At a PHC review, the immunisation card of a 13-month-old boy shows BCG at birth (scar present), OPV and pentavalent at 6, 10 and 14 weeks, rotavirus vaccine, PCV and fIPV as scheduled, but no measles-rubella vaccine. How should his status be recorded?

Not fully immunised: MR-1 is missing

Fully immunised: MR-1 can wait until 16 months

Fully immunised: all primary doses are done

Partially immunised: BCG must be repeated

Two minutes after receiving pentavalent vaccine at a PHC, a 4-month-old boy weighing 8 kg develops generalised urticaria, noisy breathing and pallor; his pulse is weak and fast. The AEFI kit holds adrenaline 1 mg/mL (1:1000). What is the correct first dose and route?

0.08 mL intramuscularly in the thigh

0.08 mL subcutaneously in the arm

0.8 mL intramuscularly in the thigh

0.8 mL intravenously as a bolus

Immunisation: UIP schedule, cold chain and AEFI

38 NEET-PG practice questions on Immunisation: UIP schedule, cold chain and AEFI, part of Community Medicine. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Easy
At a village immunisation session, an ANM reconstitutes a vial of measles-rubella vaccine at 10 am. The medical officer reviews four practices: 1. The diluent was cooled to 2-8 °C before reconstitution. 2. The reconstituted vial is used within 4 hours or until the session ends, whichever is earlier. 3. Under the open vial policy, the vial may be used in later sessions for up to 4 weeks. 4. A vial left over at the end of the session may go back to the ice-lined refrigerator if its VVM is acceptable. Which practices are correct under the Universal Immunisation Programme?
1. A2 and 4 only
2. B1 and 2 only
3. C1, 2 and 3 only
4. D1, 2 and 4 only
Show answerHide answer
Answer: B · 1 and 2 only
Practices 1 and 2 are correct. The diluent is kept in the cold chain before use so that it is at the same temperature as the vaccine, because warm diluent can damage a heat-sensitive live vaccine. Reconstituted vaccines such as measles-rubella, BCG and JE contain no preservative, so they are used within 4 hours or by the end of the session, whichever comes first; contaminated preservative-free vials have caused fatal toxic shock in children. Practices 3 and 4 are false: the open vial policy (up to 4 weeks) applies only to liquid vaccines such as OPV, Td and hepatitis B, and a reconstituted vial is never returned to the cold chain, whatever its VVM shows.
- A: Omits the cooled diluent and wrongly allows the leftover vial back into the ILR.
- C: Wrongly applies the open vial policy to a reconstituted vaccine.
- D: Wrongly allows a reconstituted vial back into the cold chain for later use.
Question 2 · Easy
Mission Indradhanush, launched by the Government of India in December 2014, held catch-up vaccination rounds in districts with many unvaccinated children. What full immunisation coverage among children did it aim to reach?
1. AAt least 90%
2. BAt least 75%
3. CAt least 95%
4. DAt least 80%
Show answerHide answer
Answer: A · At least 90%
Mission Indradhanush aimed to raise full immunisation coverage of children to at least 90% by reaching unvaccinated and partially vaccinated children and pregnant women. It focused on districts with the largest numbers of such children, with intensive rounds of a week in consecutive months. Intensified Mission Indradhanush and its later phases kept the 90% goal while targeting urban slums, migrants and hard-to-reach areas. Its name, rainbow, refers to the diseases covered by the vaccines in the programme.
- B: 75% was lower than the coverage the mission set out to reach.
- C: 95% is a herd immunity figure quoted for measles, not the mission's goal.
- D: 80% was below the mission's stated goal.
Question 3 · Medium
At a PHC review, the immunisation card of a 13-month-old boy shows BCG at birth (scar present), OPV and pentavalent at 6, 10 and 14 weeks, rotavirus vaccine, PCV and fIPV as scheduled, but no measles-rubella vaccine. How should his status be recorded?
1. AFully immunised: MR-1 can wait until 16 months
2. BNot fully immunised: MR-1 is missing
3. CFully immunised: all primary doses are done
4. DPartially immunised: BCG must be repeated
Show answerHide answer
Answer: B · Not fully immunised: MR-1 is missing
