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PE18.1-14 | Immunization — Practice Quiz
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A newborn is delivered at term in a government hospital. Which of the following vaccines are administered at birth as part of the Universal Immunization Programme (UIP)?
BCG, OPV-0 (birth dose), and Hepatitis B birth dose are the three vaccines given at birth under India's National Immunization Schedule. Pentavalent and rotavirus doses begin at 6 weeks.
At birth: BCG (0.05 mL ID right deltoid region), OPV-0 (oral), and Hepatitis B birth dose (0.5 mL IM anterolateral thigh) — ideally within 24 hours of birth.
Only BCG, OPV-0, and Hepatitis B are scheduled at birth. Pentavalent (DPT+HepB+Hib) and rotavirus begin at 6 weeks of age.
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A 6-week-old infant attends a government immunization clinic. The immunization officer plans to administer the vaccines scheduled at 6 weeks under the National Immunization Schedule. Which set is correct?
At 6 weeks: Pentavalent-1 (DPT+HepB+Hib), OPV-1, Rotavirus-1 (RVV), and fIPV-1 (fractional IPV, intradermal). PCV-1 is also scheduled at 6 weeks in states where PCV has been introduced under UIP.
The 6-week, 10-week, and 14-week visits each give Pentavalent, OPV, Rotavirus, and fIPV. fIPV (fractional IPV) is given intradermally (0.1 mL) to achieve seroconversion equivalent to full-dose IPV.
MMR and JE are not given at 6 weeks. Pentavalent replaces separate DPT+HepB, so 'DPT-1 + HepB-1' is not used in UIP.
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During a routine immunization session, a vial of OPV is removed from the cold box and left at room temperature for 3 hours. The health worker notices the vaccine vial monitor (VVM) has changed from Stage 1 to Stage 2 (inner square lighter but still lighter than outer circle). What action should be taken?
A Stage 2 VVM (inner square lighter but still lighter than outer circle) means the vaccine has experienced some heat exposure but is still usable. Discard only when Stage 3 (inner square matches or is darker than outer circle) or Stage 4 (solid dark).
VVM Stages: Stage 1 = no change (use); Stage 2 = inner square lighter than outer (use); Stage 3 = inner matches outer (do NOT use); Stage 4 = inner darker than outer (do NOT use). The shake test is applied to freeze-sensitive vaccines (DPT, pentavalent, Hep B, TT) — a flocculate that does not redisperse indicates freeze damage.
Stage 2 VVM is a 'USE — do not discard' signal. The shake test is for freeze-sensitive vaccines (DPT, pentavalent, Hep B, TT) to detect freezing damage, not heat damage.
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A 3-year-old boy presents for immunization. His mother reports he is HIV-positive and receiving antiretroviral therapy. His current CD4 count is 35%. Which vaccine should be withheld?
Yellow fever vaccine is a live attenuated vaccine and is contraindicated in HIV-positive individuals with CD4 <200 cells/mm³ or CD4 percentage <15% in children, but this child has CD4 35% — borderline. However, yellow fever is the ONLY live vaccine explicitly contraindicated in significantly immunocompromised HIV patients. MR (measles) is given to asymptomatic HIV or mildly symptomatic with CD4 ≥15%. OPV is replaced by IPV in immunocompromised children.
In HIV-positive children: use IPV instead of OPV; give MR/MMR if CD4 ≥15% (no severe immunosuppression); varicella is given if CD4 ≥15%; yellow fever is contraindicated in severe immunosuppression. BCG at birth is given only if HIV-exposed-but-unconfirmed; defer if confirmed symptomatic HIV.
MR vaccine is recommended for HIV-positive children with CD4 ≥15% (no severe immunosuppression). Hepatitis B is a non-live vaccine — safe in all immunocompromised patients. OPV is avoided and replaced with IPV in immunocompromised children; OPV itself is not absolutely contraindicated in HIV but IPV is preferred.
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A vaccine van arrives at a primary health centre and the immunization officer finds that the ILR (Ice-Lined Refrigerator) thermometer reads −3°C. Which vaccines from the following are most likely to have been damaged?
ILRs should be maintained at +2°C to +8°C. At −3°C, freeze-sensitive vaccines (DPT, pentavalent, Hepatitis B, TT/Td, IPV) are damaged by freezing, which disrupts the alum adjuvant and renders them ineffective. OPV, MMR, BCG, and rotavirus are freeze-tolerant (stored at or below −15°C in deep freezers).
Cold chain targets: ILR +2 to +8°C (stores all vaccines for district/PHC level); deep freezer −15 to −25°C (stores freeze-tolerant vaccines: OPV, MMR, varicella, yellow fever, BCG, rotavirus). Freeze-sensitive vaccines (pentavalent, DPT, Hep B, Td, TT, IPV) must NEVER be frozen — detect freeze damage with the shake test.
