Immunization and Vaccine-Preventable Diseases Practice Questions

Q: All are correct about Mission Indradhanush (the launched programme) except:

Covers 5 vaccine preventable diseases. ***Correct: Covers 5 vaccine preventable diseases*** - **Mission Indradhanush** initially covered **seven vaccine-preventable diseases** (not 5). - The seven diseases were: Diphtheria, Whooping Cough, Tetanus, Polio, Tuberculosis, Measles, and Hepatitis B. - This statement is incorrect, making it the correct answer to this "except" question. *Incorrect: Launched in 2014* - Mission Indradhanush was launched in **December 2014** by the Ministry of Health and Family Welfare, Government of India. - The program's primary objective was to rapidly increase full immunization coverage in the country. *Incorrect: Target year 2020* - The initial goal of Mission Indradhanush was to achieve **90% full immunization coverage by 2020**. - This target was later brought forward to 2018 with the launch of **Intensified Mission Indradhanush (IMI)**. *Incorrect: Covers all unvaccinated and partially vaccinated children* - Mission Indradhanush focuses on accelerating full immunization coverage for **unvaccinated and partially vaccinated children** up to two years of age. - It also includes pregnant women who missed out on routine immunization.

Q: Which of the following vials can be used? (AIIMS Nov 2017)

1,2 can be used. ***1,2 can be used*** - Vials 1 and 2 show the **inner square lighter than or equal in color to the outer circle** on the VVM, indicating the vaccine has been stored correctly and is safe to use. - The **Vaccine Vial Monitor (VVM)** is a time-temperature indicator that changes color irreversibly when exposed to excessive heat. - These vials are at **VVM Stage 1 or 2** (usable stages), confirming they have not been exposed to heat that would degrade vaccine potency. *3,4 can be used* - This is **INCORRECT** because both vials 3 and 4 show VVM indicators that have reached **discard point**. - Vial 3's VVM shows the **inner square darker than the outer circle**, indicating heat exposure (VVM Stage 3 or beyond). - Vial 4's VVM shows an even **darker inner square, nearly merged with the outer circle**, signifying severe heat damage. - **WHO/EPI guidelines** mandate discarding vaccines when VVM inner square becomes darker than outer circle. *1,2,3 can be used* - This is **INCORRECT** because vial 3 has crossed the **VVM discard point**. - The inner square in vial 3 is **darker than the outer circle**, indicating heat exposure that compromises vaccine efficacy. - Using heat-damaged vaccines leads to **immunization failure** and false sense of protection. *Only 1 can be used* - This is **INCORRECT** because vial 2 also shows a **safe VVM status** (inner square lighter than outer circle). - Both vials 1 and 2 are at usable VVM stages and can be administered safely. - There is **no visual difference** between the VVM status of vials 1 and 2 that would justify discarding vial 2.

Q: Consider the following statements with regard to Ice-Lined Refrigerator (ILR) employed for storing vaccines at the sub-district level : I. These types of refrigerators are top-opening. II. Based on the temperature zone, the inside of ILRs can be divided into 3 parts. III. The upper part of ILR is cooler compared to the lower part. IV. Vaccines should never be kept directly on the floor of the ILR as they can get damaged. Which of the statements given above are correct?

II and III. ***II and IV*** - **Statement II is correct**: ILRs can be divided into **3 temperature zones** based on cold air distribution: - **Upper zone** (near door): Warmest area - **Middle zone**: Optimal temperature (2-8°C) for vaccine storage - **Lower zone/floor**: Coldest area with risk of freezing - **Statement IV is correct**: Vaccines should **never be placed directly on the floor** of the ILR as this is the coldest zone where temperatures can drop below 0°C, causing **freeze damage** to vaccines like DPT, Hepatitis B, and TT which are freeze-sensitive. *I and III* - **Statement I is incorrect**: ILRs used at sub-district level in India's Universal Immunization Programme are **front-opening** (not top-opening) refrigerators. Top-opening freezers may be used for ice-pack preparation, but vaccine storage ILRs are front-opening. - **Statement III is incorrect**: The **lower part is cooler** than the upper part, not the opposite. Cold air sinks, making the floor area the coldest zone (prone to freezing), while the upper area near the door is relatively warmer.

