Pediatric Immunization and Vaccines MCQs

Pediatrics · 67 free questions with answers & explanations.

1. Under the Indian National Immunization Schedule (2024), which vaccines are administered to a neonate at birth (Day 0)?
2. A 9-month-old child receives Measles-Rubella (MR) vaccine as per the Indian NIS. Which of the following is the CORRECT route and site of administration?
3. Rotavirus vaccine has been introduced in the Universal Immunization Programme of India. At which ages is it administered under the current NIS?
4. A mother asks about the Pneumococcal Conjugate Vaccine (PCV) schedule for her child under the Indian NIS. Which of the following is the CORRECT schedule?
5. During a measles outbreak, a 7-month-old unvaccinated child is exposed to a confirmed measles case. What is the MOST appropriate immediate intervention?
6. Under the Universal Immunization Programme (UIP) India 2024, which of the following vaccines is given SUBCUTANEOUSLY at 9 months?
7. A healthcare worker asks about the correct handling of the OPV vial during an immunization session. According to India's UIP open-vial policy, OPV vials that have been opened can be kept for use in subsequent sessions for a maximum of:
8. A 10-month-old child develops high fever, rash, and Koplik's spots 3 weeks after receiving MR vaccine. The MOST likely explanation is:
9. In IMNCI (Integrated Management of Neonatal and Childhood Illness) protocol, a 3-month-old infant is classified as having 'pneumonia' (not severe). According to current IMNCI guidelines updated for India, the recommended outpatient treatment is:
10. Rotavirus vaccine (Rotavac) is included in India's UIP schedule. A 6-week-old infant is brought for the first dose. Which IMNCI-based contraindication would DEFER this vaccination today?
11. Under the Universal Immunization Programme (UIP) in India, rotavirus vaccine was introduced in a phased manner. Which of the following correctly describes the currently recommended rotavirus vaccination schedule under IAP 2023 guidelines for a child receiving Rotavac (116E strain)?
12. A 2-month-old infant is brought for routine vaccination. The child was born prematurely at 28 weeks and is now 8 weeks chronological age (but corrected age of 2 weeks premature). The child is currently well and thriving. Which of the following is the most appropriate approach to immunization?
13. A 12-month-old child has previously received 3 doses of IPV under the UIP schedule. During a campaign, OPV is also administered. Which of the following best explains the rationale for 'supplementary' OPV campaigns alongside routine IPV in India?
14. A 15-month-old child is scheduled for MMR vaccine. Parents report the child had a mild febrile illness with runny nose 3 days ago, which has now resolved. The child has a known egg allergy causing hives but no anaphylaxis. Which of the following is the MOST appropriate course of action?
15. A child aged 10 years needs hepatitis B vaccination. Her vaccination records are lost. She tests anti-HBs negative and HBsAg negative. Which of the following schedules is appropriate for her primary hepatitis B immunization?
16. A child who received BCG vaccination at birth now undergoes Mantoux test at 5 years of age showing an induration of 14 mm. The child has no symptoms. What is the most appropriate interpretation and action?
17. A 6-week-old infant is scheduled for the first dose of pentavalent vaccine (DTwP-HepB-Hib). The mother mentions that the previous child had persistent inconsolable screaming for 4 hours after the second dose of DTwP. The most appropriate decision is:
18. Under the Universal Immunization Programme (UIP) of India, which vaccine was introduced into the national programme in 2017 and given as a single dose at 9 months along with MR vaccine?
19. A 12-month-old child with HIV infection (CD4 count 800 cells/mm³, clinically asymptomatic, not on ART) requires MMR vaccination. The correct approach is:
20. The Oral Polio Vaccine (OPV) bivalent (types 1 and 3) replaced the trivalent OPV in India's routine immunization in which year, and what was the primary reason?
21. In the Indian National Immunization Schedule (NIS), Inactivated Poliovirus Vaccine (IPV) has been introduced at specific ages. Which statement about the COMBINATION of OPV and IPV is MOST accurate under the current NIS?
22. A 9-month-old child arrives from a village for the first time. The vaccine register confirms no vaccines have been received. Which vaccines should be given TODAY at this visit?
23. A 6-week-old infant born prematurely at 30 weeks is now ready for immunization. The child's corrected age is 0 weeks (still in the NICU). Which vaccine should NOT be given at this time due to specific prematurity concerns?
24. Regarding the varicella vaccine in the Indian Academy of Pediatrics (IAP) recommended schedule, which statement is MOST accurate?
25. A 6-week-old infant is scheduled for the first dose of DTwP-HepB-Hib pentavalent vaccine. The mother reports that her previous child developed a hypotonic-hyporesponsive episode (HHE) 8 hours after the first pentavalent dose. What is the appropriate action regarding vaccination of this infant?
