (OPV) to provide additional protection and prevent **vaccine-derived poliovirus** cases. - Essential for maintaining India's polio-free status achieved in 2014. *MR vaccine (incorrectly listed as MMR)* - India's UIP includes the **MR vaccine (Measles-Rubella)**, NOT MMR. - **Measles vaccine** was part of UIP since its inception; **Rubella** was added in phased campaigns starting 2017. - **Mumps vaccine is NOT part of routine UIP** - it's only available privately. - The option should technically say "MR vaccine" for accuracy, but MMR was listed in the original question. *Pentavalent vaccine* - The **pentavalent vaccine** was introduced in UIP starting **2011** (phased) and nationwide by 2015. - Protects against five diseases: **Diphtheria, Pertussis, Tetanus, Hepatitis B, and Haemophilus influenzae type b (Hib)**. - Replaced the earlier DPT + Hepatitis B + Hib schedule, reducing injection burden.

Question 1

Which is the first step in carrying out an Adverse Event Following Immunization (AEFI)?

Accepted Answer

Confirm information in report

Answer

Collect data about the suspected vaccine

Answer

Observe the immunization service in action

Answer

Formulate a working hypothesis

Question 2

At the end of an immunization session, you found that a reconstituted BCG vaccine vial has around two doses left in it. What should be done in such a situation?

Accepted Answer

Discard the vial in a red coloured bin

Answer

Discard the vial in a black coloured bin

Answer

Take decision depending upon the Vaccine Vial Monitor (VVM) status

Answer

Can reuse the remaining two doses during the next immunization session

Question 3

With reference to Vaccine Vial Monitors (VVM) being used on vaccine vials, which of the following statements is/are correct?

1. It gives information about heat exposure over a period of time
2. It directly indicates vaccine potency

Select the correct answer using the code given below:

Accepted Answer

1 only

Answer

2 only

Answer

Neither 1 nor 2

Answer

Both 1 and 2

Question 4

Why is matching done in a case-control study?

Accepted Answer

To remove the effect of known confounders

Answer

To remove the effect of unknown confounders

Answer

To eliminate selection bias

Answer

To eliminate interviewer’s bias

Question 5

Which of the following vaccines has NOT been introduced in the Universal Immunization Programme in India?

Accepted Answer

Cervical cancer vaccine

Answer

Injectable polio vaccine

Answer

MMR vaccine

Answer

Pentavalent vaccine

UPSC-CMS 2017

Community Medicine