Q: In a child who has not received any dose of DPT and OPV immunization, up to what age can these vaccines be given under the Universal Immunization Programme?

DPT up to 7 years of age and OPV up to 5 years of age. ***DPT up to 7 years of age and OPV up to 5 years of age*** - Under the **Universal Immunization Programme (UIP)**, this represents the accepted upper age limit for catch-up vaccination in children who have not received any previous doses - **DPT vaccine** (Diphtheria, Pertussis, Tetanus) can be given up to **7 years of age** for primary immunization series - **OPV (Oral Polio Vaccine)** can be administered up to **5 years of age** for catch-up immunization - Beyond these ages, alternative formulations are typically used (Td vaccine for older children instead of DPT) *DPT up to 10 years of age and OPV up to 7 years of age* - These age limits **exceed the standard UIP guidelines** for catch-up vaccination - Not the recommended upper age limits for primary immunization series - Would be beyond the typical age range for initiating these vaccines in unimmunized children *DPT up to 12 years of age and OPV up to 10 years of age* - These age cut-offs are **significantly higher than UIP recommendations** - For children beyond standard ages, **Td (Tetanus-diphtheria)** vaccine is preferred over DPT - These limits do not align with catch-up vaccination protocols under UIP *DPT up to 8 years of age and OPV up to 6 years of age* - While closer to the correct limits, these ages still **exceed the standard recommendations** - The accepted upper limits are **7 years for DPT** and **5 years for OPV** under UIP guidelines - Not the officially recognized age cut-offs for catch-up immunization

Q: Which among the following vaccines best represent interventions that focus on cancer prevention too ? 1. Hepatitis A vaccine 2. Hepatitis B vaccine 3. Hemophilus influenzae B vaccine 4. Human papilloma virus vaccine Select the correct answer using the code given below :

2 and 4. ***2 and 4*** - The **Hepatitis B vaccine** prevents **Hepatitis B virus (HBV)** infection, which is a major risk factor for developing **hepatocellular carcinoma (HCC)**, a type of liver cancer. Vaccination significantly reduces the incidence of HBV-related liver cancer. - The **Human Papillomavirus (HPV) vaccine** protects against high-risk HPV types, which are responsible for almost all cases of **cervical cancer**, as well as many cases of anal, oropharyngeal, vaginal, and penile cancers. - Both vaccines directly prevent cancer by preventing the viral infections that cause these malignancies. *1 and 4* - The **Hepatitis A vaccine** prevents **Hepatitis A virus (HAV)** infection, which causes acute liver inflammation but is **not associated with chronic liver disease or liver cancer**. - While the **HPV vaccine** indeed prevents cancer, the inclusion of Hepatitis A vaccine makes this option incorrect for cancer prevention. *2 and 3* - The **Hepatitis B vaccine** effectively prevents liver cancer by preventing HBV infection. - The **Hemophilus influenzae B (Hib) vaccine** prevents serious infections caused by *Haemophilus influenzae* type b, such as meningitis and epiglottitis, but it has **no direct role in cancer prevention**. *1 and 2* - The **Hepatitis A vaccine** prevents HAV infection but **does not prevent cancer**. - While the **Hepatitis B vaccine** effectively prevents liver cancer, the inclusion of Hepatitis A vaccine makes this option incomplete for the best representation of cancer prevention interventions.

Q: Consider the following vaccines : 1. BCG Vaccine 2. Hepatitis B Vaccine 3. Inactivated Polio Vaccine (IPV) 4. Oral Polio Vaccine (OPV) What is the correct order of the above vaccines as per their sensitivity to heat (most sensitive to least sensitive) given in the National Immunization Schedule (NIS) ?