OPV, MMR, BCG, and rotavirus vaccines are freeze-tolerant and are not damaged by accidental freezing. They are normally stored in deep freezers at −15 to −25°C.
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A 9-month-old child receives her first MR vaccine. Two days later she develops fever, rash, and local swelling at the injection site. According to the AEFI classification, which category best describes this event?
Fever, rash, and local swelling are known, expected reactions from the vaccine product itself (MR vaccine's live attenuated measles component causes mild viremia 5–12 days post-injection; local inflammation from adjuvant). This is a vaccine product-related reaction (formerly 'reactogenicity').
WHO AEFI classification (2013): (1) Vaccine product-related — inherent property of vaccine; (2) Vaccine quality defect — manufacturing/storage failure; (3) Immunization error — programme error; (4) Immunization anxiety — psychogenic; (5) Coincidental — not caused by vaccine. Mild fever and rash 5–12 days after MR/MMR are expected product-related reactions.
Vaccine quality defect is a manufacturing defect. Immunization error is due to wrong preparation, dosing, or administration. Anxiety-related reactions are vasovagal/psychogenic, not febrile rashes.
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A preterm infant born at 30 weeks gestation is clinically stable and ready for discharge at 6 weeks of chronological age. His corrected age is 34 weeks. The mother asks about immunization. What is the correct approach?
For preterm infants, immunization is based on chronological age (date of birth), not corrected age, and full doses are used. BCG should be given at a weight ≥2 kg. This infant at 6 weeks chronological age receives the 6-week vaccines (Pentavalent-1, OPV-1, Rotavirus-1, fIPV-1).
Preterm infants receive vaccines as per chronological age at full doses. BCG: give at birth if ≥2 kg; if <2 kg, defer until weight ≥2 kg. OPV may be replaced with IPV if hospitalized (risk of vaccine-derived poliovirus in other neonates).
Using corrected age would delay immunization unnecessarily and leave the infant unprotected. Dose reduction is not recommended and leads to suboptimal immune response. Deferring until term would miss critical protection windows.
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A mother brings her 18-month-old child for the first DPT booster. She mentions the child has not received the booster DPT+OPV scheduled at 16–24 months. Which national schedule age is correct for this booster, and what is the appropriate action now?
The National Immunization Schedule schedules DPT booster + OPV booster + MR2 at 16–24 months. Since the child is 18 months, all three can be given simultaneously at this visit.
National Immunization Schedule booster schedule: 16–24 months = DPT booster + OPV booster + MR2 (+ PCV booster where applicable). 5–6 years = DPT booster + OPV booster. 10 years = Td. 16 years = Td.
The 12-month visit gives MR-1/JE-1/PCV, not the DPT booster. There is no reason to schedule MR2 separately when all three are due simultaneously. A 4th pentavalent dose is not part of the schedule.
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A 12-year-old girl is brought to a school immunization camp. She has no prior immunization records. Which vaccine is indicated for her under the National Immunization Schedule (NIS) of India?
Under the NIS of India, Td (Tetanus-diphtheria) is scheduled at 10 years and again at 16 years as adolescent boosters. A 12-year-old girl without records should receive the 10-year Td booster. HPV vaccine (for girls 9–14 years) has also been introduced in some states and is being expanded nationally.
NIS adolescent vaccines: Td at 10 years and 16 years. HPV vaccine (Cervarix/Gardasil) is being introduced nationally for girls 9–14 years as part of the cervical cancer prevention initiative. MR supplementary immunization campaigns also cover school-age children.
MMR is given in early childhood (9–15 months and 16–24 months); it is not scheduled at age 12. Pentavalent primary series ends at 14 weeks. Hepatitis A is not part of UIP (it is a recommended/private schedule vaccine).
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A vaccination record card shows a child received BCG at birth, Pentavalent 1–3 and OPV 1–3 at 6, 10, and 14 weeks, and MR-1 at 9 months. The child is now 2 years old. What documentation would confirm that the immunization record is complete up to age 2?
For the NIS to be complete at 2 years, the 16–24 month visit must show DPT booster (1st booster) + OPV booster + MR2. Earlier milestones are already documented. The record is incomplete without the 16–24 month booster entries.
Immunization record documentation must capture: date given, batch number, site, route, any AEFI observed. The Mother and Child Protection (MCP) card is the standard UIP documentation tool. At 2 years of age, a complete NIS record shows BCG, Hep B-birth, OPV-0/1/2/3, Pentavalent-1/2/3, fIPV-1/2, Rota-1/2 (or 1/2/3 depending on brand), MR-1, JE-1 (endemic areas), PCV-1/2/booster (where introduced), and DPT booster + OPV booster + MR2 at 16–24 months.
MMR and varicella at 15 months are private/IAP schedule items, not NIS standard. fIPV is given at 6 and 14 weeks (not just 14 weeks), and fIPV-2 at 14 weeks. Pentavalent-4 does not exist in the NIS — the primary series is 3 doses.
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