A fully immunised child has received BCG, three doses of pentavalent (or DPT), three doses of OPV and the first dose of measles-containing vaccine (MR-1) before the first birthday. This boy lacks MR-1, so he is not fully immunised and must get MR-1 now; MR can be given up to 5 years of age, with the second dose at least 4 weeks after the first. Measles protection is the dose most often missed because it comes months after the 14-week visit. BCG is not repeated, and he has a scar in any case.
- A: MR-1 is due at 9-12 months; MR-2 is the dose given at 16-24 months.
- C: MR-1 is part of the definition of a fully immunised child.
- D: BCG is not repeated, and he has a scar.
Question 4 · Hard
Two minutes after receiving pentavalent vaccine at a PHC, a 4-month-old boy weighing 8 kg develops generalised urticaria, noisy breathing and pallor; his pulse is weak and fast. The AEFI kit holds adrenaline 1 mg/mL (1:1000). What is the correct first dose and route?
1. A0.08 mL subcutaneously in the arm
2. B0.8 mL intramuscularly in the thigh
3. C0.08 mL intramuscularly in the thigh
4. D0.8 mL intravenously as a bolus
Show answerHide answer
Answer: C · 0.08 mL intramuscularly in the thigh
This is anaphylaxis: urticaria with stridor and signs of shock minutes after a vaccine. The first drug is intramuscular adrenaline 0.01 mg/kg into the anterolateral thigh: 0.01 x 8 = 0.08 mg, which is 0.08 mL of the 1 mg/mL (1:1000) solution; it may be repeated after 5-15 minutes if needed. Intramuscular injection is absorbed faster and more reliably than subcutaneous, and an undiluted intravenous bolus risks arrhythmia; 0.8 mL is a tenfold overdose. He is laid flat with legs raised, given oxygen, and referred after stabilisation; this is why every child is observed for 30 minutes after vaccination.
- A: Subcutaneous absorption is slower and less reliable in shock.
- B: 0.8 mL of 1:1000 is a tenfold overdose.
- D: An IV bolus of this strength risks arrhythmia and is not first aid.
Question 5 · Easy
A newly posted medical officer inspects the cold chain point of her PHC, where all UIP vaccines are kept in an ice-lined refrigerator (ILR). Within which temperature range must the ILR be kept?
1. A+4 °C to +12 °C
2. B-15 °C to -25 °C
3. C0 °C to +4 °C
4. D+2 °C to +8 °C
Show answerHide answer
Answer: D · +2 °C to +8 °C
All UIP vaccines at the PHC are stored in the ILR at +2 °C to +8 °C, and the temperature is read and recorded in the log book twice a day. Below this range, freeze-sensitive vaccines such as pentavalent, hepatitis B and Td are damaged; above it, heat-sensitive vaccines such as OPV lose potency. The ice lining keeps the cabinet cold for many hours during power cuts. The -15 °C to -25 °C range belongs to the deep freezer, which at PHC level is used to freeze ice packs.
- A: Above +8 °C heat-sensitive vaccines such as OPV lose potency faster.
- B: This is the deep freezer range, used for ice packs at the PHC.
- C: Temperatures near 0 °C risk freezing the adsorbed vaccines.
Question 6 · Hard
A 2-year-old boy from a district where only 55% of children received three doses of OPV develops acute flaccid paralysis of the left leg. His stool yields poliovirus type 1 whose VP1 region differs from the Sabin type 1 vaccine strain by about 2%; the same virus is found in stool from two healthy children in the neighbourhood and in local sewage. He had never received OPV. What is the most likely diagnosis?
1. AWild poliovirus type 1 infection
2. BGuillain-Barré syndrome after infection
3. CCirculating vaccine-derived poliovirus
4. DVaccine-associated paralytic polio
Answer and explanation in LearnFree account
Question 7 · Easy
During a school health visit, the medical officer reviews the immunisation card of a healthy 16-year-old boy who has received every dose of the national schedule so far. Which UIP vaccine is due now?
1. ATT
2. BDPT booster
3. CTd
4. DTdap
Answer and explanation in LearnFree account
Question 8 · Easy
At a sub-centre session, the mother of a 6-week-old girl asks what the 'five-in-one' injection protects against. The ANM explains that the pentavalent vaccine covers diphtheria, pertussis, tetanus, hepatitis B and:
1. AInactivated poliovirus
2. BMeasles virus
3. CHaemophilus influenzae type b
4. DStreptococcus pneumoniae
Answer and explanation in LearnFree account
Question 9 · Easy