4→3→2→1. ***4→3→2→1 (OPV → IPV → Hepatitis B → BCG)*** * **Oral Polio Vaccine (OPV)** is the **most heat-sensitive** vaccine among these options. As a live attenuated viral vaccine, it requires storage at -20°C (freezer storage) and is extremely thermolabile, necessitating the strictest cold chain management with VVM monitoring. * **Inactivated Polio Vaccine (IPV)** is the second most heat-sensitive vaccine, requiring refrigeration at 2-8°C. While more stable than OPV due to inactivation, it remains highly sensitive to heat exposure and requires careful cold chain maintenance. * **Hepatitis B Vaccine** has moderate heat sensitivity. As a recombinant subunit vaccine, it requires storage at 2-8°C but is more thermostable than the polio vaccines. It can tolerate brief temperature excursions better than live attenuated vaccines. * **BCG Vaccine** is the **least heat-sensitive** among these four vaccines, though it still requires proper cold chain management at 2-8°C. While BCG is light-sensitive, it demonstrates relatively better heat stability compared to OPV, IPV, and Hepatitis B vaccines in field conditions per National Immunization Schedule guidelines. *Incorrect Option 2→1→3→4* - Incorrectly places Hepatitis B as most sensitive when OPV is actually most thermolabile *Incorrect Option 2→3→1→4* - Wrong order placing Hepatitis B first instead of OPV *Incorrect Option 3→1→4→2* - Incorrectly suggests IPV is most sensitive and has an inaccurate sequence

Q: What is the correct increasing order of minimum age at which the following vaccines are administered to a child, as part of the National Immunization Schedule (NIS) after birth of child ? 1. BCG vaccine 2. Japanese Encephalitis (JE) vaccine 3. Rotavirus vaccine 4. Tetanus and adult diphtheria (Td) vaccine Select the correct answer using the code given below :

1→3→2→4. **1→3→2→4** - This order reflects the standard schedule of vaccine administration in the **National Immunization Schedule (NIS)**, starting with vaccines given at birth or shortly after, followed by those administered in late infancy and early childhood, and finally those for adolescents. - The correct sequence is: **BCG at birth**, **Rotavirus at 6 weeks**, **Japanese Encephalitis at 9 months**, and **Td at 10 and 16 years**. *1→2→3→4* - This option incorrectly places the **Japanese Encephalitis (JE) vaccine** before the **Rotavirus vaccine**. The Rotavirus vaccine is typically given at 6 weeks, while JE is given later at 9 months. - The sequence of **JE** and **Rotavirus** is inverted compared to the NIS guidelines. *2→3→1→4* - This order is incorrect because it places the **BCG vaccine** after both the **Japanese Encephalitis (JE) vaccine** and the **Rotavirus vaccine**, even though BCG is administered at birth. - The early administration of **BCG** at birth is a fundamental aspect of the immunization schedule, making this sequence incorrect. *3→1→4→2* - This option incorrectly places the **Rotavirus vaccine** as the earliest, ahead of the **BCG vaccine**, which is given at birth or very soon after. - It also incorrectly places the **Td vaccine** before the **Japanese Encephalitis (JE) vaccine**, as JE is given at 9 months and Td later, in adolescence.

Q: Regarding active immunization against Typhoid fever, consider the following statements : 1. The typhoid polysaccharide vaccine is injectable and can be given subcutaneously or intramuscularly. 2. The typhoid polysaccharide vaccine is required to be given in two doses and administered on 0 and 7th day. 3. The typhoid oral Ty21a vaccine requires to be given in three doses on 0, 3rd and 7th days. 4. Protective immunity with typhoid vaccines is achieved immediately after the vaccine is received. Which of the statements given above is/are correct ?