26. A 14-month-old child with known congenital immunodeficiency (severe combined immunodeficiency, SCID) is brought for routine immunization. Which vaccine schedule modification is MOST appropriate?
27. A 9-month-old child receives measles vaccine (MV) as per the IAP schedule. At 15 months, the child needs the MMR vaccine. The mother mentions the child had a febrile seizure 3 days after the first measles dose. What is the recommended approach for the MMR dose?
28. According to the IAP Immunization Advisory Committee 2023 schedule, at what age is the second dose of chickenpox (varicella) vaccine recommended in healthy children, and what is the minimum interval between the two doses?
29. A 6-week-old infant is brought for vaccination. The child has moderate acute diarrhea with mild dehydration and a temperature of 38.2°C. According to the current IAP immunization schedule, which vaccines can SAFELY be given today?
30. A 3-month-old infant receives the third dose of pentavalent vaccine (DTwP+HiB+HepB). Two hours later, the infant develops a high-pitched inconsolable cry lasting 4 hours, fever of 40.5°C, and the limbs become flaccid (hypotonic hyporesponsive episode). What is the appropriate action for subsequent vaccination?
31. BCG vaccine is given to a neonate. At 6 weeks, the injection site shows a papule that progresses to a pustule. Regional (left axillary) lymph nodes are enlarged to 1.5 cm, non-fluctuant, and the skin overlying them is normal. The infant is thriving and afebrile. This represents:
32. A 9-month-old HIV-infected infant who has never received antiretroviral therapy is brought for vaccination. The infant's CD4% is 18%. Which vaccine is ABSOLUTELY CONTRAINDICATED at this visit?
33. A 9-month-old child received the first dose of MMR vaccine. His mother is HIV-positive, and the child's CD4 count is 500 cells/µL (CD4% 22%). Should the MMR vaccine be administered to this child according to current Indian Academy of Pediatrics (IAP) guidelines?
34. According to the IAP 2023 immunization schedule, which vaccine is given as a SINGLE dose at 9 months and protects against four diseases simultaneously?
35. A 6-week-old infant receives the first dose of oral poliovirus vaccine (OPV). Two weeks later, the infant develops acute flaccid paralysis. Stool viral culture isolates a type 2 poliovirus. Which phenomenon explains this complication?
36. A 15-month-old child received varicella vaccine 3 days ago. The child's 4-year-old sibling is now diagnosed with leukemia and is about to begin immunosuppressive chemotherapy. The vaccinated child has developed a mild varicelliform rash (5 lesions). What is the CORRECT advice regarding contact between the vaccinated child and the leukemic sibling?
37. A child receives a dose of live attenuated MMR vaccine. Two weeks later the child requires an emergency splenectomy. The next dose of MMR vaccine should ideally be scheduled:
38. A 2-month-old infant receives pentavalent vaccine (DTP-HBV-Hib). Which component of this vaccine has the highest risk of causing a serious adverse event (grade 3 or higher systemic reaction)?
39. An 18-month-old child in India is due for the second dose of OPV booster under the National Immunization Schedule. The child had received birth dose OPV, and three doses of IPV at 6, 10, and 14 weeks. Which statement best reflects the current IAP recommended schedule for combining OPV and IPV?
40. A 9-month-old child with known HIV infection (asymptomatic, CD4% 28%) is brought for vaccination. Which of the following vaccines is CONTRAINDICATED in this child?
41. Rotavirus vaccine (live, oral) is given to a 6-week-old infant. The MOST important contraindication that must be checked before administering the first dose is:
42. In the Indian National Immunization Schedule, the fractional dose IPV strategy is used. Which of the following CORRECTLY describes the fractional dose IPV administration in India?
43. A 6-week-old infant comes for vaccination. The nurse notes the BCG vial has been open for 3 hours in a session lasting 4 hours in total. The infant has not yet received BCG. What is the CORRECT action?
44. A 12-month-old child with a documented egg allergy (hives after egg ingestion) is due for MMR vaccination. Which of the following is the MOST appropriate approach?
45. A mother brings her 15-month-old child for varicella vaccination. The child is on low-dose prednisolone (0.5 mg/kg/day) for nephrotic syndrome in remission for the past 2 months. Which statement about varicella vaccination in this situation is CORRECT?
46. In the National Immunization Schedule of India, at which age is the rotavirus vaccine (RVV-NRVS) scheduled, and what is the maximum age for the first dose?
47. A 6-week-old infant receives his first dose of pentavalent vaccine (DTwP-HepB-Hib). Three hours later, he develops inconsolable high-pitched crying lasting 4 hours, which resolves spontaneously. He has no fever, no seizures, and no hypotonic-hyporesponsive episode. According to the Indian Academy of Pediatrics (IAP) and WHO guidelines, what is the correct action regarding the next scheduled pentavalent dose?
