Immunization and Vaccine-Preventable Diseases Practice Questions

Q: What are the types of HPV vaccines that have been licensed and are available?

Bivalent, Quadrivalent, and Nonavalent. ***Bivalent, Quadrivalent, and Nonavalent*** - Three types of HPV vaccines have been licensed: **bivalent** (2vHPV, Cervarix), **quadrivalent** (4vHPV, Gardasil), and **nonavalent** (9vHPV, Gardasil 9). - The **bivalent vaccine** protects against HPV types 16 and 18 (responsible for ~70% of cervical cancers). - The **quadrivalent vaccine** protects against HPV types 6, 11, 16, and 18 (also covers genital warts). - The **nonavalent vaccine** protects against nine HPV types (6, 11, 16, 18, 31, 33, 45, 52, 58) and is currently the most widely used, offering the broadest protection. *Monovalent* - This term refers to a vaccine targeting only **one specific strain** of a pathogen. - No HPV vaccine has ever been licensed as monovalent, as even the earliest vaccines covered multiple high-risk types. *Trivalent* - This describes a vaccine protecting against **three different strains** of a pathogen. - No **trivalent HPV vaccine** has ever been developed or licensed. *Only Quadrivalent* - While the **quadrivalent vaccine (Gardasil)** was an important advancement, it is not the only type available. - Both **bivalent** and **nonavalent** vaccines are also licensed and available globally.

Q: Vaccines at primary health care centers are stored in:

ILR. ***ILR*** - An **ILR (Ice Lined Refrigerator)** is specifically designed to maintain vaccines within the **recommended temperature range (2°C to 8°C)**, even during power outages. - Its **ice lining** provides a cold reserve, ensuring temperature stability critical for vaccine efficacy, especially in primary health care settings that may have unreliable power supply. *Ultra-low temperature freezer* - **Ultra-low temperature freezers** (e.g., -70°C to -80°C) are used for storing highly sensitive vaccines like some mRNA COVID-19 vaccines, but they are not standard for routine primary health care vaccine storage due to their cost and specialized maintenance requirements. - Storing routine vaccines at such **extreme cold temperatures** can actually damage them or reduce their potency, as many are designed for storage in a refrigerator, not a freezer. *Ice-lined box* - An **ice-lined box** is primarily used for **transporting vaccines** for short periods, such as during outreach sessions or between health facilities. - While it helps maintain temperature, it is a **temporary solution** and not designed for long-term storage at a primary health care center. *None of the options* - This option is incorrect because the **ILR (Ice Lined Refrigerator)** is specifically designed and commonly used for vaccine storage at primary health care levels, making it the most appropriate answer.

Q: In a measles outbreak, measles vaccine can be given to infants at what age range:

6-9 months. ***6-9 months*** - During a **measles outbreak**, infants as young as **6 months** can receive an early dose of the measles vaccine to provide protection. - This early vaccination is crucial in high-risk situations, even though the standard first dose is typically given at **12-15 months** of age. *2-3 months* - Administering the measles vaccine at **2-3 months** is generally avoided because of the presence of persistent **maternal antibodies**. - These antibodies can interfere with the infant's immune response to the vaccine, making it less effective. *3-5 months* - Similar to the 2-3 month range, **maternal antibodies** are still likely present and at sufficiently high levels in infants aged 3-5 months. - This interference reduces the vaccine's efficacy and the likelihood of developing a robust, lasting immune response. *2-7 months* - While this range includes the accepted 6-month age for early vaccination, infants under **6 months** still pose a challenge due to **maternal antibody interference**. - Combining these ages into a single range doesn't differentiate between the reduced efficacy in younger infants versus the permissible early vaccination at 6 months and older during an outbreak.

Q: Which of the following vaccines has the highest coverage among children aged 12-23 months according to NFHS-5 data?

