A woman in her seventh month of pregnancy has come to you at the HWC for an antenatal visit (ANC Visit). Which of the following vaccines should the CHO administer to that woman?

1. A

   TD vaccine

2. B

   Hepatitis B vaccine

3. C

   Rubella

4. D

   Tetanus

Appeared in: Maharashtra CHO - 2020

Explanation

• The Td (Tetanus and adult Diphtheria) vaccine is the currently recommended vaccine for all pregnant women under India's National Immunization Schedule (NIS).
• This combination vaccine replaced the older Tetanus Toxoid (TT) vaccine to provide dual protection against both tetanus and diphtheria for the mother and the newborn (neonatal tetanus).
• The first dose is given as early as possible in pregnancy, and the second dose is given 4 weeks later.
• Since the woman is at her ANC visit, and assuming she has not been vaccinated in this pregnancy, the CHO should administer the Td vaccine.

Why Other Options Were Wrong

• Option B: The Hepatitis B vaccine is not a routine part of the antenatal immunization schedule in India.
• Option C: The Rubella vaccine is a live attenuated vaccine and is strictly contraindicated during pregnancy.
• Option D: The standalone Tetanus Toxoid (TT) vaccine is no longer the standard of care for pregnant women in India's NIS.

Related Visual

Clinical Relevance

• Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Immunization during pregnancy as per the National Immunization Schedule (NIS) of India as background academic context rather than a clinical decision trigger.
• Administering the Td vaccine is a critical nursing intervention to prevent maternal and neonatal tetanus, a life-threatening condition, and also to protect against diphtheria.
• A CHO must be aware of the current NIS guidelines, including the replacement of TT with Td, to provide appropriate and safe care.
• Patient safety requires screening for contraindicated vaccines. A nurse must always verify that a vaccine, like Rubella, is not a live virus before administering it to a pregnant woman.

How to Approach the Question

• First, identify the key elements of the question: the patient is a pregnant woman (seventh month), the setting is an ANC visit in India, and the question asks for the appropriate vaccine.
• Recall the National Immunization Schedule (NIS) specific to pregnant women in India.
• Remember the recent update where the Tetanus Toxoid (TT) vaccine was replaced by the Td (Tetanus-diphtheria) vaccine.
• Evaluate each option based on the NIS guidelines.
• Eliminate contraindicated vaccines like Rubella (live vaccine).
• Eliminate vaccines not routinely given, like Hepatitis B.

Concept Tested & Keywords

• Concept Tested: Immunization during pregnancy as per the National Immunization Schedule (NIS) of India.
• Stem keywords: seventh month of pregnancy, antenatal visit, ANC Visit, vaccines, CHO
• Lead-in keywords: Which of the following
• Clinical cues: The patient is a pregnant woman, which has specific guidelines for vaccination.
• Clinical cues: The setting is an HWC (Health and Wellness Centre) in India, implying that the National Immunization Schedule (NIS) must be followed.

Question ID

QXi9peBK1jiDlqk_AuV6qg

Copy ID

Reference Book

E6 Comprehensive Textbook of Community Health NursingShyamala D part 1 (pp 26-389 of 389) p. 37-39

E6 Pharmacology KD Tripathi Essentials 9e Part 3 p. 292-294