Immunization and Vaccine-Preventable Diseases Practice Questions

Q: BCG is maximally protective against:

CNS and Disseminated TB. ***CNS and Disseminated TB*** - **BCG vaccination** is highly effective in preventing severe forms of tuberculosis, specifically **meningeal TB** (a form of CNS TB) and **disseminated TB** (miliary TB) in children. - While it doesn't offer complete protection against all forms of TB, its efficacy is greatest against these life-threatening manifestations. *Pulmonary TB* - BCG offers only **modest protection** against **pulmonary TB** in adults, and its effectiveness varies significantly depending on the population and geographical location. - The vaccine's primary benefit is not in preventing typical adult pulmonary disease. *Extra pulmonary TB* - Although **CNS and disseminated TB** are forms of extrapulmonary TB, BCG's protection against other extrapulmonary manifestations (e.g., lymph node TB, bone TB) is generally **less robust** than its protection against CNS and disseminated forms. - The term "extra pulmonary TB" is too broad; BCG's highest efficacy is specific to the most severe forms. *Pulmonary and CNS TB* - While BCG is effective against **CNS TB**, it offers only **limited protection** against **pulmonary TB**. - Combining these two forms overstates its overall efficacy against pulmonary disease.

Q: For which of the following is PPV-23 most beneficial:

Sickle cell anemia patient. ***Sickle cell anemia patient*** - Individuals with **sickle cell anemia** are at a **high risk of invasive pneumococcal disease** due to functional asplenia, making PPV-23 highly beneficial for them. - The **PPV-23 vaccine** targets 23 serotypes of *Streptococcus pneumoniae* and is recommended for those aged 2 years and older with certain chronic medical conditions, including sickle cell disease. - This is one of the **strongest indications** for PPV-23 due to the severe immunocompromise from splenic dysfunction. *Child less than 2 years* - The **polysaccharide vaccines** like PPV-23 are generally **not effective in children younger than 2 years** as their immature immune system does not respond well to polysaccharide antigens. - For children in this age group, the **pneumococcal conjugate vaccine (PCV13)**, which elicits a T-cell-dependent immune response, is recommended. *Cystic fibrosis patient* - While patients with **cystic fibrosis** are at increased risk for respiratory infections, the primary pathogens are typically *Pseudomonas aeruginosa* and *Staphylococcus aureus*, not *Streptococcus pneumoniae*. - Although pneumococcal vaccination (including PPV-23) is generally recommended for individuals with chronic lung disease, it is **not as specifically indicated or beneficial as for sickle cell patients** who demonstrate profoundly impaired splenic function. *Patient with recurrent rhinitis and sinusitis* - **Recurrent rhinitis and sinusitis** are commonly caused by **viral infections**, allergies, or anatomical abnormalities, not typically by serious invasive pneumococcal disease against which PPV-23 offers protection. - While some episodes might involve *Streptococcus pneumoniae*, this condition does not place a patient in the same **high-risk category for severe, invasive pneumococcal infections** that would mandate PPV-23 vaccination as a primary intervention.

Q: A child has received full rabies vaccination in December 2023 and now presented with an oozing wound on the great toe and the pet was also vaccinated. Next line of management is

2 doses of Rabies vaccine. ***2 doses of Rabies vaccine*** - For individuals who have received **previous full rabies vaccination** (either pre-exposure or post-exposure prophylaxis), a subsequent exposure requires only **two booster doses of vaccine on days 0 and 3**, regardless of wound category. - Even though this is a **Category III exposure** (oozing wound with break in skin), **no RIG is required** for previously immunized individuals as per WHO and APCRI guidelines. - The pre-existing immunity from the prior vaccination provides a **rapid anamnestic (memory) response**, eliminating the need for passive immunization or a full primary series. *RIG + 5 doses of vaccine* - This regimen is for individuals with **no prior vaccination history** and represents the full post-exposure prophylaxis for Category III exposures (transdermal bites, oozing wounds). - The child has been previously vaccinated, rendering this extensive protocol unnecessary and potentially harmful due to **immune complex formation** if RIG is given to an immune individual. *5 doses of vaccines only* - This approach is suitable for **previously unvaccinated individuals** with Category II exposure (nibbling, minor scratches without bleeding) where RIG may not be available. - However, in a previously vaccinated individual, the full 5-dose series is **excessive and not indicated** as immunity is already established. *No vaccine required* - Even with a previously vaccinated child and a vaccinated pet, there is still a **potential risk of exposure** to rabies, especially with a Category III wound (oozing wound). - Omitting vaccination entirely would be **negligent** and violates standard guidelines, as vaccine efficacy is not 100% and animal vaccination status can be uncertain or lapsed.