BCG vaccine. ***BCG vaccine (Correct Answer)*** - According to **NFHS-5 (2019-21)**, BCG vaccine has the **highest coverage at 93.3%** among children aged 12-23 months in India. - BCG is administered **at birth or as soon as possible thereafter**, making it the first vaccine in the immunization schedule. - Its high coverage is attributed to **institutional deliveries** and administration at birth in healthcare facilities. - BCG serves as a **key indicator** of access to immunization services. *Measles/MR vaccine* - NFHS-5 data shows **measles/MR first dose coverage at 88.7%**, which is lower than BCG. - Despite being part of routine immunization, measles coverage is **second highest** among commonly tracked vaccines. - Coverage gaps exist due to **dropout rates** and challenges in reaching children at 9-12 months of age. *DPT vaccine* - **DPT3 (third dose) coverage is 76.4%** according to NFHS-5, showing significant dropout from the first dose. - The **multi-dose requirement** (at 6, 10, and 14 weeks) leads to progressive decline in coverage. - DPT3 completion is used as an indicator of **immunization program performance** and demonstrates dropout challenges. *None of the vaccines* - This is incorrect as **all three vaccines have substantial coverage** in India's Universal Immunization Programme. - NFHS-5 data clearly documents **high coverage rates** for these essential childhood vaccines, with BCG leading at over 93%.

Q: Which vaccine is associated with complications such as osteomyelitis?

BCG vaccine. ***BCG vaccine*** - The BCG vaccine, particularly when given to immunocompromised individuals or sometimes due to improper administration, can lead to disseminated infection, including **BCG osteitis** or **osteomyelitis**. - This complication, though rare, involves the infection of **bone tissue** by the attenuated *Mycobacterium bovis* strain used in the vaccine. *Hepatitis B vaccine* - The Hepatitis B vaccine is generally safe, with common side effects limited to **local reactions** at the injection site. - It is not associated with an increased risk of developing **osteomyelitis**. *Measles vaccine* - The measles vaccine (MMR) is a live attenuated vaccine, and side effects usually include **fever** or a mild rash. - There is no established link between the measles vaccine and the development of **osteomyelitis**. *IPV* - Inactivated Poliovirus Vaccine (IPV) is a safe vaccine, and its serious complications are exceedingly rare, primarily involving **severe allergic reactions**. - It does not contain live virus and is not known to cause **osteomyelitis**.

Q: Which of the following vaccines is not part of the National Immunization Programme?

Hepatitis A. ***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.

Q: Which of the following statements about measles is incorrect?

Secondary attack rate is 30%. ***Secondary attack rate is 30%*** - Measles is highly contagious, and its **secondary attack rate** is much higher than 30%, often reaching **90% or more** among susceptible household contacts. - A 30% secondary attack rate would be exceptionally low for a disease with measles's known **high transmissibility**. *Maximum incidence in 6 months to 3 years age group* - This statement is correct as **maternal antibodies wane** around 6 months, making infants susceptible, and young children in this age range are often actively exposed in community settings. - Peak incidence occurs in this age group, particularly in **unvaccinated or under-vaccinated populations**. *Best age for immunization is 9-12 months* - This is the **recommended age** for measles vaccination under India's **Universal Immunization Programme (UIP)**. - Immunizing at this age ensures that waning maternal antibodies do not interfere with vaccine efficacy while providing timely protection during the high-risk period. *Secondary attack rate is 90%* - This statement is correct. Measles is one of the **most contagious infectious diseases**, with a secondary attack rate among susceptible household contacts often **exceeding 90%**. - Its high transmissibility is due to its **airborne spread** and long communicable period.

Q: Mission Indradhanush was started in

Dec-14. ***Dec-14*** - Mission Indradhanush, a flagship immunization program in India, was launched on **December 25, 2014**. - Its primary aim was to **immunize all children and pregnant women** against preventable diseases. *Jan-05* - This date does not correspond to the launch of Mission Indradhanush. Other health initiatives or policies may have been introduced around this time. - The focus on a comprehensive, nationwide immunization drive as seen in Mission Indradhanush came later. *Jul-10* - This date is incorrect for the inception of Mission Indradhanush. There were various health programs ongoing in India during 2010. - No major national immunization campaign of the scale of Mission Indradhanush began in July 2010. *Mar-16* - While significant developments and phases of Mission Indradhanush occurred after its launch, March 2016 was not the initiation date. - This period might have seen the implementation of subsequent phases or intensified efforts of the mission.

Q: What is the recommended regimen for human diploid cell vaccine for pre-exposure rabies vaccination?