At a 6-week immunisation session in a PHC, a nursing student is about to give fractional inactivated polio vaccine (fIPV), 0.1 mL. By which route and at which site should it be given?
1. ASubcutaneous, right upper arm
2. BIntradermal, right upper arm
3. CIntramuscular, left anterolateral thigh
4. DIntradermal, left upper arm
Answer and explanation in LearnFree account
Question 10 · Medium
A 12-year-old girl with perinatally acquired HIV infection, well on antiretroviral therapy, is brought to a school session where girls are receiving the HPV vaccine. Her mother worries that a vaccine may give her daughter the infection. What is the most accurate advice?
1. AShe must not be vaccinated: it is a live attenuated vaccine
2. BShe can be vaccinated: it contains non-infectious virus-like particles
3. CShe can be vaccinated only after her CD4 count exceeds 500
4. DShe should wait until 15 years, when the response is better
Answer and explanation in LearnFree account
Question 11 · Easy
A family moves from Bihar to Pune, and the mother wants her 7-month-old son's vaccination record to be available at the new urban health centre without a paper card. Which national digital platform registers each child and records every UIP dose with a digital certificate?
1. AU-WIN
2. BHMIS
3. CCo-WIN
4. DeVIN
Answer and explanation in LearnFree account
Question 12 · Medium
During a sub-centre visit, a medical student asks why infants receive fractional IPV at 6 and 14 weeks although they also get oral polio vaccine at 6, 10 and 14 weeks. What is the main reason?
1. AIPV prevents the vaccine-associated paralysis caused by OPV
2. BOPV gives no intestinal immunity, so IPV is added
3. CIPV replaces the OPV booster at 16-24 months
4. DThe bivalent OPV used since 2016 lacks type 2 virus
Answer and explanation in LearnFree account
Question 13 · Medium
At a PHC immunisation session, the medical officer reviews when an opened, multi-dose vial of pentavalent vaccine kept from an earlier session may be used again under the open vial policy. She lists four conditions: 1. The vaccine is within its expiry date. 2. The VVM has not reached the discard point. 3. The vial has not been submerged in water. 4. The vial was first opened at a fixed session in the PHC, not at an outreach site. Which conditions are required?
1. A2 and 3 only
2. B2, 3 and 4 only
3. C1, 3 and 4 only
4. D1, 2 and 3 only
Answer and explanation in LearnFree account
Question 14 · Hard
In a quarter, a block cold chain point issued 60 vials of 10-dose OPV to its sessions, and the session registers show that 450 doses were given. What is the wastage multiplication factor for OPV?
1. A1.33
2. B0.75
3. C1.25
4. D4.00
Answer and explanation in LearnFree account
Question 15 · Hard
On the morning of a fixed session, the PHC ILR (kept at +2 to +8 °C) holds four opened vials: 1. Pentavalent opened 20 days ago, VVM stage 1, date of opening written on the label. 2. OPV opened 20 days ago, VVM stage 1, no date of opening on the label. 3. Measles-rubella reconstituted at yesterday's session. 4. Td opened 35 days ago, VVM stage 1, date written. All are within expiry and were never submerged. Which vials can be used today?
1. AThe pentavalent, OPV and Td vials
2. BThe pentavalent and OPV vials
3. CThe pentavalent and Td vials
4. DThe pentavalent vial only
Answer and explanation in LearnFree account
Question 16 · Medium
A district immunisation officer explains U-WIN to new medical officers using four statements: 1. It registers pregnant women and children for UIP vaccination. 2. It records every dose given and issues a digital vaccination certificate. 3. It monitors ILR temperatures and vaccine stock at each cold chain point in real time. 4. A child's record can be seen at any session site, so a migrant child can be vaccinated anywhere in India. Which statements are correct?
1. A1, 2 and 4 only
2. B2 and 4 only
3. C1, 3 and 4 only
4. D1, 2 and 3 only
Answer and explanation in LearnFree account
Question 17 · Medium
Three weeks after her 6-week pentavalent dose, a 9-week-old girl has a firm, non-tender swelling 2 cm across at the injection site on the thigh. She has no fever, and aspiration gives thin sterile fluid with no organisms. The ANM says she injected with a short needle just under the skin because the baby was crying. What is the most likely cause?