48. A 2-year-old child has received all recommended vaccinations. He is now diagnosed with asplenia due to hereditary spherocytosis requiring splenectomy. Which vaccines are MOST critically required before elective splenectomy to prevent overwhelming post-splenectomy infection (OPSI)?
49. The IAP Advisory Committee on Vaccines and Immunization Practices (ACVIP) 2023 revised schedule includes two categories of vaccines. In a child with moderate-to-severe acute febrile illness, which vaccines are CONTRAINDICATED until recovery?
50. In the IAP immunisation schedule, the Rotavirus vaccine (RV1 — Rotarix) is given as 2 doses. What is the maximum age for the FIRST dose, and the maximum age for the LAST dose?
51. An 18-month-old is due for the first dose of MMR. The child received oral prednisolone 2 mg/kg/day for 14 days for nephrotic syndrome 4 weeks ago. Steroids have now been stopped. Can the MMR vaccine be given now?
52. A 2-month-old infant is due for the first doses of IPV, pentavalent vaccine, and rotavirus vaccine. The mother is HIV-positive on ART; the infant's HIV PCR at 6 weeks was negative. Which vaccine modification is MOST appropriate for this 2-month HIV-exposed but uninfected infant?
53. A 15-month-old child presents 10 days after receiving MMR vaccine with fever and petechiae but no lymphadenopathy or organomegaly. Platelet count is 32,000/μL. This most likely represents:
54. Which rotavirus vaccine characteristics correctly distinguish Rotarix (RV1) from RotaTeq (RV5) in the Indian national immunization schedule?
55. A child with known HIV infection, currently asymptomatic with CD4 count of 20% (CD4% above 15), is due for immunization. Which live vaccine is CONTRAINDICATED in this child?
56. A 6-week-old infant received the first dose of oral polio vaccine (OPV) as part of the national immunisation schedule. The mother reports the infant developed flaccid paralysis of one limb 30 days later. What is the most likely diagnosis and mechanism?
57. A 2-month-old infant presents with fever and seizures 24 hours after receiving DTP-IPV-Hib pentavalent vaccine. Neurology evaluates the child and finds the febrile seizure to be simple. This event is classified under AEFI monitoring. Which of the following is the CORRECT classification of this event under WHO AEFI causality criteria?
58. Under the National Immunization Schedule (India 2024), a child who missed his 9-month measles-rubella (MR) vaccine is brought at 15 months. Which is the correct catch-up schedule for this child?
59. A 3-month-old infant receives her second dose of DPT-HepB-Hib pentavalent vaccine. Six hours later, she develops persistent inconsolable crying (>3 hours duration), high-pitched cry, temperature of 39.2°C, and a hypotonic-hyporesponsive episode lasting approximately 15 minutes. Which of these adverse events is classified as a contraindication to further doses of whole-cell pertussis-containing vaccines?
60. A preterm infant born at 30 weeks gestation is being discharged at 8 weeks chronological age. According to the National Immunization Schedule of India, which vaccines should be administered at this visit?
61. A 15-month-old child presents with fever and ear ache 12 days after receiving MMR vaccine. Physical examination reveals acute otitis media. The MOST likely explanation for this fever is:
62. A 2-month-old infant received DTwP, Hib, IPV, and Hepatitis B vaccines. Four hours later, she develops hypotonic-hyporesponsive episode (HHE) — pale/cyanotic, floppy, unresponsive for 30 minutes, then recovers fully. What is the CORRECT guidance for future vaccination of this infant?
63. Under the India Universal Immunization Programme (UIP) as of 2024, rotavirus vaccine is included in the schedule. In which states/UTs was this vaccine first introduced, and what is the schedule under UIP?
64. A 5-year-old child with sickle cell disease presents with sudden onset of pallor, weakness, and rapid pulse. His hemoglobin drops from a baseline of 9 g/dL to 3.5 g/dL within hours. The spleen is massively enlarged and tender. Reticulocyte count is 15%. What is the immediate life-saving treatment?
65. A 3-year-old child is brought by parents who found him unresponsive. There is a strong odor of alcohol on his breath, and his blood glucose is 30 mg/dL. The child had reportedly consumed the parent's flavored alcoholic drink. What is the mechanism of alcohol-induced hypoglycemia in children, and why are young children disproportionately affected?
66. A 4-year-old child with ALL in remission (on maintenance therapy with methotrexate and 6-mercaptopurine) is exposed to varicella (chickenpox) at school. She is susceptible (no previous varicella infection, unvaccinated). What is the MOST appropriate post-exposure prophylaxis?
67. A 2-year-old child has severe acute malnutrition (MUAC 10.2 cm, bilateral pitting edema grade 2). The child has no medical complications (no shock, no altered consciousness, no severe vomiting or respiratory distress). According to the WHO/UNICEF SAM management protocol, what is the CORRECT treatment approach?