1 only. ***1 only*** - The **typhoid polysaccharide vaccine** (ViCPS vaccine) is an **injectable vaccine**, typically administered **intramuscularly**. While subcutaneous administration might occur in specific situations, intramuscular is the standard route. - This statement accurately describes the general nature and administration route of the typhoid polysaccharide vaccine. *2 and 3 only* - The **typhoid polysaccharide vaccine (ViCPS) is usually given as a single dose** for primary immunization, not two doses on day 0 and 7. Boosters may be given every 2-3 years. - The **oral Ty21a vaccine requires three or four doses** (depending on the formulation and guidelines) taken on alternate days, typically on days 1, 3, and 5 (for a 3-dose regimen) or 1, 3, 5, and 7 (for a 4-dose regimen), not specifically on days 0, 3rd, and 7th. *1 and 2 only* - As explained, Statement 2 is incorrect because the **typhoid polysaccharide vaccine is generally a single-dose vaccine** for initial immunization. - Therefore, this option containing an incorrect statement cannot be the correct answer. *1, 3 and 4* - Statement 3 is incorrect as the **oral Ty21a vaccine dosing schedule is typically on alternate days** (e.g., 1, 3, 5 or 1, 3, 5, 7), not specifically 0, 3rd, and 7th. - Statement 4 is incorrect because **protective immunity from typhoid vaccines is not achieved immediately**; it takes about 1-2 weeks for the immune system to develop a sufficient response.

Q: Which among the following is correct about yellow fever vaccination requirement for international travellers ? 1. Term of validity of the certificate is changed from 10 years to the duration of the life of the vaccinated person. 2. Lifetime validity of the certificate applies automatically to all existing and new certificates. 3. Validity of the certificate begins 4 days after vaccination. 4. In India, booster dose of yellow fever vaccine is required for those whose certificate is prior to the year 2016. Select the correct answer using the code given below :

1 and 2. ***1 and 2*** - The **term of validity** of the International Certificate of Vaccination or Prophylaxis (ICVP) for yellow fever changed from 10 years to **lifetime duration** on **July 11, 2016** (WHO IHR amendment). - This **lifetime validity** applies automatically to all existing and new ICVPs, regardless of when they were issued. - Both statements accurately reflect current WHO International Health Regulations. *2 and 4* - While statement 2 is correct, statement 4 is incorrect; **India does not require a booster dose** for yellow fever even if the certificate is prior to 2016. - The lifetime validity supersedes all previous recommendations, and India follows WHO guidelines. *2 and 3* - While statement 2 is correct, statement 3 is incorrect; the **validity of the certificate begins 10 days after vaccination**, not 4 days. - This 10-day period allows for the development of adequate immune response to the yellow fever vaccine. *1 and 3* - While statement 1 is correct regarding the change to lifetime validity, statement 3 is incorrect; the **certificate's validity begins 10 days after vaccination**, not 4 days. - The 10-day waiting period is a standard requirement under WHO IHR.

Q: In countries with low levels of measles transmission, what should be the appropriate age for starting immunization with measles-containing vaccine (MCV)?

12 months. ***12 months*** - In countries with **low measles transmission**, the recommended age for the first dose of **Measles-Containing Vaccine (MCV)** is **12 months** (or 12-15 months). - In low-transmission settings, **maternal antibodies persist longer** due to reduced natural boosting from circulating virus, so vaccination can be safely delayed to 12 months for optimal immune response. - This timing ensures maternal antibodies have waned sufficiently while avoiding interference with vaccine effectiveness. *9 months* - The 9-month schedule is recommended for countries with **high measles transmission** where the risk of early infection is greater. - In low-transmission settings, vaccinating at 9 months would mean giving the vaccine when maternal antibodies may still interfere with seroconversion. - WHO recommends 9 months only in high-burden countries or outbreak situations. *15-18 months* - This age range is typically reserved for the **second dose** of the measles vaccine (MCV2) to ensure long-term immunity and catch up children who didn't respond to the first dose. - Starting immunization at this age would leave a significant period of vulnerability to measles infection. - The two-dose schedule provides approximately 97% protection when completed. *6 months* - Administering MCV at 6 months is generally not recommended as maternal **antibodies** are still high and can significantly interfere with the vaccine's effectiveness, leading to poor immune response. - Vaccination at this age might be considered only in very high-risk situations like **outbreaks**, during international travel to endemic areas, or in emergency humanitarian settings. - When given at 6 months, it is not counted as part of the routine schedule, and the child still needs doses at 9 and 15 months.

