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CM8.1-7 | Disease Epidemiology and Control — Practice Quiz
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A PHC medical officer identifies three children in the same village presenting with fever, cough for >2 weeks, and failure to thrive within one week. The FIRST action under NTEP is to:
Correct. NIKSHAY registration and CBNAAT/smear are the mandatory first steps for presumptive TB under NTEP.
Under NTEP, all presumptive TB cases (cough ≥2 weeks) must be registered on NIKSHAY and tested using CBNAAT or sputum microscopy. BCG vaccination is primary prevention, not case management; empirical antibiotics delay diagnosis.
Review NTEP case-finding protocol: all presumptive TB (cough ≥2 weeks) must be registered on NIKSHAY before initiating any treatment.
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India's Universal Immunisation Programme (UIP) currently includes the vaccine given at birth to all newborns to prevent a chronic liver disease that can progress to cirrhosis. Which vaccine is this, and what is its UIP schedule?
Correct. HepB birth dose within 24 hours is critical for mother-to-child transmission prevention; subsequent doses are packaged in pentavalent.
UIP includes Hepatitis B: birth dose (within 24 hours for MTCT prevention) + 3 doses as pentavalent (DPT+HepB+Hib) at 6, 10, 14 weeks. Hepatitis A is not in UIP. BCG and OPV are correct UIP vaccines but address TB and polio, not liver disease.
The chronic liver disease prevented by vaccination is Hepatitis B (cirrhosis/HCC pathway). Review UIP schedule for Hepatitis B: birth + 6/10/14 weeks as pentavalent.
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During an NPCDCS clinic at a PHC, a 52-year-old male presents for a routine visit. His BP is 148/94 mmHg on two readings taken 10 minutes apart. He has no symptoms. What is the correct classification and next step?
Correct. Stage 1 HT at PHC = lifestyle counselling + confirmation visit before starting drugs (unless high CV risk).
BP 140-159/90-99 mmHg = Stage 1 hypertension (JNC-8/NPCDCS). At Stage 1, the PHC protocol requires lifestyle counselling (DASH diet, salt <5g/day, physical activity, no tobacco) and confirmation. Immediate pharmacotherapy is indicated only if cardiovascular risk is high or BP ≥160/100 (Stage 2). Hypertensive urgency requires BP >180/120 with target organ damage.
Stage 1 HT (140-159/90-99) does not mandate immediate pharmacotherapy. Hypertensive urgency requires BP >180/120 mmHg with end-organ damage.
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The IDSP's L-form is submitted by which cadre, and what type of data does it capture?
Correct. L = Laboratory. Labs submit confirmed disease data, which validates the S and P reports upstream.
IDSP operates three reporting forms: S-form (Syndromic — community health workers/ASHAs); P-form (Presumptive — PHC/CHC doctors); L-form (Laboratory-confirmed — labs). The DSO compiles the weekly situation report from all three streams.
Remember the IDSP mnemonic: S-form = Syndromic (community workers), P-form = Presumptive (doctors), L-form = Laboratory (labs).
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A village reports 18 cases of acute watery diarrhoea over 3 days; expected baseline is 0-1 cases per week. The epidemic curve shows a single sharp peak on Day 1 with rapid decline. This pattern is MOST consistent with:
Correct. A sharp single-day peak followed by rapid decline = classic point-source common vehicle outbreak pattern.
A single sharp peak within one incubation period indicates all cases were exposed to a common source at approximately the same time (point-source outbreak — e.g. a contaminated water source or community meal). Propagated epidemics show multiple successive peaks separated by incubation periods. Mixed epidemics have a point-source peak followed by secondary person-to-person peaks.
Shape of the epidemic curve is diagnostic. Single sharp peak = point source; multiple peaks separated by incubation period = propagated.
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A patient on anti-TB treatment (intensive phase, DOTS) also tests positive for HIV during routine screening. Under national programme guidelines, the PHC physician should:
Correct. TB treatment continues; concurrent referral to ICTC/ART centre for CD4 and ART planning is the NTEP-NACO protocol.
NTEP-NACO integration: TB treatment is NEVER interrupted for HIV. The patient is co-referred to the ICTC/ART centre for CD4 count and ART initiation (usually 2-8 weeks after starting TB treatment, per NACO/WHO guidelines). Cotrimoxazole prophylaxis is recommended for all TB-HIV co-infected patients but ART timing depends on CD4 count — do not start simultaneously without assessment.
Never stop TB treatment for HIV co-infection. NTEP-NACO integration requires co-referral to ICTC; ART timing (2-8 weeks post-TB treatment start) depends on CD4 count.
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Which of the following is the CORRECT attack rate formula for evaluating an outbreak?
Correct. AR = (Cases ÷ Population at risk) × 100.
Attack rate (AR) = (Number of cases ÷ Population at risk during the defined period) × 100. It is expressed as a percentage and is used to describe the force of an outbreak in a defined group. Option C is the case fatality rate. Option D resembles incidence rate but uses per 1,000 population (not specific to outbreaks).
Attack rate = (Cases ÷ Population at risk) × 100. Do not confuse with CFR = (Deaths ÷ Cases) × 100.
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NVBDCP is responsible for control of which group of diseases?
Correct. NVBDCP = all major vector-borne diseases (malaria, dengue, filariasis, kala-azar, chikungunya, JE).
NVBDCP (National Vector Borne Disease Control Programme) covers all major vector-borne diseases in India: Malaria, Dengue, Filariasis (Lymphatic), Kala-azar, Chikungunya, and Japanese Encephalitis. TB → NTEP; HIV → NACO; Leprosy → NLEP; NCDs → NPCDCS; enteric diseases → IDSP/routine surveillance.
Remember the programme-disease mapping: NTEP=TB, NACO=HIV, NLEP=Leprosy, NVBDCP=vector-borne diseases, NPCDCS=NCDs.
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A PHC physician discovers that the weekly S-form submitted by the ASHA for the past month shows zero entries for any syndrome. The physician should FIRST:
Correct. The physician must first verify whether zero-reports are 'active zeros' (real visits, no cases) or 'passive zeros' (no visits at all) using the village health register.
Legitimate zero reporting (actively confirming no cases) is a quality indicator; however, zero reports from an ASHA who has not actually conducted visits represent a surveillance gap ('false zero'). The PHC physician's supervisory role includes triangulating S-form data against the village health register and conducting field visits. Surveillance failure is a systems problem requiring mentoring, not punitive action as the first step.
Zero reports are only valid if the ASHA has conducted active surveillance. The supervisory duty includes verification against field records before accepting or reporting.
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Which statement BEST describes the primary goal of the National Leprosy Eradication Programme (NLEP)?
Correct. NLEP targets elimination (<1/10,000 prevalence) through early detection and MDT; grade-2 disability rate is the sentinel outcome.
NLEP's goal is elimination as a public health problem — defined as prevalence <1 per 10,000 — not biological eradication. Key strategies: early case detection (self-reporting, active surveys), multi-drug therapy (MDT: dapsone+rifampicin+clofazimine), disability prevention (grade-2 disability prevention is a key indicator), and community-based rehabilitation. Isolation/leprosaria were discontinued decades ago; integration into general health services is the current approach.
NLEP aims for elimination as a public health problem (prevalence <1/10,000), not biological eradication. Isolation in leprosaria is obsolete.
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