0, 7, 28 then booster dose 1 year. ***0, 7, 28 then booster dose 1 year*** - The recommended schedule for **pre-exposure prophylaxis** with human diploid cell vaccine (HDCV) in India is three doses on days **0, 7, and 28**. - A **booster dose at 1 year** is recommended for individuals with **continuous risk of exposure** (e.g., veterinarians, laboratory workers, animal handlers). - This schedule provides adequate antibody titers and long-term protection. Further boosters may be given every 3-5 years based on antibody titers or risk assessment. *0, 7, 21 then booster dose 12 months* - While the 0, 7, 21 (or 21-28) day schedule is used in some international protocols (WHO/CDC), the **standard schedule in India is 0, 7, 28 days**. - The booster timing at 12 months is appropriate, but the primary series schedule is not the preferred Indian guideline. *0, 7, 28 then booster dose 2 years* - The primary series schedule of 0, 7, 28 days is correct. - However, the **booster interval of 2 years is too long** for the first booster dose in pre-exposure prophylaxis. The first booster is recommended at **1 year**, with subsequent boosters at longer intervals (3-5 years) based on risk. *0, 14, 28 then booster dose 90 days* - A **day 14 dose is not part of the standard schedule** for pre-exposure rabies vaccination. - A **booster at 90 days is incorrect** – this is far too soon and not part of established pre-exposure prophylaxis guidelines. The first booster should be at 1 year, not 3 months.

Q: What are the possible mild reactions after receiving the influenza vaccine?

All of the options. ***All of the options*** - All three reactions listed (local swelling, fever, and itching) are recognized **mild side effects** of the influenza vaccine. - **Local reactions** such as swelling, soreness, redness, and itching at the injection site are common and typically resolve within 1-2 days. - **Systemic reactions** like low-grade fever, headache, malaise, and muscle aches can occur as the immune system responds to the vaccine, usually lasting 1-2 days. - Since all the individual options represent possible mild reactions, the correct answer encompasses all of them. *Why individual options alone are incomplete* - Selecting only "Local swelling," "Fever," or "Itching" would be medically accurate but incomplete, as the question asks for "possible mild reactions" (plural). - Each individual option represents only one type of mild reaction, while multiple types can occur. - The most comprehensive and correct answer includes all possible mild reactions listed.

Question 1

What are the types of HPV vaccines that have been licensed and are available?

Accepted Answer

Bivalent, Quadrivalent, and Nonavalent

Answer

Monovalent

Answer

Trivalent

Answer

Only Quadrivalent

Question 2

Vaccines at primary health care centers are stored in:

Accepted Answer

ILR

Answer

Ultra-low temperature freezer

Answer

Ice-lined box

Answer

None of the options

Question 3

In a measles outbreak, measles vaccine can be given to infants at what age range:

Accepted Answer

6-9 months

Answer

2-3 months

Answer

3-5 months

Answer

2-7 months

Question 4

Which of the following vaccines has the highest coverage among children aged 12-23 months according to NFHS-5 data?

Accepted Answer

BCG vaccine

Answer

DPT vaccine

Answer

Measles vaccine

Answer

None of the vaccines

Question 5

Which vaccine is associated with complications such as osteomyelitis?

Accepted Answer

BCG vaccine

Answer

Hepatitis B vaccine

Answer

Measles vaccine

Answer

IPV

Question 6

Which of the following vaccines is not part of the National Immunization Programme?

Accepted Answer

Hepatitis A

Answer

TT

Answer

OPV

Answer

Measles

Question 7

Which of the following statements about measles is incorrect?

Accepted Answer

Secondary attack rate is 30%

Answer

Secondary attack rate is 90%

Answer

Maximum incidence in 6 months to 3 years age group

Answer

Best age for immunization is 9-12 months

Question 8

Mission Indradhanush was started in

Accepted Answer

Dec-14

Answer

Jan-05

Answer

Jul-10

Answer

Mar-16

Question 9

What is the recommended regimen for human diploid cell vaccine for pre-exposure rabies vaccination?

Accepted Answer

0, 7, 28 then booster dose 1 year

Answer

0, 14, 28 then booster dose 90 days

Answer

0, 7, 28 then booster dose 2 years

Answer

0, 7, 21 then booster dose 12 months

Question 10

What are the possible mild reactions after receiving the influenza vaccine?

Accepted Answer

All of the options

Answer

Itching

Answer

Local swelling

Answer

Fever

Immunization and Vaccine-Preventable Diseases — MCQs

Immunization and Vaccine-Preventable Diseases — MCQs

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