Immunization and Vaccine-Preventable Diseases

Immunization and Vaccine-Preventable Diseases Indian Medical PG Question 1: Which of the following vaccines is/are contraindicated in pregnancy? 1. Rubella 2. Hepatitis-B 3. Diphtheria 4. Mumps 5. Measles Select the correct answer using the code given below:

• A. 1, 2, 3, 4 and 5
• B. 1, 4 and 5 only (Correct Answer)
• C. 1 only
• D. 2 and 3 only

Immunization and Vaccine-Preventable Diseases Explanation: ***1, 4 and 5 only*** - **Rubella, Mumps, and Measles** vaccines are **live attenuated vaccines**, which are **contraindicated during pregnancy** due to the theoretical risk of congenital infection. - The live viral components could potentially cross the placenta and cause fetal harm or **congenital anomalies**. *1, 2, 3, 4 and 5* - This option incorrectly includes **Hepatitis B** and **Diphtheria** vaccines as contraindicated during pregnancy. - Both **Hepatitis B** (inactivated) and **Diphtheria** (toxoid) vaccines are considered safe and often recommended during pregnancy if indicated. *1 only* - This option is incomplete as it only lists **Rubella** as contraindicated, while **Mumps and Measles** are also **live attenuated vaccines** and thus contraindicated. - It misses other important live vaccines also contraindicated in pregnancy. *2 and 3 only* - This option is incorrect because **Hepatitis B** and **Diphtheria** vaccines are generally considered **safe during pregnancy** and are not contraindicated. - **Hepatitis B** is an inactivated vaccine, and **Diphtheria** is a toxoid vaccine, both of which do not pose a risk of active infection to the fetus.

Immunization and Vaccine-Preventable Diseases Indian Medical PG Question 2: Which vaccine is given at birth to provide protection against tuberculosis as per the National Immunization Schedule in India?

• A. Measles
• B. BCG (Correct Answer)
• C. OPV
• D. Hepatitis B

Immunization and Vaccine-Preventable Diseases Explanation: ***Correct: BCG*** - The **BCG vaccine** (Bacille Calmette-Guérin) is the only vaccine given at birth specifically to protect against **tuberculosis** - It is administered at birth or as early as possible as part of the **National Immunization Schedule** - BCG is particularly important in India due to the high burden of tuberculosis *Incorrect: Measles* - The **measles vaccine** is given at **9 months of age**, not at birth - Early administration is less effective due to the presence of **maternal antibodies** that can interfere with vaccine response *Incorrect: OPV* - While **OPV zero dose (OPV0)** is also given at birth for early polio protection, it protects against **poliomyelitis**, not tuberculosis - OPV is followed by subsequent doses at 6, 10, and 14 weeks *Incorrect: Hepatitis B* - **Hepatitis B birth dose** is also given within 24 hours of birth to prevent **vertical transmission** - However, it protects against **Hepatitis B virus infection**, not tuberculosis

Immunization and Vaccine-Preventable Diseases Indian Medical PG Question 3: Due to a measles outbreak in a community, a medical officer decided to immunize a child aged seven months with measles vaccine. When should the next measles vaccine be administered?

• A. Not required
• B. When the child completes nine months of age (Correct Answer)
• C. When the child completes fifteen months of age
• D. After four weeks

Immunization and Vaccine-Preventable Diseases Explanation: ***When the child completes nine months of age*** - A measles vaccine given at **seven months during an outbreak** is considered a **zero-dose** or **early dose** and does NOT replace the routine immunization schedule. - According to the **Indian National Immunization Schedule**, the routine first dose of measles vaccine (MR vaccine) is given at **9 months of age**, regardless of whether an earlier outbreak dose was administered. - Vaccines given before 9 months have **reduced efficacy** due to interference from maternal antibodies, making the 9-month dose essential for adequate seroconversion. - After the 9-month dose, a second dose is given at **16-24 months** as per routine schedule. *When the child completes fifteen months of age* - While 15-18 months is appropriate timing for the **second dose** of measles vaccine in the routine schedule, it is not the immediate next dose after a 7-month outbreak vaccination. - The child still requires the **routine 9-month dose first**, followed by the second dose at 16-24 months. - Skipping the 9-month dose and going directly to 15 months would leave a prolonged gap without adequate protection. *Not required* - This is **incorrect** because early doses given before 9 months are considered zero-doses and do not provide reliable long-term immunity. - The routine schedule **must still be followed** to ensure proper immunization, starting with the 9-month dose. *After four weeks* - A four-week interval after the 7-month dose is **too short** and not recommended in immunization guidelines. - There is **no indication** for such an early repeat dose; the child should wait until the routine 9-month schedule for the next dose.

Immunization and Vaccine-Preventable Diseases Indian Medical PG Question 4: Which one of the following is an absolute contraindication for administration of killed vaccine?

• A. Hodgkin's disease
• B. Pregnancy
• C. Severe reaction to a previous dose (Correct Answer)
• D. Immunodeficiency

Immunization and Vaccine-Preventable Diseases Explanation: ***Severe reaction to a previous dose*** * A **severe allergic reaction** (e.g., **anaphylaxis**) to a previous dose of any vaccine or its components is an **absolute contraindication** to further doses of that vaccine. * This is due to the potential for a life-threatening anaphylactic response upon re-exposure to the allergen. *Hodgkin's disease* * While Hodgkin's disease is a **malignancy** that can affect the immune system, it is generally considered a **precaution** or a reason to defer live vaccines, not an absolute contraindication for killed vaccines. * **Killed vaccines** are generally safe in immunocompromised patients, though their efficacy may be reduced. *Pregnancy* * **Pregnancy** is a contraindication for certain **live attenuated vaccines** (e.g., MMR, varicella) due to the theoretical risk of fetal infection. * However, most **killed vaccines** (e.g., inactivated influenza, tetanus, diphtheria, acellular pertussis) are **safe and often recommended** during pregnancy for maternal and fetal protection. *Immunodeficiency* * **Immunodeficiency** (e.g., HIV/AIDS, chemotherapy) is primarily a contraindication for **live attenuated vaccines**, as these can cause disseminated infection in immunocompromised individuals. * **Killed vaccines** are generally safe in immunocompromised individuals, although the **immune response may be suboptimal**, and repeat doses or higher doses may be necessary.

Immunization and Vaccine-Preventable Diseases Indian Medical PG Question 5: 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

Immunization and Vaccine-Preventable Diseases 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

Immunization and Vaccine-Preventable Diseases Flashcard 1 of 5

Question: What is the duration of validity of 17D vaccination?_____

Answer: Lifelong

Immunization and Vaccine-Preventable Diseases Flashcard 2 of 5

Question: Vaccine-_____ polio virus is very rare strain of polio virus, genetically changed from the original strain contained in OPV

Answer: derived

Immunization and Vaccine-Preventable Diseases Flashcard 3 of 5

Question: DPT (with booster doses) can only be given up to _____ year of age, according to the National Immunisation Schedule.

Answer: 7

Immunization and Vaccine-Preventable Diseases Flashcard 4 of 5

Question: Some vaccines are kept in a _____ coloured bottle as these vaccines & vaccine related products are sensitive to light

Answer: amber

Immunization and Vaccine-Preventable Diseases Flashcard 5 of 5

Question: If the HCW is unvaccinated and the source is HbsAg +ve, what is the next step?_____

Answer: HBIG x 1 and initiate HB vaccine series