Q: Which vaccine is given at birth to provide protection against tuberculosis as per the National Immunization Schedule in India?

BCG. ***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

Q: All of the following regarding rotavirus vaccine are correct except?

Inactivated vaccine. ***Inactivated vaccine*** - The rotavirus vaccines (Rotarix and RotaTeq) are **live-attenuated vaccines**, meaning they contain weakened forms of the virus, not inactivated forms. - Live-attenuated vaccines replicate in the host to induce a robust immune response similar to natural infection. - This is the **incorrect statement**, making it the correct answer to this "except" question. *Available as monovalent and pentavalent* - This statement is correct. There are two main types: **Rotarix**, which is a **monovalent** vaccine targeting G1P strains, and **RotaTeq**, which is a **pentavalent** vaccine targeting G1, G2, G3, G4, and P strains. - Both forms provide broad protection against common rotavirus strains. *Last dose should be completed by 8 months of age* - This statement is correct. The first dose should be given between **6-14 weeks**, and the final dose should be administered by **8 months (32 weeks) of age**. - For **Rotarix** (2-dose series): complete by 24 weeks; for **RotaTeq** (3-dose series): complete by 32 weeks. - This age limit is primarily due to a theoretical increased risk of **intussusception** when administered later in infancy. *Administered orally* - This statement is correct. Rotavirus vaccines are given **orally** and are not injectable. - This method of administration makes the vaccine easy to administer and simulates the natural route of rotavirus infection, promoting mucosal immunity.

Q: A 29-year-old sexually active woman is concerned about preventing genital warts after learning about HPV. What is the most effective prevention strategy for her?

HPV vaccination. ***HPV vaccination*** - **HPV vaccination** is the most effective primary prevention strategy for sexually active individuals against genital warts and HPV-related cancers. - It targets the high-risk HPV types (16, 18) responsible for most cervical cancers and low-risk types (6, 11) that cause 90% of genital warts. - The 9-valent vaccine (Gardasil 9) provides protection against 9 HPV types and is recommended for individuals up to age 45. - **Most practical and effective real-world prevention strategy** for sexually active individuals. *Condom use* - While **condoms** can reduce the risk of HPV transmission by approximately 70%, they do not offer complete protection. - The virus can be present on genital skin areas not covered by the condom, allowing transmission through skin-to-skin contact. - Useful as an adjunct measure but less effective than vaccination. *Routine screening* - **Routine screening** (e.g., Pap smear, HPV DNA testing) is a **secondary prevention** method for cervical cancer. - It detects cervical cellular changes caused by HPV but does not prevent initial HPV infection or genital warts. - Important for early detection but not a prevention strategy. *Abstinence* - **Abstinence** from all sexual activity would prevent HPV transmission but is not a realistic or sustainable strategy for most sexually active adults. - The question context implies the woman is sexually active and seeking practical prevention methods.

Q: A 4-year-old child with no prior immunization history is bitten by a stray dog. What is the appropriate post-exposure prophylaxis for this child?