Question 1

All are correct about Mission Indradhanush (the launched programme) except:

Accepted Answer

Covers 5 vaccine preventable diseases

Answer

Launched in 2014

Answer

Target year 2020

Answer

Covers all unvaccinated and partially vaccinated children

Question 2

Which of the following vials can be used? (AIIMS Nov 2017)

Accepted Answer

1,2 can be used

Answer

3,4 can be used

Answer

1,2,3 can be used

Answer

Only 1 can be used

Question 3

Consider the following statements with regard to Ice-Lined Refrigerator (ILR) employed for storing vaccines at the sub-district level :
I. These types of refrigerators are top-opening.
II. Based on the temperature zone, the inside of ILRs can be divided into 3 parts.
III. The upper part of ILR is cooler compared to the lower part.
IV. Vaccines should never be kept directly on the floor of the ILR as they can get damaged.

Which of the statements given above are correct?

Accepted Answer

II and III

Answer

I and IV

Answer

III and IV

Answer

I and II

Question 4

In a child who has not received any dose of DPT and OPV immunization, up to what age can these vaccines be given under the Universal Immunization Programme?

Accepted Answer

DPT up to 7 years of age and OPV up to 5 years of age

Answer

DPT up to 10 years of age and OPV up to 7 years of age

Answer

DPT up to 12 years of age and OPV up to 10 years of age

Answer

DPT up to 8 years of age and OPV up to 6 years of age

Question 5

Which among the following vaccines best represent interventions that focus on cancer prevention too ?

1. Hepatitis A vaccine
2. Hepatitis B vaccine
3. Hemophilus influenzae B vaccine
4. Human papilloma virus vaccine

Select the correct answer using the code given below :

Accepted Answer

2 and 4

Answer

1 and 4

Answer

2 and 3

Answer

1 and 2

Question 6

Consider the following vaccines :

1. BCG Vaccine
2. Hepatitis B Vaccine
3. Inactivated Polio Vaccine (IPV)
4. Oral Polio Vaccine (OPV) What is the correct order of the above vaccines as per their sensitivity to heat (most sensitive to least sensitive) given in the National Immunization Schedule (NIS) ?

Accepted Answer

4→3→2→1

Answer

2→1→3→4

Answer

2→3→1→4

Answer

3→1→4→2

Question 7

What is the correct increasing order of minimum age at which the following vaccines are administered to a child, as part of the National Immunization Schedule (NIS) after birth of child ?

1. BCG vaccine
2. Japanese Encephalitis (JE) vaccine
3. Rotavirus vaccine
4. Tetanus and adult diphtheria (Td) vaccine

Select the correct answer using the code given below :

Accepted Answer

1→3→2→4

Answer

1→2→3→4

Answer

2→3→1→4

Answer

3→1→4→2

Question 8

Regarding active immunization against Typhoid fever, consider the following statements :

1. The typhoid polysaccharide vaccine is injectable and can be given subcutaneously or intramuscularly.
2. The typhoid polysaccharide vaccine is required to be given in two doses and administered on 0 and 7th day.
3. The typhoid oral Ty21a vaccine requires to be given in three doses on 0, 3rd and 7th days.
4. Protective immunity with typhoid vaccines is achieved immediately after the vaccine is received. Which of the statements given above is/are correct ?

Accepted Answer

1 only

Answer

2 and 3 only

Answer

1 and 2 only

Answer

1, 3 and 4

Question 9

Which among the following is correct about yellow fever vaccination requirement for international travellers ?

1. Term of validity of the certificate is changed from 10 years to the duration of the life of the vaccinated person.
2. Lifetime validity of the certificate applies automatically to all existing and new certificates.
3. Validity of the certificate begins 4 days after vaccination.
4. In India, booster dose of yellow fever vaccine is required for those whose certificate is prior to the year 2016.

Select the correct answer using the code given below :

Accepted Answer

1 and 2

Answer

2 and 4

Answer

2 and 3

Answer

1 and 3

Question 10

In countries with low levels of measles transmission, what should be the appropriate age for starting immunization with measles-containing vaccine (MCV)?

Accepted Answer

12 months

Answer

9 months

Answer

15-18 months

Answer

6 months

Immunization and Vaccine-Preventable Diseases — MCQs

Immunization and Vaccine-Preventable Diseases — MCQs

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