1. AContaminated needle at the injection
2. BFreezing of the vaccine in the cold chain
3. CAllergy to a component of the vaccine
4. DAdsorbed vaccine injected too superficially
Answer and explanation in LearnFree account
Question 18 · Medium
A block PHC reports that in the past year 480 infants received the first dose of pentavalent vaccine and 384 received the third dose. What is the pentavalent 1 to 3 dropout rate, and what does it suggest?
1. A20%, a problem of access
2. B25%, a problem of utilisation
3. C20%, a problem of utilisation
4. D80%, satisfactory performance
Answer and explanation in LearnFree account
Question 19 · Medium
A 10-week-old boy receives pentavalent, OPV and rotavirus vaccine at a PHC. That night he develops fever, fast breathing and chest indrawing, and a chest X-ray the next day shows pneumonia. His mother says he had a cough and runny nose for two days before the session. Using the WHO causality assessment for AEFI, how should the event be classified?
1. AVaccine product-related reaction
2. BImmunisation error-related reaction
3. CCoincidental event
4. DImmunisation anxiety-related reaction
Answer and explanation in LearnFree account
Question 20 · Medium
At a sub-centre session, an ANM has a vial of BCG vaccine but finds that the matching diluent has run out. A colleague suggests using the diluent from the MR vaccine box or a vial of sterile water for injection. What is the correct practice?
1. AUse normal saline from the dressing room
2. BUse only the diluent supplied with that BCG vaccine
3. CUse the MR diluent, as all diluents are sterile water
4. DUse sterile water for injection from the PHC stock
Answer and explanation in LearnFree account
Question 21 · Medium
A 7-week-old boy who received BCG on the day of birth is brought to the PHC because a small, painless sore with a little discharge has appeared at the vaccination site on the left upper arm. There is no axillary swelling, and he is feeding and gaining weight well. What is the most appropriate advice?
1. AIncise and drain the lesion at the PHC
2. BRepeat BCG, as the first dose has failed
3. CReassure; keep it clean and dry without a dressing
4. DStart oral isoniazid for local BCG infection
Answer and explanation in LearnFree account
Question 22 · Hard
After a night when the ILR thermostat failed and the temperature fell to -4 °C, the medical officer does a shake test on a pentavalent vial. As a control she uses a vial of the same vaccine, batch and manufacturer that she froze solid overnight and then thawed. Both vials are shaken together and observed. After 20 minutes, both show a dense sediment at the bottom with clear liquid above, and the two look alike. What should she do with the test vial?
1. ADiscard it: it has been frozen
2. BRepeat the test after warming the vial
3. CUse it if its VVM is still at stage 1
4. DUse it: a sediment means a potent vaccine
Answer and explanation in LearnFree account
Question 23 · Medium
On a hot day an ANM takes four ice packs straight from the PHC deep freezer, packs them around pentavalent and hepatitis B vials in a vaccine carrier and leaves for a village session. At the session, the vials look slightly frosted. Which step would have prevented this problem?
1. AWrapping each vial in newspaper inside the carrier
2. BKeeping the carrier lid open for ten minutes
3. CUsing only two ice packs instead of four
4. DConditioning the ice packs until water sloshes inside
Answer and explanation in LearnFree account
Question 24 · Medium
A newly joined medical officer finds the OPV stock of her PHC stored in the deep freezer at -20 °C, beside the ice packs, while the other vaccines are in the ILR. What should she do?
1. AMove the OPV to the ILR; keep the freezer for ice packs
2. BDo a shake test on the OPV before moving it
3. CLeave it, as OPV must be kept frozen at every level
4. DDiscard the OPV, as freezing has destroyed its potency
Answer and explanation in LearnFree account
Question 25 · Medium
A 16-month-old girl comes to the Anganwadi session for her MR second dose and DPT booster. She received vitamin A with her first MR dose at 9 months. What dose of vitamin A should she get today under the national schedule?
1. A1 lakh IU orally
2. B3 lakh IU orally
3. C2 lakh IU orally
4. D50,000 IU orally
Answer and explanation in LearnFree account