Rabies immunoglobulin and rabies vaccine (4 doses). ***Rabies immunoglobulin and rabies vaccine (4 doses)*** - For a **non-immunized** individual with **Category III exposure** (bite from stray dog), both **passive immunity** (rabies immunoglobulin) and **active immunity** (rabies vaccine) are crucial for immediate and long-term protection. - The immunoglobulin provides immediate antibodies while the vaccine stimulates the body's own immune response over several weeks. - **Current regimen:** RIG infiltrated around wound + vaccine on **Days 0, 3, 7, and 14** (Updated Essen regimen as per WHO 2018 and NCDC guidelines). *Rabies vaccine only (4 doses)* - Administering only the vaccine provides active immunity which takes time to develop, leaving the child vulnerable during the initial period after exposure. - This approach is insufficient for a non-immunized individual with Category III exposure, as there is no immediate protection against the rapidly progressing rabies virus. *Rabies immunoglobulin only* - Rabies immunoglobulin provides immediate, temporary passive immunity but does not stimulate the body to produce its own long-lasting antibodies. - Without the vaccine, the child would eventually lose protection as the administered antibodies degrade, leaving them susceptible to infection. *Observe the child for 10 days before starting treatment* - Rabies is almost universally fatal once symptoms appear, and there is no effective treatment after onset. - Post-exposure prophylaxis must be initiated **as soon as possible** after exposure, without delay, to prevent the virus from replicating and reaching the central nervous system. - The **10-day observation** applies to the **animal**, not the patient—if available, the dog should be observed, but PEP should still be initiated immediately.

Question 1

BCG is maximally protective against:

Accepted Answer

CNS and Disseminated TB

Answer

Pulmonary TB

Answer

Extra pulmonary TB

Answer

Pulmonary and CNS TB

Question 2

For which of the following is PPV-23 most beneficial:

Accepted Answer

Sickle cell anemia patient

Answer

Child less than 2 years

Answer

Cystic fibrosis patient

Answer

Patient with recurrent rhinitis and sinusitis

Question 3

A child has received full rabies vaccination in December 2023 and now presented with an oozing wound on the great toe and the pet was also vaccinated. Next line of management is

Accepted Answer

2 doses of Rabies vaccine

Answer

RIG + 5 doses of vaccine

Answer

5 doses of vaccines only

Answer

No vaccine required

Question 4

Which vaccine is given at birth to provide protection against tuberculosis as per the National Immunization Schedule in India?

Accepted Answer

BCG

Answer

Measles

Answer

OPV

Answer

Hepatitis B

Question 5

All of the following regarding rotavirus vaccine are correct except?

Accepted Answer

Inactivated vaccine

Answer

Available as monovalent and pentavalent

Answer

Last dose should be completed by 8 months of age

Answer

Administered orally

Question 6

In a community experiencing an outbreak of meningitis, which preventive measure is most effective in controlling the spread of the disease?

Accepted Answer

Vaccination

Answer

Hand washing

Answer

Antibiotic prophylaxis

Answer

Quarantine of affected individuals

Question 7

A 29-year-old sexually active woman is concerned about preventing genital warts after learning about HPV. What is the most effective prevention strategy for her?

Accepted Answer

HPV vaccination

Answer

Condom use

Answer

Routine screening

Answer

Abstinence

Question 8

A 4-year-old child with no prior immunization history is bitten by a stray dog. What is the appropriate post-exposure prophylaxis for this child?

Accepted Answer

Rabies immunoglobulin and rabies vaccine (4 doses)

Answer

Rabies immunoglobulin only

Answer

Observe the child for 10 days before starting treatment

Answer

Rabies vaccine only (4 doses)

Question 9

Which of the following factors should be critically evaluated before introducing a new vaccine for tuberculosis in a high-burden country?

Accepted Answer

Efficacy of the vaccine and availability of healthcare infrastructure.

Answer

Prevalence of tuberculosis and political stability in the region.

Answer

Cost-effectiveness and cultural acceptance of the vaccine.

Answer

None of the options.

Question 10

What is the primary objective of the Intensified Mission Indradhanush 4.0?

Accepted Answer

To achieve comprehensive immunization coverage in underserved areas

Answer

To introduce new vaccines into the immunization schedule

Answer

To reduce vaccine wastage

Answer

To increase the frequency of vaccination sessions

Immunization and Vaccine-Preventable Diseases — MCQs

Immunization and Vaccine-Preventable Diseases — MCQs

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