13 more Immunisation: UIP schedule, cold chain and AEFI questions

Answer them one by one, keep your score and see your weak topics in Learn. Signed-out visitors try 25 per exam; sign in with Google to see them all.

Study Community Medicine

Immunisation: UIP schedule, cold chain and AEFI

Mission Indradhanush, launched by the Government of India in December 2014, held catch-up vaccination rounds in districts with many unvaccinated children. What full immunisation coverage among children did it aim to reach?

At a PHC review, the immunisation card of a 13-month-old boy shows BCG at birth (scar present), OPV and pentavalent at 6, 10 and 14 weeks, rotavirus vaccine, PCV and fIPV as scheduled, but no measles-rubella vaccine. How should his status be recorded?

Two minutes after receiving pentavalent vaccine at a PHC, a 4-month-old boy weighing 8 kg develops generalised urticaria, noisy breathing and pallor; his pulse is weak and fast. The AEFI kit holds adrenaline 1 mg/mL (1:1000). What is the correct first dose and route?

A newly posted medical officer inspects the cold chain point of her PHC, where all UIP vaccines are kept in an ice-lined refrigerator (ILR). Within which temperature range must the ILR be kept?

During a school health visit, the medical officer reviews the immunisation card of a healthy 16-year-old boy who has received every dose of the national schedule so far. Which UIP vaccine is due now?

At a sub-centre session, the mother of a 6-week-old girl asks what the 'five-in-one' injection protects against. The ANM explains that the pentavalent vaccine covers diphtheria, pertussis, tetanus, hepatitis B and:

At a 6-week immunisation session in a PHC, a nursing student is about to give fractional inactivated polio vaccine (fIPV), 0.1 mL. By which route and at which site should it be given?

A 12-year-old girl with perinatally acquired HIV infection, well on antiretroviral therapy, is brought to a school session where girls are receiving the HPV vaccine. Her mother worries that a vaccine may give her daughter the infection. What is the most accurate advice?

A family moves from Bihar to Pune, and the mother wants her 7-month-old son's vaccination record to be available at the new urban health centre without a paper card. Which national digital platform registers each child and records every UIP dose with a digital certificate?

During a sub-centre visit, a medical student asks why infants receive fractional IPV at 6 and 14 weeks although they also get oral polio vaccine at 6, 10 and 14 weeks. What is the main reason?

In a quarter, a block cold chain point issued 60 vials of 10-dose OPV to its sessions, and the session registers show that 450 doses were given. What is the wastage multiplication factor for OPV?

A block PHC reports that in the past year 480 infants received the first dose of pentavalent vaccine and 384 received the third dose. What is the pentavalent 1 to 3 dropout rate, and what does it suggest?

At a sub-centre session, an ANM has a vial of BCG vaccine but finds that the matching diluent has run out. A colleague suggests using the diluent from the MR vaccine box or a vial of sterile water for injection. What is the correct practice?

On a hot day an ANM takes four ice packs straight from the PHC deep freezer, packs them around pentavalent and hepatitis B vials in a vaccine carrier and leaves for a village session. At the session, the vials look slightly frosted. Which step would have prevented this problem?

A newly joined medical officer finds the OPV stock of her PHC stored in the deep freezer at -20 °C, beside the ice packs, while the other vaccines are in the ILR. What should she do?

A 16-month-old girl comes to the Anganwadi session for her MR second dose and DPT booster. She received vitamin A with her first MR dose at 9 months. What dose of vitamin A should she get today under the national schedule?